Caries pattern and diagnosis caring for children and yp Flashcards
1
Q
What is the definition of caries?
A
- Disease of mineralised tissues; enamel, dentine and cementum, caused by action of micro-organisms on fermentable carbohydrates…
- … in it’s very early stages the disease can be arrested since it is possible to remineralisation to take place
2
Q
What is another term for decalcification?
A
- White/brown spot lesions
3
Q
What are the different classifications of caries?
A
- Decalcification (white spot lesions)
- Pit and fissure caries
- Smooth surface caries
- Interproximal caries
- Early childhood or nursing bottle caries
- Recurrent/secondary caries
- Arrested caries
- Rampant caries
4
Q
Where are smooth surface caries usually found? (3)
A
- Buccal/lingual/cervical areas
5
Q
What do caries look like when they are very active?
A
- Light brown
- Soft and mushy
6
Q
Which teeth are most likely to be affected by nursing bottle caries? (3)
A
- Max incisors
- 1st molars
- Mandibular canines
7
Q
Which teeth are usually protected from nursing bottle caries?
A
- Lower incisors protected by the tongue
8
Q
What is the definition of rampant caries?
A
- > or equal to 10 mew lesions per year
9
Q
What teeth are likely to be affected by rampant caries?
A
- Lower anterior’s = have some uncontrolled caries to deal with
10
Q
What is the definition of young permanent dentition?
A
- From the age of about 12 where the permanent teeth are there but they are still maturing - they do not have closed apexes
- So still a developing dentition
11
Q
In the primary dentition which type of teeth are most likely to be affected by caries? (3)
A
- Lower molars
- Upper molars
- Upper anteriors
12
Q
In the primary dentition which type of teeth are least likely to be affected by caries? (3)
A
- Lower anteriors
- Buccal and lingual surfaces (except rampant caries)
13
Q
In the primary dentition where are they most likely to get occlusal caries?
A
- 1st primary molars (more than 2nd molars)
14
Q
Does the primary dentition usually get affected by interproximal caries?
A
- Not until contacts develop
15
Q
Does enamel hypo mineralisation in the primary dentition make a child more susceptible to caries?
A
- Yes
16
Q
In the mixed dentition are upper or lower molars (6’s) more likely to get caries?
A
- Lower 6’s
17
Q
Where in the mixed dentition are pit and fissure caries likely to develop? (3)
A
- Buccal lower 6’s
- Palatal upper 6’s
- Palatal upper laterals (cingulum pits)
18
Q
When would you get caries in the mixed dentition in upper and lower incisors?
A
- With uncontrolled caries
19
Q
What might you want to do with erupting second molars in the early permanent dentition?
A
- Might want to put fissure sealants on if child is high risk
20
Q
What are 2 host factors that can increase caries risk in the early permanent dentition?
A
- Reduced salivary flow rate
- High mutans counts
21
Q
What are 3 caries management factors that are particular to children?
A
- Parental Involvement
- Patient development
- Dealing with 2 dentitions
22
Q
What would be included in an assessment of a child? (7)
A
- Parent/patient management
- Symptoms?
- History of present complaint
- Past dental history
- Medical history
- Social history
- Caries risk assessment
23
Q
What might be included in a past dental history of a child? (2)
A
- Treatment experiance to date
- Oral hygiene habits, F history, Dietary habits
24
Q
What would you assess in an extra-oral examination? (2)
A
- Asymmetry
- Nodes
25
What would you check about the soft tissues in an intra-oral examination? (5)
- Oral hygiene
- Swellings
- Sinuses
- Ulceration
- Gingival health
26
What would you check about the hard tissues in an intra-oral examination? (6)
- Teeth present, dental age
- Occlusion
- Loose, missing, extra teeth
- Trauma
- Dental anomalies
- Caries activity - past and present
27
What are different ways of detecting caries? (5)
- Clinical examination
- Radiographs
- Sensibility testing - nerve (hot/cold/electric)
- Vitality testing - blood supply (laser dopler)
- (only gentle probing to appreciate surface texture)
28
How can we detect caries through a clinical examination? (4)
- Visual (dry teeth, good light, sharp eyes, FOTI)
- Ortho separators
- Caries detector dyes
- Lasers
29
When evaluating the dentition what do you need to consider? (6)
- Tooth restorable?
- Patient/parent compliance
- Stage dental development
- Space management
- Anticipated difficulties
- Overall prognosis
30
What can temporary restorations be good for? (6)
- Prevent pain
- Preventive therapy
- Arrest restorable lesions
- Acclimatisation (e.g. hand excavation, use of carisolv, atraumatic restorative technique, Intermediate restorative material/GIC, diet advice, OHI)
- Decrease bacterial load in mouth
- Improve OH by making areas easier to clean
31
What does the parent need to do to show motivation to comply with improving the caries risk of their child? (3)
- Compliance with prevention regimes
- Attendance
- Support at home
32
What might effect the co-operation of a parent in preventing their child's risk of caries?
- Their own anxieties
33
What might effect the co-operation of the child in preventing their own risk of caries? (5)
- Emotional maturity
- Fears
- Previous bad experience
- Behavioural problems
- Ability to co-operate
34
With the primary dentition what do we need to consider in relation to stages of development that will determine whether we try to restore the tooth or not?
- Are they close to exfoliation?
35
With permanent molars what do we need to consider in relation to stages of development that will determine whether we try to restore the tooth or not? (3)
- What is the long term prognosis?
- Cold extractions be part of the ortho treatment plan?
- What about space maintainers?
36
What is caries prognosis dependent on?
- Preventive issues and motivation
37
What does the effect of premature loss of primary teeth depend on? (4)
- Tooth size/jaw relation
- Muscle behaviour
- Age at loss
- Which tooth it was
38
Why can the loss of first permanent molars be a problem?
As this can have a big effect in regards to spacing and where things are going to end up
39
What can premature loss of primary teeth cause?
Crowding
40
What is a band and loop space maintainer and what is it used for?
- Used where the second primary molar has been removed
- Type of space maintainer if have a good compliance patient
- First permanent molar with an orthodontic band around it
- Instead of ortho band can also use a stainless steel crown
41
When would a Distal shoe space maintainer be places instead of a band and loop SM?
- Placed when FPM is still unerupted
42
How does a distal shoe space maintainer work?
- When removing a second primary molar when the first permanent molar isn't there
- Has a spike that goes down into the bone so that then the first molar can slide up the piece of metal and sit in the right space
43
What are possible results of early primary tooth loss? (2)
- Increased crowding = Increased tendency for space loss
| - Earlier removal = increased degree of space loss
44
How can we balance/compensate early primary tooth extractions? (4)
- Balance primary canines to prevent centre-line shift
- Consider balance of lower 1st primary molars if arch is crowded
- In general no other b's or a's necessary in the primary dentition
- Must always consider balance/compensation when removing FPM's
45
If the patient loses their upper first molars (6's) before the complete eruption of the second molars (7's) what will happen?
- Will get rotation & mesial movement of 7 & distal drift of 5
46
If the patient loses their lower first molars (6's) after optimum age what will happen?
- Tilting of 7's
47
If the patient loses their lower first molars (6's) before optimum age what will happen?
- 5 drifts distally and rotates
48
What are our aims of treatment? (3)
- Relief of symptoms
- Prevention of disease initiation and progression
- Restore function and aesthetics
49
In order to relieve symptoms what does the treatment depend on? (5)
- Nature of the pain
- Status of the pulp
- Stage of dental development
- Level of patient compliance
- Parental factors
50
What could you ask the child when taking a pain history from them? (7)
- Where is the pain?
- What does the tooth feel like?
- How long has the tooth been painful?
- Does anything make the pain better or worse?
- Does the pain keep the patient awake or wake them from sleeping?
- Is the pain spontaneous or precipitated e.g. by eating
- Is the pain relieved by analgesics or antibiotics? (antibiotics should only ever be prescribed when there is systemic illness, pyrexia and or facial swelling)
51
What are possible emergency treatment options for treating children with caries? (5)
- Caries excavation and sedative dressing
- Pulp therapy - pulpotomy or pulpectomy
- Drainage of pus
- Extraction (LA, Inhalation sedation, GA)
- (IV sedation only considered for 12 years and over)
52
What are possible ways of giving pain free LA to children? (4)
- Topical
- Warm LA cartridge
- Lower 6's rule (if patient doesn't have their lower 6's in then can get away with an infiltration rather than an IDB but if 6 years old or 6's erupting then use IDB)
- Intra-papillary infiltration avoids palatal injection (not always avoids but makes it more co mfortable)
53
Use of rubber dam increases safety by decreasing...? (3)
- Damage to soft tissues
- Risk of inhalation
- Cross-infection
54
Use of rubber dam has a benefit to the operator and patient by increasing...? (5)
- Isolation and moisture control
- Retraction of gingivae and cheeks
- Patient confidence
- Operator confidence
- Effective inhalation sedation
55
What is the sequence of restorations you would go through with a child? (6)
- Fissure sealants
- Preventive restorations
- Simple fillings e.g. shallow cervical cavities
- Fillings requiring LA but not into the pulp (do upper arch first as it is easier to do a pain free injection in the upper arch)
- Pulpotomies/pulpectomies
- Extractions
56
What are possible methods of caries removal? (5)
- Hand excavation
- Rotary instruments
- Chemo-mechanical removal (don't use this in the dental school)
- Air abrasion
- Lasers
57
What are 3 types of chemo-mechanical caries removal?
- Caridex
- Carisolv gel
- Ozone
58
Look at the anatomical features and clinical significance of primary teeth slide
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59
When the marginal ridge has a breakdown of more than 2/3 of its length what does this mean?
- Means there is caries in the pulp so plan pulp treatment not a simple restoration
60
If caries are > or equal to 2/3 into dentine what does this mean?
- The pulp is involved
61
What are general considerations that need to be made when deciding on a restorative material/technique for a child? (9)
- Longevity of the tooth - how long must it last?
- Co-operation - how easy?
- Medical and dental history
- Extent of the lesion - how much of restoration exposed to wear
- Which tooth?
- Oral hygiene
- Diet history
- Attitude
- Parental preference
62
What are dental considerations that need to be made when choosing which restorative material/ technique for a child? (3)
- Extent of lesion - how much of restoration exposed to wear
- Which tooth?
- Oral hygiene
