Caries management in the anterior dentition Flashcards
What is caries?
The localised destruction of susceptible dental hard tissues by acidic by-products from bacterial fermentation of dietary carbohydrates
What is needed for caries to develop?
- Teeth
- Time
- Diet
- Bacteria in biofilm
What do white spot less tell us?
Caries is at least 50% of enamel depth (if see white specs with enamel dry)
How do we identify dentine caries?
Shadow into dentine (on tooth or radiograph)
What do brown spot lesions tell us?
Caries is in the process of arresting if it hasn’t already (does not need restoration unless cavitated)
What does a pulp polyp tell us?
The caries has reached the pulp
How do we diagnose caries?
- 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
What do we look for when carrying out a visual inspection?
Use Light & magnification - dry the teeth first Looking for: - Variations - Opacities - Shadows - Frank cavitation
How do we carry out tactile inspection?
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)
What are the limitations of radiographic assessment of caries?
- Snapshot in time = no information of activity or cavitation
- 2D representation of 3D tooth
What may shredding floss indicate?
Presence of a cavitated carious lesion
What are diagnostic methods used to do?
To build clinical picture = aids diagnosis
What are the different classification systems for caries detection etc?
Huge number Main ones: Blacks 1917 International caries detection and assessment system (iCAD) Site and stage Radiographic
n.b. others combine demographic data
What is a Blacks Class I cavity?
Occlusal (also includes palatal surface of incisors)
What is a Blacks Class II cavity?
Occlusal but also tends interproximally
What is a Blacks Class III cavity?
Interproximal lesion
What i a Blacks Class IV cavity?
Anterior tooth fracture
What is a Blacks Class V cavity?
Gingival lesion
What is a Blacks Class VI cavity?
Loss of cusp of posterior tooth
What is an ICADs 0?
Sound tooth surface
What is an ICAD 1?
First visual change in dried enamel
What is an ICAD 2?
Distinct visual change in wet enamel
What is an ICAD 3?
Localised enamel breakdown due to caries with no visible dentine (with or without enamel breakdown)
What is an ICAD 4?
Underlying dark shadow from dentine (with or without enamel breakdown)
What is an ICAD 5?
Distinct cavity with visible dentine
What is ICAD 6?
Extensive distinct cavity with visible dentine
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
What influences techniques and materials used for anterior restorations?
Higher aesthetic demands
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
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
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)
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)
When is quadrant excavation indicated?
Where there is a vast number of carious lesions
What does quadrant excavation enable?
Rapid stabilisation
What is quadrant excavation?
Remove caries from entire quadrant placing temporary or permanent restorations depending on time management
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
What is pulpal extirpation?
Remove pulp, initial canal instrumentation, placement of non-setting calcium hydroxide, restore with temporary restoration, post-operative periodical radiograph required
What is indirect pulp capping?
Layer of residual caries remains, place calcium hydroxide over the top and a permanent restoration is placed
When is indirect pulp capping used?
Where likelihood of pulpal exposure i.e. > 3/4 dentine thickness is demineralised
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
When is the stepwise technique used?
Where likelihood of pulpal exposure i.e. >3/4 dentine thickness demineralised
What are the disadvantages of tunnel preparations?
- Undermines marginal ridge (can break)
= difficult to get sufficient light to remove all caries
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
When would you use labial approach for caries removal?
When it would be difficult to access palatally
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)
What is needed for successful composite placement?
- Good moisture control
- Incremental cure
- Avoid air incorporation and voids
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
