caries pattern and diagnosis in children Flashcards
caries definition
‘‘ 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 for remineralisation to take place”
caries classification
decalcification - brown/white
spot lesions
pit and fissure caries
smooth surface - buccal/lingual/cervical
interproximal
early childhood or nursing bottle = Max incisors, 1st molars, mandibular canines
lower incisors protected by the tongue
recurrent/secondary
arrested caries
rampant caries = >10 new lesions per year
lower anteriors affected
caries pattern in primary dentition
lower molars, upper molars, upper anteriors
rare in lower anteriors, buccal / lingual surfaces (except rampant caries)
occlusal caries – 1st primary molars < 2nd
interproximal caries -not until contacts develop
enamel hypomineralisation (MIH- problems in pregnancy?)
mixed dentition caries pattern
caries rate lower 6s > upper 6s
pits / grooves -> palatal upper 6s
palatal upper laterals
buccal lower 6s
palatal upper laterals
cingulum pits of lateral incisors
upper and lower incisors = uncontrolled caries
caries management factors particular to children
parental involvement
patient development
dealing with two dentitions
caries assessment
Parent/patient management
Symptoms?
History of present complaint
Past dental history
treatment experience to date
Oral hygiene habits, F history, Dietary habits
Medical history
Social history
Caries Risk assessment
caries detection
Clinical examination
visual
dry teeth, good light, sharp eyes
FOTI
ortho separators
caries detector dyes
lasers
Radiographs
Sensibility testing – nerve (hot/cold/electric)
Vitality testing - blood supply (laser dopler)
(Only gentle probing to appreciate surface texture)
evaluation of dentition
Consider:
Tooth restorable?
Patient/parent compliance
Stage dental development
Space management
Anticipated difficulties
Overall prognosis
stabilisation tips
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
patient/parent compliance
Motivation
parent - compliance with prevention regimes, attendance, support at home
child – compliance, OH
Co-operation
parent - own anxieties
child - emotional maturity, fears, previous bad experience, behavioural problems, ability to co-operate
caries activity and prognosis
Pattern indicates level of caries activity
Prognosis dependant on preventive issues and motivation
why consider space maintenance
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
early loss of FPM’s
Maxilla 16, 26:
loss before complete eruption of 7 = rotation & mesial movement 7 & distal drift of 5
Mandible 36, 46:
loss after optimum age = tilting 7’s
loss before optimum age = 5 drifts distally and rotates
relief of symptoms
Treatment depends on
nature of the pain
status of pulp
stage of dental development
level of patient compliance
child pain history
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 with analgesics or antibiotics? (Note: antibiotics should only ever be prescribed when there is systemic illness, pyrexia and/or facial swelling).
