Caries Pattern And Diagnosis - Caring For Children And Young People

Question 1

What do white/brown spot lesions on a tooth indicate? (1)

Answer 1

Decalcification

Question 2

Remember

Answer 2

Nursing bottle caries

Question 3

What criteria classify rampant caries?

Answer 3

=> 10 lesions per year

• lower anteriors affected

Question 4

Describe the caries patterns in a primary dentition (5)

Answer 4

1. Lower molars, upper molars, upper anteriors
2. Rare in lower anteriors, buccal/lingual surfaces (except rampant caries)
3. Occlusal caries - 1st primary molars < 2nd
4. Interproximal caries do not occur until contacts develop
5. Enamel hypomineralisation - occasionally in 1st and 2nd molars

Question 5

Describe the caries pattern in a mixed dentition (4)

Answer 5

1. Caries rate in lower 6s > upper 6s
2. Pits/grooves - check palatal upper 6s, buccal lower 6s and palatal upper laterals
3. Cingulum pits of lateral incisors
4. Upper and lower incisors = uncontrolled caries

Question 6

Describe the caries pattern in an early permanent dentition (2)

Answer 6

1. Second molars erupting
2. Host factors
   - reduced salivary flow rate
   - High mutans counts

Question 7

What management factors need to be considered when treating caries in children ? (3)

Answer 7

1. parental involvement
2. Patient development
3. Dealing with two dentitions

Question 8

What components should make up your assessment of a child patient? (7)

Answer 8

1. Parent/patient management
2. Symptoms
3. HPC
4. PDH
   - treatment experience to date
   - oral hygiene habits, Fluoride history, dietary habits
5. MH
6. SH
7. Caries risk assessment

Question 9

What areas are examined in an extra oral examination/ what is the clinician looking for? (2)

Answer 9

1. Asymmetry

2. Lymph nodes, muscles

Question 10

What is examined intra orally?

Answer 10

1. Soft tissues
   - oral hygiene/ swellings / sinuses, ulceration, gingival health
2. Hard tissues
   - teeth present, dental age
   - occlusion
   - loose, missing, extra teeth
   - trauma
   - dental anomalies
   - caries activity - past and present

Question 11

What are tools used in clinics to detect caries? (4)

Answer 11

1. Visual
   - dry teeth, good light
   - fibre optic trans illumination
   - ortho separators
   - caries detector dyes
   - lasers
2. Radiographs
3. Sensibility testing - nerve (hot/cold/electric)
4. Vitality testing - blood supply (laser dopler)

Question 12

What are the purposes of stabilising caries in child patients? (4)

Answer 12

1. Prevent pain
2. Preventive therapy
3. Arrest restorable lesions
4. Acclimatisation
5. Decrease bacterial load in mouth
6. Improve OH by making areas easier to clean

Question 13

What are examples of treatments used for acclimatisation?

Answer 13

1. Hand excavation, use of Carisol/GIC, diet advice, OHI

Question 14

What factors are important for motivation and co-operation of child patients?

Answer 14

1. Motivation
   - parent-compliance with prevention regimes, attendance, support at home
   - child - compliance, OH
2. Co-operation
   - parent - own anxieties
   - child - emotional maturity, fears, previous bad experiences, behavioural problems, ability to co-operate

Question 15

What is the function of a band and loop space maintainer?

Answer 15

To prevent overcrowding in the event of premature primary tooth loss

Question 16

When would a distal shoe be used instead of a band and loop space maintainer?

Answer 16

When the tooth next to the empty socket has not yet erupted

Question 17

What is the result of early primary tooth extractions?

Answer 17

1. Increased crowding, increased tendency for space loss

2. Earlier removed, greater the degree of space loss

Question 18

What can you do to balance/compensate extractions of primary teeth?

Answer 18

1. If you are extracting one canine, balance this by extracting the other in order to prevent a centre-line shift
2. Consider balance of lower 1st primary molars if arch is crowded
3. In general no other a’s and b’s necessary in the primary dentition
4. Must always consider balance/compensation when removing FPM’s

Question 19

Describe the tooth movements that occur due to loss of FPMs

Answer 19

1. Maxilla (16 and 26)
   - loss before complete eruption of 7 = rotation and mesial movement of 7 and distal drift of 5
2. Mandible (36 and 46)
   - loss after optimum age = tilting of 7’s
   - loss before optimum age = distal drift and rotation of 5

Question 20

What are emergency treatment options for caries in children?

Answer 20

1. Caries excavation and sedative dressing
2. Pulp therapy - pulpotomy or pulpectomy
3. Drainage of pus
4. Extraction (LA +- IHS) or GA
5. (IV sedation only considered for 12 years and over)

Question 21

What can you do to optimise treatment conditions for child patients?

Answer 21

1. Pain free LA
   - topical
   - warm LA cartridge
   - lower 6s rule (6 years old or 6s erupting - use IDB)
   - intrapapillary injection avoids palatal injection
2. Rubber dam

Question 22

What factors must be considered when examining caries in primary teeth?

Answer 22

1. Extent of lesion
2. When marginal ridge has broken down more than 2/3 of its length pulp will be involved
3. Radiographic examination
   - proximity of caries to pulp
   - => 2/3 into dentine means pulp is involved
   - pathology / root length