Caries Pattern And Diagnosis - Caring For Children And Young People Flashcards
What do white/brown spot lesions on a tooth indicate? (1)
Decalcification
Remember
Nursing bottle caries
What criteria classify rampant caries?
=> 10 lesions per year
- lower anteriors affected
Describe the caries patterns in a primary dentition (5)
- Lower molars, upper molars, upper anteriors
- Rare in lower anteriors, buccal/lingual surfaces (except rampant caries)
- Occlusal caries - 1st primary molars < 2nd
- Interproximal caries do not occur until contacts develop
- Enamel hypomineralisation - occasionally in 1st and 2nd molars
Describe the caries pattern in a mixed dentition (4)
- Caries rate in lower 6s > upper 6s
- Pits/grooves - check palatal upper 6s, buccal lower 6s and palatal upper laterals
- Cingulum pits of lateral incisors
- Upper and lower incisors = uncontrolled caries
Describe the caries pattern in an early permanent dentition (2)
- Second molars erupting
- Host factors
- reduced salivary flow rate
- High mutans counts
What management factors need to be considered when treating caries in children ? (3)
- parental involvement
- Patient development
- Dealing with two dentitions
What components should make up your assessment of a child patient? (7)
- Parent/patient management
- Symptoms
- HPC
- PDH
- treatment experience to date
- oral hygiene habits, Fluoride history, dietary habits - MH
- SH
- Caries risk assessment
What areas are examined in an extra oral examination/ what is the clinician looking for? (2)
- Asymmetry
2. Lymph nodes, muscles
What is examined intra orally?
- Soft tissues
- oral hygiene/ swellings / sinuses, ulceration, gingival health - Hard tissues
- teeth present, dental age
- occlusion
- loose, missing, extra teeth
- trauma
- dental anomalies
- caries activity - past and present
What are tools used in clinics to detect caries? (4)
- Visual
- dry teeth, good light
- fibre optic trans illumination
- ortho separators
- caries detector dyes
- lasers - Radiographs
- Sensibility testing - nerve (hot/cold/electric)
- Vitality testing - blood supply (laser dopler)
What are the purposes of stabilising caries in child patients? (4)
- Prevent pain
- Preventive therapy
- Arrest restorable lesions
- Acclimatisation
- Decrease bacterial load in mouth
- Improve OH by making areas easier to clean
What are examples of treatments used for acclimatisation?
- Hand excavation, use of Carisol/GIC, diet advice, OHI
What factors are important for motivation and co-operation of child patients?
- Motivation
- parent-compliance with prevention regimes, attendance, support at home
- child - compliance, OH - Co-operation
- parent - own anxieties
- child - emotional maturity, fears, previous bad experiences, behavioural problems, ability to co-operate
What is the function of a band and loop space maintainer?
To prevent overcrowding in the event of premature primary tooth loss
When would a distal shoe be used instead of a band and loop space maintainer?
When the tooth next to the empty socket has not yet erupted
What is the result of early primary tooth extractions?
- Increased crowding, increased tendency for space loss
2. Earlier removed, greater the degree of space loss
What can you do to balance/compensate extractions of primary teeth?
- If you are extracting one canine, balance this by extracting the other in order to prevent a centre-line shift
- Consider balance of lower 1st primary molars if arch is crowded
- In general no other a’s and b’s necessary in the primary dentition
- Must always consider balance/compensation when removing FPM’s
Describe the tooth movements that occur due to loss of FPMs
- Maxilla (16 and 26)
- loss before complete eruption of 7 = rotation and mesial movement of 7 and distal drift of 5 - Mandible (36 and 46)
- loss after optimum age = tilting of 7’s
- loss before optimum age = distal drift and rotation of 5
What are emergency treatment options for caries in children?
- Caries excavation and sedative dressing
- Pulp therapy - pulpotomy or pulpectomy
- Drainage of pus
- Extraction (LA +- IHS) or GA
- (IV sedation only considered for 12 years and over)
What can you do to optimise treatment conditions for child patients?
- Pain free LA
- topical
- warm LA cartridge
- lower 6s rule (6 years old or 6s erupting - use IDB)
- intrapapillary injection avoids palatal injection - Rubber dam
What factors must be considered when examining caries in primary teeth?
- Extent of lesion
- When marginal ridge has broken down more than 2/3 of its length pulp will be involved
- Radiographic examination
- proximity of caries to pulp
- => 2/3 into dentine means pulp is involved
- pathology / root length
