Caries pattern and diagnosis- caring for the children and young people Flashcards
What are the classes of caries?
8
- decalcification (white/brown spot lesions)
- pit and fissue
- smooth surface
- interproximal
- early childhood/ nursing bottle caries
- recurrent/ secondary caries
- arrested caries
- rampant caries
What teeth are mostly affected in nursing bottle caries?
maxillary incisors, 1st molars and mandibular canines
What determines rampant caries?
– >10 new lesions per year
– lower anteriors affected (usually protected by tongue)
What is the usual caries pattern in the primary dentition?
– lower molars, upper molars, upper anteriors
– rare in lower anteriors, buccal / lingual surfaces (except rampant caries)
– occlusal caries – 1st primary molars less than 2nd
– interproximal caries -not until contacts develop
– enamel hypomineralisation (MIH- problems in pregnancy?)
What is the usual caries pattern in the mixed dentition?
– caries rate lower 6s more than upper 6s
– pits / grooves in buccal lower 6s, palatal upper 6s, palatal upper laterals
– cingulum pits of lateral incisors
– upper and lower incisors = uncontrolled caries
What is the usual caries pattern in the early permanent dentition?
– second molars erupting
– host factors
* reduced salivary flowrate
* high mutans counts
What is examined in the physical exam?
extra, intra oral
- Extra-oral-asymmetry,nodesetc.
- Intra-oral
– soft tissues - Oral hygeine/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 tests used to clinically examine?
– visual (dry teeth, good light, sharp eyes FOTI)
– ortho separators
– caries detector dyes
– lasers
- radiographs
- sensibility nerve testing (hot/cold/electric)
- vitality testing - blood supply (laser dopler)
- probing for surface texture
What must be considered when deciding to retain or extract?
- Tooth restorable?
- Patient/parent compliance
- Stage dental development
- Space management
- Anticipated difficulties
- Overall prognosis
What are the ways to stablise lesions?
- prevent pain
- preventive therapy
- arrest restorable lesions
- acclimatisation
e.g. hand excavation, use of carisolv®/ ART/ IRM/GIC, diet advice, OHI - decrease bacterial load in mouth
- improve OH by making areas easier to clean
What should be considered regarding stage of development in the primary teeth and permanent molars?
- Primary teeth
– are they close to exfoliation? - Permanent molars
– what is the long term prognosis?
– could extractions be part of the ortho treatment plan?
– what about space maintenance?
Why is space maintainence considered and what tool can be used?
- Effect of premature loss of primary teeth
– depends on: - tooth size/jaw relation
- muscle behaviour
- age at loss
- tooth
- Loss of 1st perm molars
- Crowding
band and loop maintainer, distal shoe (place when fpm still unerupted)
What can result from early primary tooth extractions?
- increase in crowding (the earlier removed, the higher degree space loss)
- balancing/ compensating extractions
What are some balancing/compensating extractions that maybe carried out?
– balance primary canines to prevent center-line shift
– consider balance of lower 1st primary molars if arch crowded
– in general no other b’s or c’s necessary in the primary dentition
– Must always consider balance/compensation when removing FPM’s
What does as early loss of maxillary FPM before complete eruption of 7 cause?
rotation & mesial movement 7 & distal drift of 5
