Class III Restorations Flashcards
what indicates dentine caries
triangular shaped brown lesion
what is indicated by a brown spot lesion
arrested caries
what does active caries look like
gingivitis
what does a pulp polyp indicate
caries has reached pulp
how to detect caries
- visual inspection
- tactile inspection
- radiographs
- transillumination
- floss shreds when between teeth (but may also be due to restorations)
- orthodontic separators
- electrical conductance (variable)
- detection dyes (not very useful)
how to conduct visual inspection
tooth must be dry, lighted, magnified
look for variations, opacities, shadows, frank cavitation
what is used for tactile inspection
number 9 probe
briault probe
limitations of radiographs for caries
no indication of progression- if enamel caries is arrested and pt brushes well, no need to restore)
2D image
how to use orthodontic separators
put between teeth
leave for 1 week
use impression material
Blacks classification index
I: occlusal
II: occlusal and interproximal (posterior)
III: interproximal anterior
IV: interproximal and incisal edge anterior
V:crown-root
VI: cusp tip caries
ICDAS
0: sound tooth surface
1: first visual change in dry enamel
2: distinct change in wet enamel
3: localised enamel breakdown
4: dark shadow of dentine breakdown (with or without enamel breakdown)
5: distinct cavity with visible dentine
6: extensive distinct cavity with visible dentine
Practical classification of proximal caries
0: sound on bitewing
1: radiolucency confined to enamel
2: radiolucency in enamel up to enamel-dentine junction
3: radiolucency in enamel and outer half of dentine
4: radiolucency in enamel and reaching to inner half of dentine
Evans et al criteria for scoring bitewing radiographs
C0: no radiolucency recorded
C1: radiolucency in outer 1/2 of enamel
C2: radiolucency to inner 1/2 of enamel, maybe ADJ
C3: radiolucency just beyond ADJ
C4: radiolucency evident within outer 1/3 of dentine
C5: radiolucency extends to inner 1/3 of dentine, may reach pulp
what to do about each classification of Evans et al criteria for scoring bitewing radiographs
C1-3: topical fluoride and monitor
C4: consider in relation to pt caries risk status
(high –> restore, topical fluoride, monitor)
(low/medium –> restore if radiolucency fully in to 1/3 dentine or if separation confirms cavitation, other apply topical fluoride and monitor)
C5: restore, almost certain cavity breached ADJ
in what people are anterior caries common
(generally rarer than posterior caries)
- mouth breather
- exposed root surface
- substance abusers
- reduced manual dexterity
flowchart on principles in treatment planning for caries management
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4 factors in clinical decision making surrounding caries
diagnosis
prognosis
treatment options
preventive regime
how extensive is caries if there is a white spot lesion?
50% of enamel
define dental caries
localised destruction of dental hard tissues by acidic by-products of bacterial fermentation of dietary carbohydrates
site & stage classification of Caries
site 1: pits, fissures and enamel defects on occlusal or other smooth surface
site 2: interproximal surfaces in relation to contact areas of anterior and posterior teeth
site 3: cervical 1/3 of all teeth and any exposed root surfaces
stage 0: initial lesion eg white spot
stage 1: minimal surface cavitation, dentine involvement
stage 2: moderate dentine involvement
stage 3: enlarged beyond moderate eg cusp and incisal edges with breakdown
stage 4: extensive caries with loss of cusp or incisal edges
3 aims of emergency caries treatment
- relieve pain
- eliminate infection
- initial trauma treatment
4 factors in assessment of risk factors
- pathogenic factors
- protective factors
- demineralisation
- remineralisation
factors influencing risk status of pts
- carious lesions number, location, size, type
- previous caries
- diet content and freq
- saliva flow and function
- general health and medications
- plaque control
- plaque retentive factors
- manual dexterity
- tooth brushing technique and freq
when may quadrant excavation be indicated
when there’s a vast number of carious lesions
when may pulpal extirpation be indicated
to alleviate pain of pulpitis or acute periapical periodontitis –> stabilise tooth in short-term prior to definitive treatment following stabilisation of entire dentition
how to perform pulpal extirpation
- remove pulp
- initial canal instrumentation
- place non-setting calcium hydroxide
- restore with temp restoration
