Caries Managnent For Children And Young People - Strategies At Tooth Level

Question 1

List 5 management strategies for caries in primary teeth

Answer 1

1. Complete caries removal + restoration
2. Partial caries removal + restoration
3. No caries removal + seal with restoration
4. No caries removal + provide prevention alone or after making the lesion self cleansing
5. Extraction or review with extraction if pain or sepsis develops

Question 2

What management options are only appropriate if no alternative is feasible for occlusal caries/lesions?

Answer 2

1. Seal caries with hall crown

2. Make lesion self cleansing and provide prevention

Question 3

What are the preferred management strategies for occlusal caries/lesions?

Answer 3

1. Complete caries removal and restoration
2. Partial caries removal and restoration
3. Seal caries with hall crown

Question 4

What management strategies should only be used if there are no alternatives for early approximal caries/lesions?

Answer 4

1. Provide prevention alone

Question 5

What are the preferred methods used for early approximal caries/lesions?

Answer 5

1. Complete removal and restoration
2. Partial removal and restoration
3. Seal caries with hall crown

Question 6

What management strategies are only appropriate when there are no alternatives for advanced approximal lesions?

Answer 6

1. Provide prevention alone

2. Make lesion self cleansing and provide prevention

Question 7

What management strategies are preferred for advanced approximal caries/lesions?

Answer 7

1. Complete caries removal and restoration
2. Partial caries removal and restoration
3. Seal caries with hall crown

Question 8

What management options are preferred for anterior cavitated lesions?

Answer 8

1. Complete caries removal and restoration
2. Partial caries removal and restoration
3. Provide prevention alone

Question 9

What are the preferred management strategies for grossly carious, unrestorable teeth without signs and symptoms of pain or sepsis?

Answer 9

1. Provide prevention alone

2. Extraction or review, with extraction if pain or sepsis develops

Question 10

What two factors must be considered and balanced for management of caries in primary teeth?

Answer 10

1. Reduction in risk of pain or sepsis from the tooth in future
2. The child’s ability to accept treatment now

Question 11

What types of procedures should be avoided in young and inexperienced patients?

Answer 11

Procedures involving LA (until the child can cope)

Question 12

What material should not be used for permanent restorations in children?

Answer 12

Conventional glass ionomer

Question 13

What are the management options for a primary tooth that is associated with sepsis?

Answer 13

Pulp therapy or extraction

Question 14

What are the indicators of a tooth associated with sepsis?

Answer 14

Signs and symptoms of:

1. Abscess
2. Sinus
3. Inter-radicular radiolucency
4. Non-physiological mobility

Question 15

What are indicators for the use of preformed crowns?

Answer 15

1. > 2 surfaces affected
2. Extensive 2 surface lesions
3. Pulpotomy/pulpectomy
4. Developmental defects
5. # d primary molars
6. Excessive tooth loss
7. High caries
8. Impaired OH
9. Space maintainer

Question 16

What are the advantages of partial caries removal and restoration?

Answer 16

1. Evidence largely from secondary care and private practice that this approach can be effective
2. Reduced risk of pulp exposure
3. Reduced time for cavity prep, less need for LA

Question 17

What are the disadvantages of partial caries removal and restoration?

Answer 17

1. As caries is left in the cavity, the marginal seal must be effective to prevent caries progression
2. No evidence, as yet that this approach is effective in primary care

Question 18

Describe the technique used for interproximal discing of primary anterior teeth

Answer 18

1. Sand paper discs, tapered stone or diamond in slow speed
2. Tapered crown - narrower incisally
3. Round off proximal surfaces
4. Polish and fluoride varnish

Question 19

What are indications for the use of interproximal discing?

Answer 19

1. Exfoliation time close, pre-cooperative patient, extensive superficial/minimal interproximal caries

Question 20

What are advantages of interproximal discing?

Answer 20

1. Simple
2. Fast
3. Opens contacts

Question 21

What are disadvantages of interproximal discing?

Answer 21

1. Potentially close proximity to pulp
2. Food impaction
3. Space loss
4. Aesthetics poor

Question 22

What are indications for the use of strip crowns?

Answer 22

1. Enamel hypoplasia
2. Dental anomalies - ameloblast, dentino
3. Labial and interproximal caries

Question 23

Describe the technique for the use of strip crowns

Answer 23

1. LA and isolation
2. Tapered prep - high speed diamond
3. Create a labial groove for retention
4. 2mm incisal reduction
5. Place Cellulose acetate crown form and composite - using all available enamel for bonding

Question 24

What steps should be taken to identify and arrest mesial surface, enamel only caries on primary 1st molars?

Answer 24

1. Apply fluoride varnish and monitor for progression using bitewing radiographs
2. Ensuring parents/carers are aware of the potential impact on their child’s oral health
   - encourage flossing and use of floss wands on the 6/E contact 2-3 times per week

Question 25

Describe the proper management of suspicious fissures

Answer 25

1. Thoroughly clean the fissures of all debris, dry the tooth and view it with bright, direct light 2. Take good quality radiographs 3. If there is: - micro cavitation - shadowing under enamel - dentinal caries • remove caries and place a conventional composite restoration limited to the site of the caries • fissure seal the remaining fissure system

Question 26

What are the advantages of using separators to examine interproximal surfaces of teeth?

Answer 26

1. Caries can be detected via direct vision and micro cavities repaired without having to resort to cutting a conventional interproximal cavity

Question 27

What steps should be taken when managing a developing enamel lesion on a FPM which is adjacent to a carious SPM?

Answer 27

1. Provide a preformed crown on the primary molar Or 2. Make the area self cleansing whilst taking care not to cause iatrogenic damage

Question 28

At what age should planned loss of poor prognosis FPM be considered?

Answer 28

8-9 years

Question 29

When is planned loss most ideal radiographically? Why is this?

Answer 29

1. When there is the start of calcification of the bifurcation of the unerupted lower second molars - ideally all premolars and 3rd molars should be present 2. This prevents over eruption of the opposing tooth

Question 30

What are the advantages of planned loss/removal or poor prognosis FPMs?

Answer 30

1. If extracted at the correct time, this action can allow the development of a caries free dentition in the adolescent, without spacing

Question 31

What are the disadvantages of planned loss for poor prognosis FPMs?

Answer 31

1. Requires extraction of permanent molar teeth from young children - =demanding - may require the use of GA with associated risks