Caries Managment

Question 1

What are the 5 Rs of caries managment?

Answer 1

1. Recognition (of contributory factors + disease).
2. Reorientation (of contributory lifestyle factors).
3. Remineralization (of visible/ not visible + cavitated/ not cavitated)
4. Repair (when no other solution is possible)
5. Review (of child, oral health and situation)

Question 2

What is the best predictor of future disease

Answer 2

Current disease

Question 3

A patient has two white spot lesions. What risk level are they? How often would you take bitewings?

Answer 3

HIGH risk, 6 month bitewing interval.

Question 4

What does caries risk status determine? (5)

Answer 4

• components of the preventive programme for the individual
  standard or enhanced)
• the intensity of the preventive programme
• the likelihood of success of interventions to repair
• recall interval
• radiograph use

Question 4

A child is caries free but have a sibling with caries. What caries risk is the child?

Answer 4

HIGH risk. Same food, OH from family, same environment.

Question 5

What are the 4 pillars of a preventive program?

Answer 5

Fluoride (varnish, toothpaste etc), OHI, Dietary Investigation, Sealants.

Question 6

What is the difference between standard or enhanced preventative program.

Answer 6

• Strength of fluoride toothpaste, number of times fluoride varnish is applied.

Question 7

What do all children have done?

Answer 7

All children have their 6s sealed.

Question 8

What is the maximum number of times fluoride varnish can be applied?

Answer 8

4 times a year.

Question 9

How often do you take radiographs in children at high caries risk?

Answer 9

6-12 months.

Question 10

How often do you take radiographs in children at low caries risk?

Answer 10

2 years.

Question 11

What is important for non restorative cavity control?

Answer 11

CASE SELECTION - must have a very motivated patient.

Question 12

List 5 advantages of non restorative cavity control.

Answer 12

1. allows child to develop intellectually and cope with more invasive procedure (MAKE THEM FROM PRE-COOPERATIVE TO COOPERATIVE).
2. very little technical skill needed.
3. don’t need injections (unless sound dentine must be cut)
4. very low patient tolerance required.
5. may slow caries enough to allow tooth to exfoliate without causing pain/ abscess

Question 13

List 9 disadvantages of non restorative cavity control.

Answer 13

• Only works in about 50% of cases…
• pulp may be too damaged already.
• needs particular conditions
• at the mercy of the carers!!!!
• might be interpreted as watchful neglect
• other dentists might not recognise what you’ve done
• difficulty monitoring – photographs
• doesn’t look nice
• does it feel satisfying?

Question 14

How often does non restorative cavity control work (%)?

Answer 14

50% of cases (even in engaged patients/ carers).

Question 15

When is a stainless steel crown/ Hall crown best indicated?

Answer 15

• Proximal lesion OR multisurface.

Question 16

There is a deep OCCLUSAL cavity in a primary tooth. What is the first line treatment? If child is pre-cooperative?

Answer 16

• COMPOSITE restoration (high chance of success with composite of an occlusal restoration).
• if pre-cooperative use Hall technique.

Question 17

What medication may cause severe effects in the oral cavity?

Answer 17

antiepileptic drugs cause severe gingival overgrowth.

Question 18

How might medical issues affect a child’s caries risk and your treatment planning decisions?

Answer 18

• physical/ mental disabilities.
• bleeding disorders.
• medications (ex. anticoagulants, anticonvulsants).

Question 19

What makes a tooth unrestorable?

Answer 19

• amount of coronal tooth tissue (can it retain a restoration).
• pulpal involvment.

Question 20

What is a disadvantage of Ds?

Answer 20

Very thin enamel - once a lesion is into enamel it has essentially reached dentine.

Question 21

What is a common place for upper D and E and 6s to get caries? How can this be prevented?

Answer 21

distopallatine fissure.

• prevent by covering this with the fissure sealant.

Question 22

What teeth would you not hall crown in the same appointment?

Answer 22

• teeth adjacent to each other or teeth that meet on opposing arches.

Question 23

When is the ideal time to extract a 6?

Answer 23

8.5 to 10 years.