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BDS3 - caries symposium > Caries Pattern and Diagnosis - Caring for Children and Young People > Flashcards

Caries Pattern and Diagnosis - Caring for Children and Young People Flashcards

1
Q

define caries

A

disease of mineralised tissues; enamel, dentine and cementum, caused by action of micro-organisms on fermentable carbohydrates

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2
Q

when and why can caries be arrested

A

in it’s very early stages the disease can be arrested since it is possible for remineralisation to take place

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3
Q

what can decalcification present as

A

white / brown spot lesions

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4
Q

what helps a tooth to remineralise

A

normal brushing with fluoride toothpaste

if the lesion is self cleansing

free flowing saliva

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5
Q

how narrow is the fissure of a tooth

A

so narrow at its base that you cannot even get a single brush filament into it so it is impossible to clean

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6
Q

why do we do fissure sealants

A

as part of prevention

because the base of the fissure is so narrow we cannot clean it ourselves

fissure sealants seal the fissures so that bacteria is unable to get into them and multiply in an area where we are unable to clean

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7
Q

what is meant by the smooth surfaces of the tooth

A
  • buccal
  • lingual
  • cervical areas

(more difficult to get caries in these areas)

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8
Q

how would you determine the extent of interproximal caries

A

a clinical examination (not enough on its own)

and a radiograph

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9
Q

what teeth do early childhood / nursing bottle caries affect

A

maxillary incisors
first molars
mandibular canines

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10
Q

why are lower incisors usually not affected by early childhood / nursing bottle caries?

A

tend to be protected by the tongue

any saliva we do have at night time usually comes from the floor of the mouth so this also protects the lower incisors

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11
Q

how can early childhood / nursing bottle caries occur

A

Child is put to bed with a bottle or feeding cup filled with something other than water (juice / milk)

The lactose from milk / sugars from juice can then cause this when the mouth is dried up overnight and the saliva is not flowing as much so then the milk / juice lies in the mouth

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12
Q

what does the extent of early childhood / nursing bottle caries depend on

A

the length that this bad habit is ongoing

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13
Q

how can recurrent / secondary caries occur

A
  • restorations margins ditched / there is a crack in the restoration
  • restoration has been leaking
  • bacteria getting into the tooth
  • caries can form under the restoration
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14
Q

why is grey staining not uncommon in an amalgam restoration without caries

A

amalgam tattoos

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15
Q

how can caries become arrested

A

patient follows oral hygiene and diet advice

work with fluoride application as well

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16
Q

how does arrested caries present

A

dark brown

feel shiny and tough with a probe

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17
Q

what is expected in “rampant caries”

A
  • patient has more than 10 new lesions per year
  • lower anteriors are affected

(if caries are in the lower incisors this is uncontrolled caries)

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18
Q

what is the most common caries pattern in the primary dentition

A
  • lower molars
  • upper molars
  • upper anteriors
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19
Q

where is caries rare in the primary dentition

A
  • lower anterior

- buccal / lingual surfaces (except in rampant caries)

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20
Q

does occlusal caries affect the second primary molars or first primary molars more

A

second primary molars

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21
Q

can interproximal caries occur in the primary dentition

A

not until contacts develop

tends to be lots of gaps in the primary dentition at the beginning
not until the child is around 3 years old when their 2nd primary molars have come through that the teeth start to tough

until contacts are formed the teeth are self cleansing so it is more difficult for interproximal caries to develop

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22
Q

in the mixed dentition, is the caries rate greater in lower 6s or upper 6s

A

lower 6s

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23
Q

what pits / grooves are worst affected in the mixed dentition

A

§ Palatal upper 6s
§ Buccal lower 6s
§ Palatal upper laterals
§ Cingulum pits of lateral incisors

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24
Q

if caries is on the upper and lower incisors in the mixed dentition what is it called

A

uncontrolled caries

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25
Q

where would we consider placing fissure sealants if the child is high caries risk

A
  • FPM
  • second permanent molars
  • premolars
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26
Q

what host factors can affect the caries pattern in the early permanent dentition

A
  • reduced salivary flow

- high mutans count

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27
Q

when might patients have a reduced salivary flow

A

certain medical conditions

patients with special needs

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28
Q

what does a high mutans count mean

A

high level of bacteria in the mouth

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29
Q

what caries management factors need to be considered that are specific to children

A
  • parental involvement
  • patient involvement
  • dealing with 2 dentitions (mixed dentition)
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30
Q

what needs to be included in the patient assessment

A

• Parent / patient management
○ Dealing with at least 2 people, sometimes more

• Symptoms
○ Children sometimes get brought to the dentist for the first time only when they have symptoms - not a good method, want to see them before there is a problem

• History of present complaint
○ Often if a child is in pain they will have been in pain for a longer time than an adult patient will have been in pain just because it takes longer to communicate to their parents how sore the pain actually is and for the parents to realise something is actually wrong

• Past dental history
	○ Treatment experience to date
	○ Oral hygiene habits
	○ fluoride history
	○ dietary habits
  • Medical history
  • Social history
  • Caries risk assessment
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31
Q

what do you look for in the extra-oral examination

A

Asymmetry

Nodes etc

32
Q

what do you look for in the intra-oral examination

A 
○ Soft tissues
§ Oral hygiene
§ Swellings 
§ Sinuses 
§ Ulceration
§ Gingival health
○ Hard tissues
§ Teeth present
§ Dental age
§ Occlusion 
§ Loose / missing / extra teeth
§ Trauma
§ Dental abnormalities
§ Caries activity - Past and present
33
Q

what do you use for caries detection

A 
> clinical examination
> radiographs
> sensibility testing 
> vitality testing 
> gentle probing to feel surface texture
34
Q

what is included in the clinical examination for caries detection

A
  • visual / looking
  • ortho separators
  • caries detector dyes
  • laser
35
Q

what do you need for a good visual examination

A

§ Dry teeth
§ Good light
§ Sharp eyes

FOTI - fibre optic transillumination can help

36
Q

what do sensibility tests test

A

if the nerve is working

37
Q

what kind of sensibility tests can you use and when would you use them

A
  • hot
  • cold
  • electric

tend to be more for older children with a permanent dentition as these tests are unreliable on very young children / primary dentition

want to see if the tooth (nerve) will react to the different stimuli

38
Q

name the vitality test you can use and what does it test

A

tests blood supply

```
laser dopler
tends to be difficult to use due to big bulky size
~~~

39
Q

how is fibreoptic transillumination helpful

A

the light doesn’t travel through carious material in the same way it travels through hard tooth tissue so it makes it easier to detect caries

40
Q

what needs to be considered when evaluating the dentition

A
  • Tooth restorable?
  • Patient / parent compliance

• Stage dental development
(If we know the tooth is going to fall out soon what is the point in putting the child through a restoration / extraction)

• Space management
(Removing the second primary molar before the first permanent molar erupts can cause it to drift forward and take up the space of the premolar and results in a crowded dentition but can also use space maintainers to keep the space open)

• Anticipated difficulties

• Overall prognosis
○ Only one tooth - may as well do your best to fix it
○ 8 carious teeth then you are more looking at GA and extraction of them all

41
Q

what needs to be decided when restoring a tooth?

A
  • Choice of restorative material
  • Choice of restorative technique
  • Ideally decide cavity shape / form and restoration before starting
  • Permanent Vs Temporary restorations
42
Q

when is “stabilisation” used

A

when a patient has too many problems to fix so you want to make the overall environment better

43
Q

what is included in stabilisation

A
  • Prevent pain
  • Preventive therapy
  • Arrest restorable lesions
• Acclimatisation
○ Hand excavation
○ Use of carisolv / ART / IRM / GIC
○ Diet advice
○ OHI
  • Decrease bacterial load in mouth
  • Improve OH by making areas easier to clean
44
Q

what is ART

A

ART = Atraumatic Restorative Technique

Used a lot in 3rd world countries where they wouldnt have dental drills etc

45
Q

what does carisolv do

A

dissolves carious dentine

46
Q

what does IRM stand for

A

intermediate restorative material

47
Q

how can you make areas in the mouth easier to clean to improve OH

A

By filling big cavities, even temporarily, the patient can then clean their mouth better as these holes would have been impossible to clean

48
Q

name 2 important elements in patient and parent compliance

A

motivation

co-operation

49
Q

explain motivation in terms of patient / parent compliance

A

○ Parent
§ Compliance with prevention regimes such as right foods in diet and ensuring oral hygiene is carried out
§ Attendance
§ Support at home

○ Child
§ Compliance
§ Oral hygiene

50
Q

explain co-operation in terms of patient / parent compliance

A

○ Parent
§ Own anxieties

○ Child
§ Emotional maturity
§ Fears
§ Previous bad experience § Behavioural problems
§ Ability to co-operate
51
Q

list some things that should be considered with regards to the child’s stage of development

A

• 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 maintainers?

52
Q

what does the effect of premature loss of primary teeth depend on?

A

§ Tooth size / jaw relation
§ Muscle behaviour
§ Age at loss
§ Tooth

53
Q

why would you use space maintenance

A
  • maintain space if tooth (FPM/second primary molar/etc) lost in mixed dentition stage
  • prevent crowding
54
Q

name 2 types of space maintainers

A
  • band and loop space maintainers

- distal shoe

55
Q

explain the band and loop space maintainer

A

used for a good compliant patient
place an orthodontic band around the FPM and the loop then touches the distal surface of the first primary molar
[can also be done if the first primary molar comes out prematurely then the space maintainer can be put on the second primary molar as a crown instead of a band]

56
Q

when is the distal shoe space maintainer used and how does it work

A

placed when the first permanent molar is still unerupted but the secondary primary molar is lost

similar to band and loop, but on the loop there is a spike that goes into the bone that allows the FPM to slide up againt it when it is erupted to ensure it goes into the right space

57
Q

what results from early primary tooth extractions

A
  • Increase crowding, increase tendency for space loss
  • Earlier removed, greater degree of space loss
  • Balancing / compensating extractions
58
Q

explain balancing / compensating extracting

A

Balance primary canines to prevent centre-line shift
§ Ie taking out on primary canine we then take out the one on the other side of the same arch to prevent the centre line of your teeth from moving

If you take out an upper right canine and not the upper left canine, then the other incisor / anterior teeth will move towards the space and upset the midline

Must always consider balance / compensation when removing first permanent molars

don’t really need to balance as or bs

59
Q

what happens in early loss of maxillary FPM

A

if lost before complete eruption of 7 then:
§ Rotation and mesial movement 7
§ Distal drift of 5

60
Q

what happens in early loss of mandibular FPM

A

○ Loss after optimum age
§ Tilting 7s

○ Loss before optimum age
§ 5 drifts distally and rotates

61
Q

What are aims of treatment

A
  • Relief of symptoms
  • Prevention of disease initiation and progression
  • Restore function and aesthetics
62
Q

to relieve symptoms, treatment depends on what

A 
○ Nature of the pain
○ Status of pulp
○ Stage of dental development
○ Level of patient compliance
○ Also parental factors
63
Q

what questions do you ask when taking a pain history

A 
• Where is the pain?
• What does the tooth feel like?
• How long has the tooth been painful?
• Does anything make it better or worse?
• Kept awake?
• Spontaneous or precipitated?
	○ Does it only really feel painful when eating?
• Relieved with analgesics or antibiotics?

remember the questions must be asked in a child friendly way

64
Q

what are emergency treatment options

A

• Caries excavation and sedative dressing

• Pulp therapy
○ Pulpotomy
○ Pulpectomy

• Drainage of pus

• Extraction
○ LA with or without inhaled sedation
○ GA

• (IV sedation only considered for 12 years and over)
○ More for young permanent dentition

65
Q

how can you optimise treatment conditions

A
  • Pain-free LA

* Rubber dam

66
Q

how can LA be pain-free

A

○ Topical

○ Warm LA cartridge

○ Lower 6s rule
§ 6 years old or 6s erupting - use IDB
§ If the child does not have their lower 6s erupted then you can get away with doing infiltration instead of IDB

○ Intra-papillary infiltration avoids palatal injection
§ Makes it more comfortable

67
Q

how does rubber dam optimise treatment conditions

A

• Increase safety by decreasing
○ Damage to soft tissue
○ Risk of inhalation
○ Cross-infection

• Benefit to operator and patient by increasing
○ Isolation and moisture control
○ Retraction of gingivae and cheeks
○ Effective inhalation sedation
○ Patient confidence 
○ Operator confidence
68
Q

what is a good sequence of restoration

A 
• Fissure sealants
• Preventive restorations
• Simple fillings
	○ Eg shallow cervical cavities
• Fillings requiring LA but not into pulp
	○ Upper arch first
• Pulpotomies / pulpectomies 
• Extractions
69
Q

what are the different methods of caries removal

A
  • Hand excavation
  • Rotary instruments

• Chemo-mechanical removal
○ Caridex - N-monochloro-DL-2-aminobutyric acid (NMAB)
○ Carisolv gel - Amino acids and hypochlorite
○ Ozone
○ None of these are done in the dental school

  • Air abrasion
  • Lasers - Erbium-YAG
70
Q

list anatomical features of the crown of primary teeth and where possible say the clinical significance

A

> shorter = limited room for cavity prep so linings are not usually required

> narrower occlusal tables

> thin enamel / dentine

> broad contact areas

> enamel rods in gingival 1/3 extend occlusally = clinical caries only detected if large, bitewings are essential

> marked cervical constrictions = enamel at floor of box not undermined

> whiter = retention of SS crown

71
Q

list anatomical features of the pulp of primary teeth and where possible say the clinical significance

A

> large = limited room for cavity prep

> pulp horns close to surface = pulp exposure easy

72
Q

list anatomical features of the roots of primary teeth and where possible say the clinical significance

A

> narrow mesio-distally = pulpectomy more difficult

> long

> slender

> flared

73
Q

what do you need to consider about primary teeth in the clinical examination

A

○ Extent of lesion

○ When the marginal ridge has breakdown more than 2/3 of its length there is caries in the pulp so plan pulp treatment not simple restoration

74
Q

what do you need to consider about primary teeth in the radiographic examination

A

○ Proximity of caries to pulp?

○ >2/3 into dentine = pulp involved

○ Pathology / root length

75
Q

in general what do you need to consider when choosing the material and technique for restoring a tooth

A

○ Longevity of tooth - How long must it last?

○ Co-operation

○ Medical and dental history

○ Extent of lesion

○ Which tooth?

○ Oral hygiene

○ Diet history

○ Attitude

○ Parental preference

BDS3 - caries symposium (6 decks)

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