Caries Management In Early Childhood

Question 1

What is a possible risk in doing an intracoronal restoration on primary teeth?

Answer 1

They have shorter clinical crown heights so these teeth have less support and retention

Question 2

What is a pulpal risk of doing a intracoronal restoration on molar teeth?

Answer 2

The mesiobuccal pulp horn

Question 3

What are the indications to demineralization and observation?

Answer 3

1. Incipient lesions
2. Asymptomatic cavitated lesions
3. Teeth approaching exfoliation

Question 4

What is/are the goal(s) for the remineralization process?

Answer 4

Create an environment that favors remineralization:

• cleansable (open contacts)
• raise pH
• reduce solubility of tooth

Question 5

What are the indications for sealants?

Answer 5

1. High risk pit and fissure surfaces
2. Feasible isolation
3. No suspicion of interproximal lesions

Question 6

What is the procedure for sealants?

Answer 6

1. Remove plaque with brush or explorer
2. Isolate tooth with cotton rolls/rubber dam
3. Etch the tooth surface with 37% phosphoric acid (15-30 seconds)
4. Rinse and dry surface completely (enamel does not have tubules)
5. Apply bonding agent
6. Evaporate solvent and cure with UV light

Question 7

Why is bonding agent applied in the sealant procedure?

Answer 7

Studies have shown that bonding agent will improve the bond strength and minimize micro leakage

Question 8

What should you avoid when applying sealants?

Answer 8

You should not create a big plateau of sealant because this will fracture. It might also cause the need for occlusal reduction which could cause rough plaque adherent surfaces

Question 9

What is the most common material used in deeply fissured primarily molars?

Answer 9

Glass ionomer is used in deeply fissured primary molars or partially erupted permanent molars that has a risk for decay

Question 10

What is resin infiltration?

Answer 10

It is where resin is applied in response to the infiltration of an initial enamel caries lesion. The surface layer is first eroded and desiccated then followed by resin application. Resin penetrates into the lesion microporosities driven by capillary force and is hardened by light

Question 11

Describe the enamel rods in primary teeth

Answer 11

Enamel rods slope occlusally, ending abruptly at the cervix rather than being oriented gingival lay and gradually becoming thinner (like permanent teeth)

Question 12

What are the indications to amalgam for primary teeth?

Answer 12

• Class I
• Class II - restorations don’t extend beyond proximal line angle
• Class V in posterior teeth

Question 13

_________angles thought the preparation will result in less concentration of stress

Answer 13

Rounded

Question 14

The cavity design should have ________ Buccal and lingual extension at the cervical area of the preparation to clear contact with the adjacent tooth

Answer 14

Greater

Question 15

Why does the proximal box need Buccal and lingual divergence?

Answer 15

Because the broad and flat contact areas of the primary molars and because of the distinct Buccal bulge in the gingival third

Question 16

True or false: the Buccal and lingual walls of the proximal walls and occlusion need to be “S” contoured

Answer 16

False - DO NOT make an “S” contour

Question 17

How big should the width of the occlusal preparation (isthmus) for amalgam be?

Answer 17

No more than 1/3 of the inter usual distance

Question 18

Does the gingival contact need to be broken for amalgam preps in primary teeth?

Answer 18

YES

Question 19

How does the composite preparation differ from the amalgam preparation in primary teeth?

Answer 19

The cavosurface margin must be beveled for composite
- increase enamel surface for bonding

The CSM is butt-joint for amalgam
- brittle material

Question 20

Where should the proximal wall point in an amalgam prep for primary teeth?

Answer 20

It should point to the center of the tooth as much as possible

Question 21

What occurs when the occlusal preparation is too shallow for amalgam preps in primary teeth?

Answer 21

Less retention

Question 22

What is the tooth susceptible to if the isthmus of an amalgam prep is too narrow?

Answer 22

Fractures

Question 23

If you make the interproximal preparation too wide in an amalgam prep for primary teeth, what must you convert to?

Answer 23

SCC

Question 24

If you are doing an amalgam prep for primary 1st molars – what are you likely to see?

Answer 24

An adequate amalgam preparation for primary 1st molars will most likely have mechanical pulp exposure

Question 25

What are the indications to composite preparations for primary teeth?

Answer 25

1. Class I pit and fissure
2. Class I caries extending into dentin
3. Class II restorations that do not extend beyond proximal line angles

Question 26

What are the indications to SCC for primary teeth?

Answer 26

1. Full coverage for teeth with pulp therapy
2. Children with extensive decay, large lesions, or multiple surface lesions
   - 3 surface lesions should be SCC
   - SSC have higher success rate for multiuser face amalgam preps
3. Strong consideration should be given to the use of SSCs who require general anesthesia

Question 27

What is the objective to crimping?

Answer 27

To make sure SCC has retention – snap fit. The SCC should require an instrument to take off. It also makes a custom margin for a prefabricated crown

Question 28

What material is used for repairing the primary tooth before putting on the SCC?

Answer 28

Glass ionomer or cement

Question 29

When are resin crown treatments indicated?

Answer 29

When there is a high risk of anterior tooth caries and/or molar caries may be treated with resin crowns to protect the remaining at-risk tooth surface

Question 30

Why are resin crowns called strips crowns?

Answer 30

Because the celluloid matrices are stripped off after the curing process.

***The matrices should have a sub gingival passive fit