caries management for children and young people, strategies at the tooth level Flashcards
1
Q
what are the strategies for caries in primary teeth
A
- complete caries removal and restoration
- partial caries removal and restoration
- no caries removal and seal with restoration
- no caries removal and provide prevention alone of make lesion self-cleansing
- extraction, or review with extraction if pain or sepsis develops
2
Q
what colour is active caries
A
- active caries is very soft and light brown in colour
- if caries is dark and hard then it is not active
3
Q
what can you do with occlusal cavitated lesions
A
- complete caries removal and restoration
- partial caries removal and restoration
- seal caries with Hall crown = can’t seal with fissure sealant
- provide prevention alone
- make lesion self-cleansing and provide prevention
4
Q
what is a stainless steel crown
A
- it is a crown that can be used when completely removed caries, partially removed caries or not at all
5
Q
what is the Hall technique
A
- when don’t remove any caries at all and just place crown on top
6
Q
what do you do for approximate, early dentinal lesions
A
- complete caries removal and restore
- partial caries removal and restore
- seal with Hall crown
- provide prevention alone = only if child won’t allow anything else
7
Q
what can you do for approximate, advanced lesions
A
- complete caries removal and restore
- partial caries removal and restore
- seal with Hall technique =preferred technique
- provide prevention alone
- make lesion self-cleansing and provide prevention
8
Q
what do you do for anterior cavitated lesions
A
- complete removal and restore
- partial caries removal and restore
- provide prevention alone
9
Q
what can you do for grossly carious unrestorable teeth
A
- provide prevention alone
- extraction, or review with extraction if pain or sepsis develops
10
Q
how do you choose the treatment
A
- need to choose management options for primary teeth that balance a reduction in the risk of pain or sepsis from the tooth in the future with the child’s ability to accept treatment now
- avoid operative interventions which need LA until child can cope
11
Q
how do you treat sepsis
A
- either a pulp therapy or an extraction
- don’t leave sepsis untreated
12
Q
how do you do complete caries removal and restoration
A
- give LA before commencing cavity prep as this requires sound dentine to be cut
- gain access to caries using a high-speed handpiece, leaving a wall of enamel to protect adjacent tooth
- remove caries with a slow-speed and excavators
- be aware of pulp chamber and anatomy
- prepare approximate cavity margins with gingival margin trimmers to prevent iatrogenic damage
- place restoration
13
Q
how to place restoration
A
- if at risk of pulpal exposure then place an indirect pulp cap
- use a matrix band for good shape
- don’t use conventional GIC = use composite, composer, RMGI, PMC
- material choice depends on the cavity
- no longer legal to use amalgam in children
14
Q
what treaty is reducing mercury usage
A
- the Minimata Treaty
15
Q
who can amalgam not be used in
A
- primary teeth
- persons under 15
- pregnant or breast-feeding women
16
Q
what are some restorative option for primary molars
A
- composite
- compomer = glass ionomer composite hybrid
- stainless steel crowns
- glass ionomer cement = only temporary
- resin modified glass ionomer
17
Q
what is compomer
A
- composite glass ionomer hybrid
- polyacid modified composites
- Dyract, Compoglass
- occlusal and 2 surface cavities
- must be light cured
- need good isolation and moist control
18
Q
what is the best restoration for primary molars
A
- PMC
19
Q
what are the indications for a traditional PMC
A
- > 2 surfaces affected
- extensive 2 surface lesions
- have done a pulpotomy/pulpectomy
- developmental defects = weakness in enamel
- fractured primary molars
- high caries
- imparted OH
- space maintainer
20
Q
why do you need a crown after pulp therapy
A
- as following endo treatment there is no longer dentinal fluid movement and dentine becomes very brittle and likely to fracture so crown needed to bind whole tooth together to prevent it falling to bits
21
Q
what is the traditional prep for PMC
A
- give LA
- remove caries
- cut a mesial and distal slice = a wall of enamel should b left ensure no iatrogenic damage, the wall will fall away as cut cervically, keep separating burr moving
- reduce occlusal surface of tooth enough to allow a straight probe to be passed through when in occlusion
- select correct size of PMC
- cement crown with GIC, remove excess cement and clear contacts with floss
- measure contra-lateral tooth for right crown size
22
Q
where do you need to reduce tooth surface for traditional PMC
A
- need to do occlusal, approximal and peripheral reduction
- no buccal or lingual reduction
23
Q
what is the difference in occlusion for traditional PMC and Hall
A
- in traditional, because you remove some occlusal tooth tissue teeth will touch again when in occlusion
- in Hall, you don’t remove any tooth tissue so there will be a gap in occlusion once crown is placed
24
Q
how do you do partial caries removal and restoration
A
- gain access to caries = no LA as not sound dentine
- remove superficial caries with slow speed or excavator until no caries at ADJ
- place restoration using adhesive material and bonding system = no GI for Class II
- fissure seal tooth surface
- monitor for any caries progression using radiographs
- inform of approach taken
25
what are the advantages of partial caries removal
- can be effective
- reduced risk of pulp exposure = not going as deep
- reduced time for cavities prep, need less LA
26
what are the disadvantages of partial caries removal
- marginal seal must be effective to prevent caries progression
27
how do you do no caries removal and seal with restoration
- place fissure sealant over non-cavitated pit or fissure caries to completely seal fissure system
- if child pre-cooperative then consider using press finger technique with GI
- if child cooperative then use GI
- isolate tooth then with gloved finger with GI on it and Vaseline on other swipe GI on tooth then vaseline
28
how do you do Hall technique
- no LA
- no tooth prep
- crown covers all caries
- no caries removal
- just place crown over tooth
29
how do you do no caries removal and just prevention with or without self-cleansing
- may need enhanced prevention if secondary caries forms
| - want caries to turn dark and hard
30
how do you make a lesion self-cleansing
- shouldn't need LA unless sub gingival tooth prep needed
- remove undermined enamel adjacent to carious lesions making surface accessible to toothbrushing
- apply fluoride varnish
- aim is to make space so saliva can get in and clean area
- use a separating burr
31
how do you do partial caries removal and restorations on primary anterior teeth
- thoroughly clean tooth with prophylaxis paste
- LA not needed
- acid etch entire crown = wash, dry and apply bonding system
- place composite restoration either by hand or using strip crowns
- not aesthetically great
32
what are the indications for interproximal discing of anteriors
- exfoliation time close
- pre-conceptive
- extensive superficial/minimal interproximal
33
what are the advantages to interproximal discing of anteriors
- simple
- quick
- opens contacts
34
what are the disadvantages to interproximal discing of anteriors
- will get close to pulp
- food impaction
- space loss
- aesthetics poor
35
what is the technique for interproximal discing for anteriors
- sandpaper discs, tapered stone fo diamond in slow speed
- tapered crown = narrower incisally
- round off proximal surfaces
- polish and fluoride varnish
36
what are the indications for strip crown for primary anteriors
- enamel hypoplasia
- dental anomalies
- labial and interproximal caries
37
what is the technique for strip crowns for primary anterior
- LA and isolation
- tapered prep = high speed diamond
- labial groove = helps with retention
- 2mm incised reduction
- cellulose acetate crown from composite = using all available enamel for bonding
38
how do you manage interproximal caries on 1st or 2nd permanent molars
- apply fluoride varnish and monitor progression with bitewing radiographs
- ensuring parent/carers are aware of potential impact on child's oral heath and encourage to floss
- if distal of E is carious consider managing it with restoration or even extract
39
what signs show there is caries in fissures of FPM
- micro-cavitation
- shadowing under enamel
- dentinal caries in radiograph
40
how do you manage fissure caries of FPM
- thoroughly clean fissures of all debris
- take good radiographs
- remove caries and then place conventional composite restoration limited to site of caries and fissure seal the remaining fissure system
41
what do you do if FPM fissure is stained but has no other signs of caries
- place fissure sealants and review it at every recall visit
42
what do you do for enamel only lesions in permanent teeth
- use an ortho separator
| - make area self-cleansing
43
when do you use an ortho separator
- if unsure if cavitated or not
44
how is an ortho separator used
- placed and removed after 5 days
- allows visualisation of the proximal surface
- caries can be detected via a direct visions and microcavtiies repaired without having to resort to cutting conventional interproximal cavity
45
when would you consider to remove FPM
- at age 8-9 make an assessment of likely prognosis
- ideally want to remove when there is the start of calcification of the bifurcation of the unerupted lower 2nd molars
- would have to remove all 4 6's
46
why would you have to remove all 4 6's
- if only remove form one arch then would get over-eruption of the 6's on the other arch
- if only removed from one side then would get central line drift
47
what are the advantaged of planned removal of FPM
- can allow development of a caries free dentition in the adolescent without spacing
48
what are the disadvantages of planned removal of FPM
- demanding for the child
| - may need GA and that has its associated risks
