Caries management for children and young people at the tooth level Flashcards
What are the management strategies for primary teeth
- Complete caries removal, and restoration
- Partial caries removal, and restoration
- No caries removal, seal with restoration
- No caries removal, provide prevention alone or after first making the lesion self-cleansing
Extraction or review with extraction if pain/sepsis develops
If the tooth is not restorable and there is signs and symptoms of abscess formation what should be done
extraction
If the tooth is not restorable and there is no signs and symptoms of abscess formation what should be done
provide enhanced prevention and monitor the tooth
If the tooth is restorable and there is no signs and symptoms of sepsis and the caries is not active what should be done
provide enhanced prevention and monitor the tooth
If the tooth is restorable and there is no signs and symptoms of sepsis and the caries is active what should be done
select most appropriate caries management option
If the tooth is restorable and there is signs and symptoms of sepsis and the tooth is near exfoliation what should be done
extraction
If the tooth is restorable and there is signs and symptoms of sepsis and the tooth is not near exfoliation what should be done
carry out pulp treatment
What is the management strategy for caries in occlusal, non cavitated lesions in primary teeth
- Complete caries removal and restoration
- Partial caries removal and restoration
- Seal caries with fissure sealant (no caries removal)
- Provide prevention alone (no caries removal) - only appropriate if no alternative is feasible
What is the management strategy for caries in occlusal, cavitated lesions in primary teeth
- Complete caries removal and restoration
- Partial caries removal and restoration
- Seal caries with Hall Crown (no caries removal)
What is the management strategy for caries in approximal early dentinal lesions in primary teeth
- Complete caries removal and restoration
- Partial caries removal and restoration
- Seal caries with hall crown (no caries removal)
What is the management strategy for caries in approximal advanced lesions in primary teeth
- Complete caries removal and restoration
- Partial caries removal and restoration
- Seal caries with hall crown (no caries removal)
What is the management strategy for caries in anterior cavitated lesions
- Complete caries removal and restoration
- Partial caries removal and restoration
- Provide prevention alone (no caries removal)
What is the management strategy for caries in grossly carious unrestorable tooth without signs or symptoms of pain or sepsis
- Provide prevention alone (no caries removal)
- Extraction or review, with extraction if pain or sepsis develops
Describe the management of caries in primary teeth
- 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 involve local anaesthetic until the child can cope
- Do not use conventional glass ionomer for permanent restorations (RMGI is fine)
closely monitor lesions with prevention only
DO NOT leave active caries in primary teeth unmanaged (even if it is just enhanced prevention)
How should caries in a primary tooth be managed if associated with sepsis
either a pulp therapy or an extraction; do not leave sepsis untreated
What is the procedure for complete caries removal and restoration
- Give LA
- Gain access via highspeed, leave wall of enamel to protect adjacent teeth
- Remove caries with slow speed/excavator (beware of proximity of pulp)
- Prepare approximal cavity margins with gingival margin trimmers (to avoid iatrogenic damage)
Place restoration
What is the mercury regulations
- Minimata Treaty - global treaty to reduce release of mercury into environment
Phase-down in use of amalgam is advocated
Who is amalgam contraindicated for
○ Primary teeth
○ Persons U15
○ Pregnant/breastfeeding woman
- There is an exception if specific medical needs of patient requires amalgam
What are restorative options for primary molars
- Composite
- Compomer
- Stainless steel crown
- GI cement (temp restorations only)
RMGI
What is composer
- Polyacid modified composites (GI/comp hybrid)
Brand names include: dyract, compoglass, hytac
What does composer require
- Good for occlusal and 2 surface cavities
- Can’t set in the dark as only small GIC content, must be light cured
Must have good isolation
- Can’t set in the dark as only small GIC content, must be light cured
What are indications for traditional PMC
○ >2 surfaces affected ○ Extensive 2 surface lesions ○ Pulpotomy/pulpectomy ○ Developmental defects ○ Fractured primary molars ○ Excessive tooth surface loss ○ High caries ○ Impaired oral hygiene Space maintainer
What is procedure for traditional PMC
- Give LA
2. Remove caries
3. Trim mesial and distal side
4. Reduce occlusal surface of the tooth enough to allow a straight probe to be passed across the surface when teeth in occlusion
5. Select the correct size of PMC and cement with GIC and remove excess with floss
What is a way of getting snap fit for PMC
measure contra-lateral tooth, flatten proximally if necessary
What cement is used for PMC
GIC cement for reduced microleakage
What restoration has highest 5 year survival rate
PMC
What is the procedure for partial caries removal
- Gain access to caries using a high speed handpiece (will require LA if getting to dentine)
2. Remove superficial caries with slow speed/excavator until no obvious caries is visible at ADJ and the cavity allows adequate thickness of restorative material
3. Place restoration (do not use GIC)
4. Fissure seal the tooth surface and as many of the restoration margins as possible
5. Monitor for any caries progression using radiographs where appropriate
Inform the child and parent carer of the approach taken and record details in px notes
What are the advantages of partial caries removal
○ Evidence largely from secondary care and private practice, this approach can be effective
○ Reduced risk of pulp exposure
Reduced time for cavity prep, less need for LA
What are the disadvantages of partial caries removal
○ As caries is left in the cavity, the marginal seal must be effective to prevent caries progression
No evidence, as yet that this approach is effective in primary care
What is the procedure for no caries removal and sealing with restoration
- Place a fissure sealant over non-cavitated pit or fissure caries, to completely seal the fissure system
- If using this approach on a pre-cooperative child, consider using the press finger technique using a GI material as a temporary measure
What is procedure for GI as fissure sealant
- Isolate tooth as best as you can
- Put GI on finger and Vaseline on other
Quick swipe with GI then swipe with Vaseline
- Put GI on finger and Vaseline on other
What is the hall technique
- Involves sealing caries into primary molars with PMC
- No LA or tooth prep or caries removal required
Crown must cover all caries otherwise the bacteria/substrate will continue to feed the caries process under the crown
- No LA or tooth prep or caries removal required
What is the procedure for making a lesion self cleansing
- Use high speed to remove undermined enamel adjacent to the carious lesion making the surface of lesion accessible to toothbrushing
2. Apply fluoride varnish
3. Inform child and parent of approach and record in px notes
What i the procedure for partial caries removal for primary anteriors
- Thoroughly clean teeth with prophylaxis paste
- Caries removal is minimal so shouldn’t require LA
- Acid etch entire crown, wash and dry
- Place the composite restoration, either by hand building or using strip crowns
Inform child and parent carer of approach taken
What is the indications for inter proximal discing of primary atneriores
○ Exfoliation time close
○ Pre-cooperative
Extensive superficial/minimal caries
What is the advantages for inter proximal discing of primary anteriors
○ Simple
○ Quick
○ Opens contacts
What is the disadvantages for inter proximal discing of primary anteriors
○ May get close to the pulp
○ Food impaction (as strange gaps are created)
○ Space loss
Aesthetics are poor
What is the technique for inter proximal discing of primary anteriors
○ Sand paper discs, tapered stone or diamond in slow speed
○ Tapered crown - narrower incisally
○ Round off proximal surfaces
Polish & fluoride varnish
What are the indications for primary anteriors
○ Enamel hypoplasia
○ Dental anomalies - amelo, dentino
Labial and interproximal caries
What is the technique for primary anteriors
○ LA and isolation
○ Tapered prep - high speed diamond
○ Labial groove - just to help with retention
○ 2mm incisal reduction
○ Cellulose acetate crown form & composite - using all available enamel for bonding to make the new white composite filmed crown
What is the management of inter proximal caries on 1st and 2nd permanent molars
Make it a priority to identify and arrest enamel only lesions on the mesial surface of 6’s
How can you identify and arrest enamel only lesions on the medial surface of the 6;s
○ Applying fluoride varnish and monitoring progression with bitewings
○ Ensuring parents are aware of potential impact on their child’s oral health, and encouraging them to floss or use floss wands on the 6/E contact 2-3 times a week
If the distal of the E is carious consider managing the E with either a restoration, a hall crown or slice preparation (taking care to avoid iatrogenic damage to the 6 (or even extraction of the E)
How do you manage a suspicious fissure on a FPM
- Thoroughly clean the fissures of all debris, dry the tooth and view it with bright, direct light
- Take good quality radiographs
What should be done if there is microcavitation, shadowing under enamel or dentinal caries of a fissure of a FPM
- Then remove the caries and place a conventional composite restoration limited to the site of the caries and fissure seal the remaining fissure system
If the fissure is stained but none of the previous slide applies then place fissure sealant and review at next visit
How should you manage a enamel only lesion in permanent teeth
f uncertain if a cavity is cavitated (interproximal) then use a separator
- Using this technique caries can be detected via direct vision and microcavities repaired without having to resort to cutting a conventional interproximal cavity
- Make it a priority to identify and arrest early enamel lesions on the mesial surface of the FPM
Where an enamel lesion is developing next to a carious second molar, provide a PMC on the primary molar or make the area self-cleansing and take care not to damage the FPM
How should a FPM with poor prognosis be managed
- At around the age of 8-9 years, make an assessment of the likely prognosis of any 6’s effected by caries, if prognosis is poor consider planned loss
Ideally all premolars and 3rd molars should be present
When is it radiographically ideal to remove the FPM
- Radiographically ideal when there is the start of calcification of the bifurcation of the unerupted lower second molars
What are advantages of planned removal of FPM
In some situations, extraction of 6’s with poor long term prognosis at the correct time can allow the development of a caries free dentition in the adolescent without spacing
What are disadvantages of planned removal of FPM
Requires extraction of permanent molar teeth from young children, which is demanding for the child, and which may necessitate general anaesthesia, with associated risks
