Caries Management - 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 Extraction
Which material should not be used for permanent restorations in primary teeth
Conventional Glass Ionomer
When shouldn’t amalgam be used
Primary teeth
Persons under 15
Pregnant and breastfeeding women
What are the restorative options for primary molars
Composite Composer SS crown GIC - temporary only RMGIC
What are the indications to use a traditional preformed crown
>2 surfaces affected Extensive 2 surface lesions Pulpotomy/pulpectomy Fractured primary molars Excess tooth surface loss High caries Impaired OH Space maintainer
What are the 5 year survival rates of different preformed crowns
Amalgam - 80%
GIC - 66%
SS - 92%
What are the advantages of partial caries removal and restoration
Evidence from secondary care and private practice
Reduced risk of pulp exposure
Reduced time for cavity prep
Less need for LA
What are the disadvantages of partial caries removal and restoration
As caries is left in the cavity, the marginal seal must be effective to prevent caries progression
No proper evidence yet it is effective in primary care
Describe the technique of discing of primary anteriors
Use sand paper discs, tapered stone or diamond in slow speed
Tapered crown - narrower incisally
Round off proximal surfaces
Polish and apply fluoride varnish
What are the indications of using strip crowns for primary anteriors
Enamel hypoplasia
Dental abnormalities - amelogenesis, dentinogenesis
Labial and interproximal caries
What are the indications for discing of primary anteriors
Exfoliation time close
Pre-cooperative
Extensive superficial caries
Describe the technique for strip crowns for primary anteriors
LA and isolation Tapered prep with high speed diamond Make a labial groove 2mm incisal reduction Cellulose acetate crown form and composite - using all available enamel for bonding
How is interproximal caries on 1st and 2nd permanent molars
Apply fluoride varnish and monitor with bitewings
Ensure parent/carers are aware of impact of oral health and encourage to floss
How can enamel interproximal lesions be detected in permanent teeth
Using separators then removing after 5 days, allowing visualisation of the proximal surfaces
When should planned loss of first permanent molars be considered
Around age 8-9 make an assessment of any 6s affected by caries
Radiographically ideal when there is the start of calcification of the bifurcation of the unerupted lower second molars
Ideally all 3rd molars should be present
