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BDS3 CLINICAL Caries Symposium II > Caries Pattern and Diagnosis in Children and Young People > Flashcards

Caries Pattern and Diagnosis in Children and Young People Flashcards

1
Q

What is caries

A

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

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2
Q

What are the different caries classifications

A 
decalcification 
pit and fissure caries
smooth surface
inter proximal 
recurrent/secondary 
early childhood/nursing bottle 
arrested
rampant
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3
Q

Where are pits seen

A

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

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4
Q

What is nursing bottle caries

A

○ 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

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5
Q

How is rampant caries classified

A

10 or more new lesions per year

Lower anterior affected

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6
Q

What is the caries pattern in primary dentition

A
  • 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
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7
Q

What is the caries pattern in the mixed dentition

A

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

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8
Q

What is the caries pattern in the early permanent dentition

A

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

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9
Q

What are caries management factors particular to children

A

parent involvement
development
dealing with two dentitions

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10
Q

Explain the assessment

A
  • 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
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11
Q

What is the examination

A
  • Extra-oral (asymmetry, nodes, etc)

- Intra-oral

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12
Q

What is an intra oral examination

A

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
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13
Q

How can we detect caries

A

clinical examination
radiographs
sensibility testing
vitality testing - blood supply

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14
Q

What are the different ways to do a clinical examination

A 
○ Visual
			§ Dry teeth, good light, sharp eyes
			§ FOTI
○ Ortho separators (so we can physically see between teeth)
○ Caries detector dyes
Lasers
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15
Q

What should we consider when deciding whether to retain or extract a tooth

A

○ 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

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16
Q

If the tooth is restorable what do we need to think about

A

○ Choice of restorative material
○ Choice of restorative technique
○ Ideally decide cavity shape/form and restoration before starting
Permanent vs temporary restorations

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17
Q

What does stabilization consist of

A

○ Preventing pain
○ Preventative therapy
○ Arrest restorable lesions
Acclimatisation

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18
Q

What are exmaples of stabilization

A

hand excavation, use of carisolv, atraumatic removal technique, intermediate restorative material, glass ionomer, diet advice, oral hygiene instruction

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19
Q

When looking at patient/parent compliance what do we look at

A

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)

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20
Q

When considering stage of development what do we look at

A

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?

21
Q

When looking at caries activity and overall prognosis what do we consider

A

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?

22
Q

When looking at space maintenance what do we look at

A

effect of premature loss of primary teeth
the loss of FPM can effect spacing
crowding can occur if premature loss of primary teeth

23
Q

What does effect of premature loss of primary teeth depend on

A

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

24
Q

What are the space maintainers

A

band and loop space maintainer

distal shoe

25
Q

What is the band and loop space maintainers

A

Touches the distal surface of the first primary molar so the FPM can’t drift forward

26
Q

What is the distal shoe

A

§ 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

27
Q

What is the result of early primary tooth extractions

A
  • 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
28
Q

Which teeth may require balance/compensating extractions

A

○ 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

29
Q

What is the effect of the early loss of maxillary FPM

A

Loss before complete eruption of the 7 results in rotation and mesial movement of the 7 and distal drift of the 5

30
Q

What is the effect of the early loss of mandibular FPM

A

○ Loss after optimum age results in tilting of the 7s

Loss before optimum age results in the 5 drifting distally and rotating

31
Q

What is the aim of treatment

A
  • Relief of symptoms
    • Prevention of disease initiation and progression
      Restore function and aesthetics
32
Q

What does the relief of symptoms depend on

A
  • Nature of the pain
    • Status of the pulp
    • Stage of dental development
      Level of patient compliance
33
Q

When taking a pain history from a child what should you ask

A

○ 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

34
Q

What are the emergency tx options

A
  • 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
35
Q

When optimizing tx conditions what do we want

A

pain free LA

rubber dam

36
Q

how is pain free LA achieved

A

○ 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

37
Q

How does rubber dam increase safety

A

decreases:
§ Damage to soft tissues
§ Risk of inhalation
Cross infection

38
Q

How does rubber dam benefit operator and patient

A 
§ Isolation and moisture control 
			§ Retraction of gingivae and cheeks
			§ Effective inhalation sedation
			§ Patient confidence
Operator confidence
39
Q

What is the sequence of restoration

A
  • Fissure sealants
    • Preventive restorations
    • Simple fillings e.g shallow cervical cavities
    • Fillings requiring LA but not into pulp
    • Pulpotomies/pulpectomies
    • Extractions
40
Q

When doing sequence of restorations, why should we do upper before lower

A

easier to achieve pain free LA in the upper arch

41
Q

What are the methods of caries removal

A
  • Hand excavation
    • Rotary instruments
    • Chemo-mechanical removal
      ○ Caridex
      ○ Carisolv gel
      ○ Ozone
    • Air abrasion
      Lasers
42
Q

What are the anatomical features of the crown of primary teeth

A 
shorter
narrower occlusal table
thin enamel/dentine
broad contact areas
enamel rods in gingival 1/3 extend occlusally
marked cervical constriction 
whiter
43
Q

What are the anatomical features of the pulp

A

large so limited room for cavity prep

pulp horns close to surface so exposure is easy

44
Q

What are the anatomical features of the roots of primary teeth

A

narrow messy distally
longer
slender
flared

pulpectomy is more difficult

45
Q

What do you look at when doing a clinical examination on primary teeth

A

○ 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

46
Q

What do you look at when doing a radiographic examination on primary teeth

A

○ Proximity of caries to pulp
○ If more than 2/3 into dentine then the pulp is involved
Pathology/root length

47
Q

What are the general things to think about when choosing a material/technique

A 
○ 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
48
Q

What are the dental things to think about when choosing a material/technique

A

○ Extent of lesion - how much of restoration exposed to wear
○ Which tooth
Oral hygiene

BDS3 CLINICAL Caries Symposium II (7 decks)

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