Caries management for children and young people - strategies at the tooth level Flashcards
what are the different management strategies for caries in 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 or sepsis develops
what are the different ways of using a stainless steel crown
- completely removing caries and placing crown
- partially removing caries and placing crown
- not removing caries and placing crown (hall technique)
what are the options for occlusal, non-cavitated lesions
- complete caries removal and restoration
- partial caries removal and restoration
- seal caries with fissure sealant
- prevention alone
what are the options for occlusal, cavitated lesions?
- complete caries removal and restoration
- partial caries removal and restoration
- seal caries with hall crown
- prevention alone
- make lesion self cleansing + prevention
what are the options for approximal, early dentinal lesions
- complete caries removal and restoration
- partial caries removal and restoration
- seal caries with hall crown (her fav)
- prevention alone
what are the options for anterior cavitated lesions
- complete caries removal and restoration
- partial caries removal and restoration
- prevention alone
what are the options for grossly carious unrestorable tooth, without signs or symptoms of pain or sepsis
- prevention alone
- extraction or review, with extraction if pain/sepsis develops
what do we need to balance when choosing management options
reduction in the risk of pain/sepsis from the tooth in the future and the child’s ability to accept treatment now
what should we avoid when choosing management options
- operative interventions which involve LA until child can cope
- using conventional glass ionomer for permanent restorations
- leaving active caries in primary teeth unmanaged
- leaving sepsis untreated
how do we manage a primary tooth that is associated with sepsis
either pulp therapy or extraction
what are the signs that a primary tooth is associated with sepsis
- signs/symptoms of abscess
- sinus
- inter-radicular radiolucency
- non-physiological mobility
what is the minimata treaty
global environmental treaty aimed at reducing the release of mercury into the environment
what are the rules with amalgam use
- no amalgam in primary teeth
- no amalgam in persons under 15 years old
- no amalgam in pregnant and breastfeeding women
what are the restorative options for primary molars
- composite
- compomer (composite and GIC hybrid)
- stainless steel crowns
- glass ionomer cement (temp restorations only)
- resin modified glass ionomer)
how and when do you use compomer
- light cure as only a small GIC content
- must have good isolation
- occlusal and 2 surface cavities
what are the indications for traditional preformed crowns
- > 2 surfaces affected
- extensive 2 surface lesions
- pulpotomy/pulpectomy
- developmental defects
- fractured primary molars
- excessive tooth surface loss
- high caries
- impaired OH
- space maintainer
why would we want to restore with a crown after a pulpotomy/pulpectomy
no longer any dentinal fluid movement so becomes brittle and could fracture so crown needed to keep tooth together
how are preformed metal crowns placed
- read re op skills manual
- occlusal, approximal, peripherl reduction
- NO BUCCAL OR LINGUAL REDUCTION
- snap fit
- measure contra-lateral tooth, flatten proximally if necesarry
- GIC cement (reduced microleakage)
- margins - clear excess cement, no overhangs, pull knotted floss through interproximal areas to clear cement
what is the % 5 year survival or traditional preformed crowns
92%
advantages of partial caries removal and restoration
- evidence approach can be effective
- reduced risk of pulp exposure
- reduced time for cavity prep, less need for LA
disadvantages for partial caries removal and restoration
- marginal seal must be effective to prevent caries progression
- no evidence for effectiveness in primary care
how do we use glass ionomer as a fissure sealant
- isolate tooth as best as possible
- GI then quickly vasaline
what is the technique for making a lesion self cleansing
open up contact with separating bur, apply F varnish immediately
what are indications for interproximal discing of primary anteriors
- exfoliation time close
- pre-cooperative
- extensive superficial/minimal interproximal
