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Paediatrics > Caries management > Flashcards

Caries management Flashcards

1
Q

caries managament options

A
  • no caries removal - hall crown
  • no caries removal - FS
  • selective caries removal and restore
  • pulpotomy
  • XLA
  • complete caries removal and restore
  • prevention only
  • non restorative cavity control and prev
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2
Q

how rto manage a symptomatic primary tooth with signs of infection

A
  • intraradicular radiolucency
  • non physiological mobility
  • sinus
  • pain kept up at night
  • ttp
  • lymphadenopathy and associated swelling

treat - pulpectomy / XLA

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3
Q

initial caries sign in a primary molar

  • clinical
  • Rg
A
  • non cavitated - staining/white spot/discoloured/dentine shadowing
  • caries into initial 1/3 of dentine
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4
Q

management of initial caries of primary molar

A

-fissure sealant
top up and review at every appt, check visually and with probe
-GI sealant if bis-GMA too difficult
-hall techniquead

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5
Q

advanced occlusal caries in primary molar

signs -clinical/Rg

A

-teeth with visible shadowing/cavitation

Rg - bitewing, caries extends to inner third, clear band of dentine should separate pulp and caries

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6
Q

advanced occlusal caries in primary molar, management ops

why not complete caries removal

A
  • selective caries removal and restore
  • hall technique (also if proximal lesion)
  • if non restorative - self cleanse
  • > risk of pupl exposure
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7
Q

signs of reversible pulpitis in a child

A

sensitive to cold/sweet, short lasting pain, not kept up at night or TTP

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8
Q

management of reversible pulpitis in a child

A

-place hall crown
-if occ = selective caries removal
- if food packing/unsure of diagnosis then place a temp dressing (ZOE?) and check symps 3-7 days later. If better - hall crown/restoration.
If worse XLA/PULPOTOMY

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9
Q

irreversible pulpitis symps in a child

A 
sTILL VITAL BUT INFLAMED
NOT TTP
kept up at night
tender to cold/hot/sweet
pain spontaneous
lasts after stimulus applied
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10
Q

management of irr pulpitis in a child

A

if anxious - remove debris and apply antibiotic corticosteroid paste under temp dressing
- if good co-op - PULPOTOMY

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11
Q

symps in dental abscess/Periradicular periodontitis

A 
kept up at night
spontaneous pain
sensitive to hot/cold/sweet
long lasting pain
sinus/swelling association
TTP 
increased mobility

-Rg - increased sign of intrarradicular pathology

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12
Q

management of dental abscess/periradicular periodontitis

A

PRIMARY

  • drain inf through pulp, hand excavate
  • if tender place corticosteroid paste
  • even if asymp, XLA tooth
  • if restorable = pulpectomy

PERMANENT

  • drainage through pulp
  • access pulp chamber and remove necrotic tissue
  • ST drainage if swelling
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13
Q

indications for a primary molar pulpotomy

A
  • irreversible pulpititis (vital pulp)

- advanced lesion with no clear dentine band (Rg)

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14
Q

Pulpotomy technique steps

A

-LA and dam
- caries removal/access
-remove pulp (round slow speed/sp exc)
-irrigate pulp with sterile water (3in1)
-identify canal orifices
Max primary molars = 2b,1p
Mand primary molars = m/d canals
-assess haemostasis - cotton pledget and ferric sulphate (30s-2min)
if no bleed/major dark bleed = pulpectomy
-remove pledget and place MTA/ZOE/ns CaOH on stumps and floor
-fill cavity with ZOE and place SSC
- annual review

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15
Q

when to carry out a balancing XLA

A

If c of poor prognosis - avoid midline shift

premature exf of c

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16
Q

when NOT to carry out a balanced XLA

A

primary incisors
primary D loss - unless c centreline shift
primary E loss

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17
Q

identify initial caries lesion in perm molar

A

visual - white spot lesion, stain in fissures

Rg - lesion up to ADJ/not visible

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18
Q

initial caries management in perm molars

A

FS
PRR
review at every appt for top up, check with probe

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19
Q

identify moderate carious lesion

A

visual - probe, dark stain, shallow cavitation

Rg - bitewing - extend to mid 1/3 dentine

20
Q

management of moderate carious lesion in perm molar

A

selective caries removal and restore

seal other teeth

21
Q

identify extensive occlusal caries

A

teeth with cavitation, widespread dentinal shadow

22
Q

management of extensive occlusal lesion in perm tooth

A

stepwise caries removal, avoid pulpa exposure
1. caries removal (superficial) - enough to allow effective marginal seal
2. temp restoration - inhibit further progression and allow reactionary dentine to be laid down
3 6-12mth later re-enter cavity and restore tooth (temp will have allowed reactionary dentine to further distance from pulp.

23
Q

how can proximal caries be identified and subsequently be seen more easily in children

A

-Initial- white spot lesion/dentine shadowing especially distal of E/mesial of 6,
Rg - outer 1/3 dentine
-moderate - enamel cavitation/dentine shadowing
Rg - extend to outer/mid 1/3 of dentine
-extensive - cavitation/visible dentine
Rg - reach inner 1/3 of dentine but not reach pulp
use of ortho separator (5 days)

24
Q

management of proximal caries in perm molars

A
  • initial - arrest enamel only lesions, site specific prevention, seal lesion
  • mod - selective caries removal/complete caries removal, seal remaining fissures
  • extensive - stepwise caries removal
25
Q

how to manage a poor prog 1st perm molar - XLA?

younger child?

A
  • OPT - identify if all teeth present/good condition anf position
  • if poor of above = refer for specialist opinion
  • if pain =LA then refer for specialist opinion#

-younger - keep free of syms until old enough for XLA, hall technique for space maintenance (take photos of inner crown condition)

26
Q

Rg signs indicating good time for 6 XLA

A 
bifurcation of 7
age 8-10
8's present 
class 1 inc relationship
buccal segment crowding
good co-op
27
Q

Permanent tooth - rev pulpitis, irr pulpitis and abscess treatment

A
  • rev pulpitis -stepwise caries removal/complete caries removal
  • irr pulpitis - RCT/XLA
28
Q

pulp therapy in primary molar ind

A
  • good co-op
  • avoid GA
  • MH - haemophilia
  • child’s age (root resoption)
  • space maintenance
  • hypodontia
29
Q

pulp therapy in primary molars - contraind

A
  • poor co-op
  • MH - cardiac defect/immunosuppressed
  • tooth unrestorable
  • multiple carious teeth in mouth
  • close to exfoliation
  • severe pain/inf
  • gross bone loss
30
Q

Vital pulpotomy in primary molar

  • ind
  • technique
A

ind - carious/traumatic exposure/nosymps/no Rg sign of inf
Technique
-access and caries removal (LA/Dam), remove pulp chamber roof
-amputate coronal pulp - -slow speed/spoon excavator
-irrigate and dry chamber
-arrest haemorrhage - FERRIC SULPHATE sotton ball
-assess radicular stumps -if arrested continue, if not and hyperaemic then complete pulpectomy
-dress root stumps with ZOE/MTA/CaOH
-Restore -SSC

31
Q

Non vital - pulpectomy
ind
technique

A

-ind - hyperaemic pulp/irreversible pulpitis/exposure of non bleeding pulp

-technique
-LA/dam
-access and caries removal - pulp chamber roof
removed
-amputate coronal pulp - -slow speed/spoon excavator
-irrigate and dry chamber
-locate root canals
-file to 2mm from apex
-irrigate canals (CHX/sodium hypochlorite)
-dry canals - paper points
-obturation - calcium hydroxide and iodoform paste (VITAPEX)
-place ZOE/CaOH/GI in coronal access cavity
-Place SSC
-review every 6mth

32
Q

clinical and Rg signs of failure of SSC post pulpotomy/pulpectomy

A

Clinical - pain/sinus/pathological mobility

Rg - inter-radicular radiolucency(bone loss at furcation)/external or internal resorption/greater radiolucency

33
Q

complications of SSC placement

A

Failure to exfoliate
Damage to perm successor
Early loss

34
Q

ind for SSC

A
  • badly broken down primary tooth
  • following pulpectomy/pulpotomy
  • severe enamel hypoplasia
  • space maintenance
  • # tooth
35
Q

technique for SSC placement

A
  1. select crown size - measure m-d/trial and error using a sticky plaster to retain crown while trying on
  2. LA
  3. Prep
    - mesial prep (marginal ridge->cervical portion), produce knofe edge finish with no ledge or shoulder
    - distal portion (SAME)
    - occlusal portion - reduce by uniform depth of 1mm (keep cusp form)
    - peripheral reduction - reduce buccal/lingual portion of occlusal 1/3 of cusps with 45 degree chamfer
  4. adapt crown using crimp pliers
  5. cement - GI
    - remove and thoroughly clean crown and tooth
    - isolate with cotton rolls
    - place GI in crown and use digital pressure
    - use cotton roll for patient to bit onto
    - remove excess with microbrush/probe
36
Q

issues with a SSC

  • rocking, indicates?
  • canting to one side
A
  • rocking = discrepancy between crown circumference and tooth circumference
  • canating to one side - uneven reduction of occlusal surfaceeg if steel crown cants lingually = buccal cusps too high
37
Q

Important aspects of a child’s history

A
  • PC/HPC
  • MH: asthma/CVD/Immunocomp/cancer
  • DH: reg attendance/OH/phobia?
  • SH: school or nursery/best time to attend/Childsmile/diet
38
Q

Important aspects of child exam

  • E/O
  • I/O
  • teeth: eg order of exam
A

E/O: nides/TMJ/MoM and any signs of Non Accidental inj
-I/O: ST-Lips/BM/tongue/FoM/HP/SP

-Exam: chart / caries / to be done /plaque scores / BPE (>7yr)

39
Q

Describe the plaque score system

A

10/10 - clean tooth
8/10 - cervical line of plaque
6/10 - cervical 1/3rd plaque
4/10 - mid 1/3rd of plaque

40
Q

Describe a BPE in Paeds

  • what age from and what teeth
  • what scores used
A
  • BPE from age 7
  • age 7-17 = 16/11/26/36/31/46

-codes: 7-11 = codes 0/1/2
12-17 = codes 0-4

41
Q

Caries Risk Assessent factors

A
  • diet
  • clinical evidence
  • fluoride
  • saliva quality
  • MH
  • SH
  • plaque control
42
Q

Instructions for parents regarding OH

A
  • brush 2x daily with adult help (<7yr)
  • brush last thing at night
  • no bottle overnight
  • only water/plain milk between meals
  • spit don’t rinse
  • MW only at different time to brushing
43
Q

Duraphat prescription :

Child >16yrs with high caries risk

A

Sodium Fluoride toothpaste 1.1% (5000ppm)

  • send: 51g
  • label: brush teeth for 3min after meals, spit don’t rinse 3x daily
44
Q

Duraphat prescription:

Child >10yrs with high caries risk

A

Sodium Fluoride toothpaste 0.619% (2800ppm)

  • send 75ml
  • label: brush teeth 2x daily for 1 min after meals, spit don’t rinse.
45
Q

Additional information to inform patients of before prescribing Duraphat toothpaste (aftercare)

A
  • spit/don’t rinse
  • dont eat/drink/rinse for 30min after brushing teeth
  • only for prescribed patient
  • keep out of reach of small children

Paediatrics (8 decks)

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