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Yr 3 Restorative - biomaterials and CSL > Caries management in the anterior dentition > Flashcards

Caries management in the anterior dentition Flashcards

1
Q

What is caries?

A

The localised destruction of susceptible dental hard tissues by acidic by-products from bacterial fermentation of dietary carbohydrates

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2
Q

What is needed for caries to develop?

A
  • Teeth
  • Time
  • Diet
  • Bacteria in biofilm
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3
Q

What do white spot less tell us?

A

Caries is at least 50% of enamel depth (if see white specs with enamel dry)

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4
Q

How do we identify dentine caries?

A

Shadow into dentine (on tooth or radiograph)

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5
Q

What do brown spot lesions tell us?

A

Caries is in the process of arresting if it hasn’t already (does not need restoration unless cavitated)

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6
Q

What does a pulp polyp tell us?

A

The caries has reached the pulp

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7
Q

How do we diagnose caries?

A
  • Visual inspection
  • Tactile inspection (gently run probe over surface)
  • Radiographic
  • Transillumination
  • Shredding floss (when flossing between teeth but sometimes happens if there is a slightly rough restoration)
  • Orthodontic separators (then take a silicone impression in the space created)
  • Electrical conductance (variable) = lots of false positive = should only really use in combination with other methods
  • Detection dyes
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8
Q

What do we look for when carrying out a visual inspection?

A 
Use Light & magnification - dry the teeth first
Looking for: 
- Variations
- Opacities
- Shadows
- Frank cavitation
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9
Q

How do we carry out tactile inspection?

A

Avoid heavy pressure in potentially early carious lesions

= use No. 9/18 Probe or Briault probe (due to curved arm its handy for crown margins or difficult to reach area)

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10
Q

What are the limitations of radiographic assessment of caries?

A
  • Snapshot in time = no information of activity or cavitation
  • 2D representation of 3D tooth
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11
Q

What may shredding floss indicate?

A

Presence of a cavitated carious lesion

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12
Q

What are diagnostic methods used to do?

A

To build clinical picture = aids diagnosis

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13
Q

What are the different classification systems for caries detection etc?

A 
Huge number 
Main ones: 
Blacks 1917
International caries detection and assessment system (iCAD)
Site and stage
Radiographic

n.b. others combine demographic data

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14
Q

What is a Blacks Class I cavity?

A

Occlusal (also includes palatal surface of incisors)

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15
Q

What is a Blacks Class II cavity?

A

Occlusal but also tends interproximally

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16
Q

What is a Blacks Class III cavity?

A

Interproximal lesion

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17
Q

What i a Blacks Class IV cavity?

A

Anterior tooth fracture

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18
Q

What is a Blacks Class V cavity?

A

Gingival lesion

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19
Q

What is a Blacks Class VI cavity?

A

Loss of cusp of posterior tooth

20
Q

What is an ICADs 0?

A

Sound tooth surface

21
Q

What is an ICAD 1?

A

First visual change in dried enamel

22
Q

What is an ICAD 2?

A

Distinct visual change in wet enamel

23
Q

What is an ICAD 3?

A

Localised enamel breakdown due to caries with no visible dentine (with or without enamel breakdown)

24
Q

What is an ICAD 4?

A

Underlying dark shadow from dentine (with or without enamel breakdown)

25
What is an ICAD 5?
Distinct cavity with visible dentine
26
What is ICAD 6?
Extensive distinct cavity with visible dentine
27
What are the common specific causes of anterior caries?
Mouth breather Reduced saliva levels Exposed root surfaces Reduced manual dexterity (i.e. a broken arm) Substance abuse N.b. often combined with other risk factors
28
What influences techniques and materials used for anterior restorations?
Higher aesthetic demands
29
What are the principles in treatment planning for caries management?
- Emergency treatment (i.e. pain caused by pulpitis) - Assessment of risk factors - Appropriate preventive advice - Stabilisation of disease (consider if indicated: quadrant caries removal, stepwise caries removal, pulpal extirpation) - Permanent restoration (if not completed in previous stage) - Monitoring and maintenance * IF INDICATED: Advanced restorative/prosthodontic treatment
30
What determines an individuals risk status?
- The carious lesion(s): number, location, size and type - Previous carious experience, when last restoration was required - Saliva flow and function - Diet content and frequency - General health and medications - Plaque control - Plaque retentive factors - Manual dexterity
31
What is the importance of restorations in caries control?
To make the cavitated lesion cleanable (filling sends biofilm back to surface where the patient can cleanse it)
32
When do we treat caries?
- When active and arrested (if not kept clean by patient) - Cavitated (plaque builds up more) i.e not smooth surface - Uncleansable (need to teach how to clean anyway to avoid caries around restoration margin)
33
When is quadrant excavation indicated?
Where there is a vast number of carious lesions
34
What does quadrant excavation enable?
Rapid stabilisation
35
What is quadrant excavation?
Remove caries from entire quadrant placing temporary or permanent restorations depending on time management
36
What does pulpal extirpation achieve?
Alleviates pain of pulpitis or acute periodical periodontitis and stabilise tooth in short them prior to definitive treatment following stabilisation of entire dentition
37
What is pulpal extirpation?
Remove pulp, initial canal instrumentation, placement of non-setting calcium hydroxide, restore with temporary restoration, post-operative periodical radiograph required
38
What is indirect pulp capping?
Layer of residual caries remains, place calcium hydroxide over the top and a permanent restoration is placed
39
When is indirect pulp capping used?
Where likelihood of pulpal exposure i.e. > 3/4 dentine thickness is demineralised
40
What is the stepwise technique?
Removal of majority of demineralised dentine, leave dentine behind to facilitate biological response from vital pulp (formation of extra tertiary dentine), temporisation = good seal and re-enter in 6-8 months to remove remaining cries and place permanent restoration
41
When is the stepwise technique used?
Where likelihood of pulpal exposure i.e. >3/4 dentine thickness demineralised
42
What are the disadvantages of tunnel preparations?
- Undermines marginal ridge (can break) | = difficult to get sufficient light to remove all caries
43
What are the advantages of Rubber Dam?
``` Achieve ultimate isolation Protect gingivae and patients airway Protect cavity from saliva Retract the soft tissues improving access Contrasting background for diagnosis ```
44
When would you use labial approach for caries removal?
When it would be difficult to access palatally
45
How do we decide which sized bur to use to remove caries?
The largest one that fits to scoop out the caries (rather than burrow further into it)
46
What is needed for successful composite placement?
- Good moisture control - Incremental cure - Avoid air incorporation and voids
47
When should we consider use of Glass Ionomers?
- Stabilisation of multiple lesions - Poor oral hygiene compromises moisture control - Moisture control compromised cervically - Treatment of root surface areas - As temporary dressings :( compromised aesthetics and longevity

Yr 3 Restorative - biomaterials and CSL (16 decks)

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