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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
Q

What is an ICAD 5?

A

Distinct cavity with visible dentine

26
Q

What is ICAD 6?

A

Extensive distinct cavity with visible dentine

27
Q

What are the common specific causes of anterior caries?

A

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
Q

What influences techniques and materials used for anterior restorations?

A

Higher aesthetic demands

29
Q

What are the principles in treatment planning for caries management?

A
  • 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
Q

What determines an individuals risk status?

A
  • 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
Q

What is the importance of restorations in caries control?

A

To make the cavitated lesion cleanable (filling sends biofilm back to surface where the patient can cleanse it)

32
Q

When do we treat caries?

A
  • 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
Q

When is quadrant excavation indicated?

A

Where there is a vast number of carious lesions

34
Q

What does quadrant excavation enable?

A

Rapid stabilisation

35
Q

What is quadrant excavation?

A

Remove caries from entire quadrant placing temporary or permanent restorations depending on time management

36
Q

What does pulpal extirpation achieve?

A

Alleviates pain of pulpitis or acute periodical periodontitis and stabilise tooth in short them prior to definitive treatment following stabilisation of entire dentition

37
Q

What is pulpal extirpation?

A

Remove pulp, initial canal instrumentation, placement of non-setting calcium hydroxide, restore with temporary restoration, post-operative periodical radiograph required

38
Q

What is indirect pulp capping?

A

Layer of residual caries remains, place calcium hydroxide over the top and a permanent restoration is placed

39
Q

When is indirect pulp capping used?

A

Where likelihood of pulpal exposure i.e. > 3/4 dentine thickness is demineralised

40
Q

What is the stepwise technique?

A

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
Q

When is the stepwise technique used?

A

Where likelihood of pulpal exposure i.e. >3/4 dentine thickness demineralised

42
Q

What are the disadvantages of tunnel preparations?

A
  • Undermines marginal ridge (can break)

= difficult to get sufficient light to remove all caries

43
Q

What are the advantages of Rubber Dam?

A 
Achieve ultimate isolation
Protect gingivae and patients airway
Protect cavity from saliva
Retract the soft tissues improving access
Contrasting background for diagnosis
44
Q

When would you use labial approach for caries removal?

A

When it would be difficult to access palatally

45
Q

How do we decide which sized bur to use to remove caries?

A

The largest one that fits to scoop out the caries (rather than burrow further into it)

46
Q

What is needed for successful composite placement?

A
  • Good moisture control
  • Incremental cure
  • Avoid air incorporation and voids
47
Q

When should we consider use of Glass Ionomers?

A
  • 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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