Caries Pattern + Diagnosis Flashcards
Define caries
> Disease of mineralised tissues: enamel dentine cementum caused by the action of microorganisms on fermentable carbohydrates
> Can be arrested and remineralisation can occur in early stages
How does decalcification appear clinically?
Chalky white/brown lesions
When is decalcification most commonly seen?
Under ortho brackets
What 3 pits should be checked for possible caries?
- Buccal pits of lower 6s
- Palatal pits of uppers 6s
- Cingulum + palatal pits of upper 2s
Where is smooth surface caries found?
- Buccal
- Lingual
- Cervical
How does active caries present clinically?
- Light brown caries
- Soft mushy if you check with a probe
What teeth does early bottle caries affect?
MAXILLARY
Incisors
1st Molars
MANDIBULAR
Canines
Why are lower incisors normally not affected by early bottle caries?
They are protected by the tongue
+ saliva from floor of the mouth (salivary glands)
What is an amalgam tattoo caused by?
Amalgam gets into the dentinal tubules and stains them grey
Define rampant caries
More than or equal to 10 new lesions per year
- Lower anteriors affected
Pattern of attack for caries in deciduous dentition (yrs)
0 to 6
Pattern of attack for caries in young mixed dentition (yrs)
6 to 12
Pattern of attack for caries in young permanent dentition (yrs)
12+
What teeth is caries most prevalent in the primary dentition?
- Lower primary molars
- Upper primary molars (2nd)
- Upper anteriors
What teeth is caries least prevalent in the primary dentition?
- Lower anteriors
- Buccal + lingual surfaces
Why is interprox caries harder to develop in primary dentition?
Because primary dentition is very spaced out making the areas self cleansing
What teeth can enamel hypomineralisation occur in the primary dentition?
2nd primary molars
Whats usually the pattern of extraction for caries in primary dentition?
8 primary molars removed + centrals + laterals
- Canines saved to guide teeth in
- Lower anteriors usually spared as they don’t get caries
What teeth can be fissure sealed if the child has a high caries risk?
Molars and premolars
What steps are part of the assessment for caries? (7)
- Parent+patient management
- Symptoms
- HPC
- PDH
- Tx to date
- OH habits, F habits + Dietary habits - MH
- SH
- Caries Risk Assessment
What steps are part of the e/o I/o examination for caries?
- Extra-oral
- Intra-oral
Soft tissues: OH Swelling Sinuses Ulceration
Hard tissues: Teeth present Dental age Occlusion Loose/missing/extra teeth Trauma Dental anomalies Caries activity
Clinical examination for caries
VISUAL
- dry teeth
- good light
What tests can be done for caries diagnosis
- Radiographs
- Sensibility testing:
- Nerve (hot/cold/electric) - Vitality testing:
- Blood supply (laser dopler)
- Difficult to use, bulky
How is fiberoptic transillumination used for caries detection?
Light doesn’t carry through carious material
Why would you want to avoid extracting a second primary molar?
FPM will drift and take its place (of the premolar under it)
Resulting in crowding
What are some key considerations before you decide your tx?
- If tooth is restorable
- Patient/parent compliance
- Stage of dental development
- Space management
- Anticipated difficulties
- Overall prognosis
If the tooth is restorable what considerations do you need to make in terms of tx? (4)
- Choice of restorative material
- Choice of restorative technique
- Cavity shape
- Permanent vs temp restos
State an example of a temporary restoration material
Zinc oxide eugenol based temp material
- Prevents pain + worsening
Can hand excavate gross caries first
What material is used for stabilisation of caries?
GIC - GI Cement
What is carisol used for?
Dissolves carious dentine
Name 2 types of space maintainers (2)
- Ortho brackets
2. Band and loop space maintainer
When is a distal shoe used?
When removing a 2nd primary molar when the 1st permanent molar isn’t there
Function of a distal shoe
Spike goes into bone so the unerupted FPM can slide up the metal and sit into the right space
Disadvantages of primary tooth extractions
- Increased crowing
- Tendency for space loss
Whats a rule for extractions
If you take out one you need to take out the other in the same arch to prevent centre line shift
What is an emergency tx options for caries?
- Caries excavation + sedative dressing
- Pulp therapy - Pulpotomy or Pulpectomy
- Drainage of pus
- Extraction (LA +- IHS or GA)
What age is IV sedation considered for?
12 years +
Young permanent dentition
Lower 6s rule for LA
- If a child doesn’t have lower 6s then can get away with infiltration rather than IDB
- If 6yrs or 6s erupting then IDB
Advantages of rubber dam
- Isolation + moisture control
- Retraction of gingivae + cheeks
- Damage to soft tissues
Are linings usually required in primary teeth?
No
Limited room for cavity prep
Anatomical features of pulp in primary teeth (2)
- Large
- Limited room for cavity prep - Pulp horns close to surface
- Pulp exposure easy
Anatomical features of roots in primary teeth (2)
Narrow mesio-distally, long + slender
Implications of a narrower root in primary teeth for root tx
Pulpectomy more difficult
When do you know to plan for pulp tx just off of your clinical examination?
When the marginal ridge has breakdown of more than 2/3rds of its length -> theres caries in the pulp (pulpotomy needed)
When do you know to plan for pulp tx just off of your radiographic examination?
Caries greater than or equal to 2/3rds into dentine - pulp involved
Pulp caps dont tend to work very well in the primary teeth so go to pulpotomy
