Caries Pattern and Diagnosis in Children and Young People Flashcards
What is caries
Disease of mineralised tissue
Caused by action of microorganisms on fermentable carbohydrates
In the very early stages, the disease can be arrested since it is possible for remineralisation to take place
What are the different caries classifications
decalcification pit and fissure caries smooth surface inter proximal recurrent/secondary early childhood/nursing bottle arrested rampant
Where are pits seen
on the lower first permanent molar, the palatal of the upper first permanent molar and there is a pit near the cingulum of the lateral incisor
What is nursing bottle caries
○ Typical pattern is children being put to bed with bottle/feeding cup
○ At night there is less saliva, higher caries risk
○ Lower incisor teeth tend to be spared as any saliva that we do get at night comes from the lower salivary gland
How is rampant caries classified
10 or more new lesions per year
Lower anterior affected
What is the caries pattern in primary dentition
- Lower molars, upper molars, upper anteriors
- Rare in lower anteriors, buccal/lingual surfaces (except rampant caries)
- Occlusal caries - effects second primary molars more than the first
- Interproximal caries - when the primary dentition first comes through there are lots of gaps so until the second molars come through then they start to develop contact areas. The spaces up until then are self cleansing so it is harder for inter proximal caries to develop
Enamel hypo mineralisation more susceptible to carious attack
What is the caries pattern in the mixed dentition
Caries rate in the lower 6’s is greater than the upper 6’s
pits prone to caries
Caries in the upper and lower incisors is uncontrolled caries
What is the caries pattern in the early permanent dentition
econd molars erupting and if the patient is high risk then you may want to consider putting a fissure sealant on the second molars
- Host factors
○ Reduced salivary flow rate (not common but possible)
High mutans count
What are caries management factors particular to children
parent involvement
development
dealing with two dentitions
Explain the assessment
- Parent/patient management
- Do they have any 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
What is the examination
- Extra-oral (asymmetry, nodes, etc)
- Intra-oral
What is an intra oral examination
soft tissues- Oralhygeine/swelings/sinuses/ulceration/gingival health
hard tissues § Teeth present, dental age § Occlusion § Loose, missing, extra teeth § Trauma § Dental anomalies Caries activity, past and present
How can we detect caries
clinical examination
radiographs
sensibility testing
vitality testing - blood supply
What are the different ways to do a clinical examination
○ Visual § Dry teeth, good light, sharp eyes § FOTI ○ Ortho separators (so we can physically see between teeth) ○ Caries detector dyes Lasers
What should we consider when deciding whether to retain or extract a tooth
○ Is the tooth restorable? Otherwise the tooth is coming out
○ Is the patient/parent compliant?
○ Stage dental development? If the tooth is due to fall out there is no point in placing a restoration
○ Space management? Don’t want drifting of permanent teeth resulting in crowding
○ Anticipated difficulties
○ Overall prognosis
If the tooth is restorable what do we need to think about
○ Choice of restorative material
○ Choice of restorative technique
○ Ideally decide cavity shape/form and restoration before starting
Permanent vs temporary restorations
What does stabilization consist of
○ Preventing pain
○ Preventative therapy
○ Arrest restorable lesions
Acclimatisation
What are exmaples of stabilization
hand excavation, use of carisolv, atraumatic removal technique, intermediate restorative material, glass ionomer, diet advice, oral hygiene instruction
When looking at patient/parent compliance what do we look at
motivation of parent (compliance, attendance, support at home)
motivation of child (compliance, OH)
cooperation of parent (any anxieties)
cooperation of child (emotional maturity, fears, previous bad experience, behavioral problems, ability to cooperate)
When considering stage of development what do we look at
primary teeth - are they close to exfoliation?
permanent molars - what is the long term prognosis? could extraction be part of ortho? can we use space maintainers?
When looking at caries activity and overall prognosis what do we consider
Pattern indicates level of caries activity and that determines where we go with treatment
Prognosis dependant on preventive issues and motivation
○ Will they listen to what is said?
○ Will they make changes?
○ Is it better to just take the tooth out?
When looking at space maintenance what do we look at
effect of premature loss of primary teeth
the loss of FPM can effect spacing
crowding can occur if premature loss of primary teeth
What does effect of premature loss of primary teeth depend on
○ Tooth size/jaw relation
○ Muscle behaviour
○ Age at loss
Tooth
What are the space maintainers
band and loop space maintainer
distal shoe
What is the band and loop space maintainers
Touches the distal surface of the first primary molar so the FPM can’t drift forward
What is the distal shoe
§ Placed when FPM still hasn’t erupted
§ It is more difficult
Has a spike that goes into the bone so the unerupted first permanent molar can slide up the piece of metal into the right place
What is the result of early primary tooth extractions
- Increased crowding, increased tendency for space loss
- The earlier the tooth is removed, the greater the degree of space loss
May require balancing/compensating extractions
- The earlier the tooth is removed, the greater the degree of space loss
Which teeth may require balance/compensating extractions
○ Need to balance primary canines to prevent centre line shift
○ Consider balance of the lower 1st primary molars if the arch is crowded
○ In general no other a’s or b’c necessary in primary dentition
Must always consider balance/compensation when removing FPM
What is the effect of the early loss of maxillary FPM
Loss before complete eruption of the 7 results in rotation and mesial movement of the 7 and distal drift of the 5
What is the effect of the early loss of mandibular FPM
○ Loss after optimum age results in tilting of the 7s
Loss before optimum age results in the 5 drifting distally and rotating
What is the aim of treatment
- Relief of symptoms
- Prevention of disease initiation and progression
Restore function and aesthetics
- Prevention of disease initiation and progression
What does the relief of symptoms depend on
- Nature of the pain
- Status of the pulp
- Stage of dental development
Level of patient compliance
When taking a pain history from a child what should you ask
○ 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 pain relieved with analgesics or antibiotics
What are the emergency tx options
- Caries excavation and sedative dressing
- Pulp therapy - pulpotomy or pulpectomy
- Drainage of pus
- Extraction
○ LA with/without inhalation sedation
○ GA - IV sedation is only considered for children 12 years and over
When optimizing tx conditions what do we want
pain free LA
rubber dam
how is pain free LA achieved
○ Topical
○ Warm LA cartridge
○ Lower 6’s rule
§ 6 years old or 6’s erupting use IDB
§ If the child does not have lower 6’s you can do an infiltration
Intra-papillary infiltration avoids palatal injection
How does rubber dam increase safety
decreases:
§ Damage to soft tissues
§ Risk of inhalation
Cross infection
How does rubber dam benefit operator and patient
§ Isolation and moisture control § Retraction of gingivae and cheeks § Effective inhalation sedation § Patient confidence Operator confidence
What is the sequence of restoration
- Fissure sealants
- Preventive restorations
- Simple fillings e.g shallow cervical cavities
- Fillings requiring LA but not into pulp
- Pulpotomies/pulpectomies
- Extractions
When doing sequence of restorations, why should we do upper before lower
easier to achieve pain free LA in the upper arch
What are the methods of caries removal
- Hand excavation
- Rotary instruments
- Chemo-mechanical removal
○ Caridex
○ Carisolv gel
○ Ozone - Air abrasion
Lasers
What are the anatomical features of the crown of primary teeth
shorter narrower occlusal table thin enamel/dentine broad contact areas enamel rods in gingival 1/3 extend occlusally marked cervical constriction whiter
What are the anatomical features of the pulp
large so limited room for cavity prep
pulp horns close to surface so exposure is easy
What are the anatomical features of the roots of primary teeth
narrow messy distally
longer
slender
flared
pulpectomy is more difficult
What do you look at when doing a clinical examination on primary teeth
○ Extent of the lesion
When the marginal ridge has broken down more than 2/3 of its length then there is caries in the pulp so plan pulp treatment (most likely pulpotomy) not a simple restoration
What do you look at when doing a radiographic examination on primary teeth
○ Proximity of caries to pulp
○ If more than 2/3 into dentine then the pulp is involved
Pathology/root length
What are the general things to think about when choosing a material/technique
○ Longevity of the tooth - how long must it last ○ Cooperation - how easy ○ Medical and dental history ○ Extent of lesion - how much of restoration is exposed to wear ○ Which tooth ○ Oral hygiene ○ Diet history ○ Attitude Parent preference
What are the dental things to think about when choosing a material/technique
○ Extent of lesion - how much of restoration exposed to wear
○ Which tooth
Oral hygiene
