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CSA clinical aspects > CSA Management of deep caries > Flashcards

CSA Management of deep caries Flashcards

1
Q

What is caries?

A

• disease of hard tissue of teeth characterised by demineralisation and proteolytic destruction of tissues by acids produced by bacteria in dental plaque feeding on dietary carbohydrates

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2
Q

How does an early lesion present itself?

A
  • lesion may just reach ADJ
  • clinical appearance may be brown (if stain) or white
  • beginnings of a pulpal response:
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3
Q

What is the beginning of a pulpal response>

A

increased blood flow to the odontoblasts connected to the affected dentinal tubules

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4
Q

What is the main pulpal response?

A
  • increasing fluid flow in dentinal tubular fluid

• Toxins are flushed away from the pulp

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5
Q

What does fluid contain?

A

immunoglobulins

• fluid carries calcium & phosphate to form a barrier

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6
Q

What does Ca and Ph. do on walls of tubules?

A

settle and form barrier, then sclerose and close up

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7
Q

What happens when sclerosis occurs?

A

dead tract form

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8
Q

What is the dentine response to caries?

A

dentine under lesion made at higher rate >reactionary/secondary dentine

  • pulp chambers changes shape
  • area between lesion and pulp incr.
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9
Q

How can an advancing lesion spread?

A

laterally at ADJ, enamel prisms undermined

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10
Q

What happens if you don’t tackle problem of lesion?

A

• pulp keep trying to produce more dentine >reach point where pulp is inflamed
o Toxins moving down dentinal tubules faster than fluid flow can push them back out

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11
Q

What happens beyond a threshold of pulpal injury?

A

lesion becomes irreversible

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12
Q

what happens when pulp dies?

A

cells die, C fibres are last cells to die ahah

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13
Q

What are good for seeing if caries is deep?

A

x rays

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14
Q

How to check if tooth is alive or dead?

A 
if sensitive - alive
long lasting throbbing -dead
o	Pain history 
How long have the symptoms lasted?
o	Examination (clinical) 
o	Special tests
o	Radiographs
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15
Q

What are vitality tests?

A

• Electric pulp tests and ethyl chloride (cold)

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16
Q

What is wrong with vitality tests?

A

• get false positives >patient waiting for something to hurt

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17
Q

How to reach a diagnosis?

A

must decide if a tooth is alive &
o Healthy
o If its reversible pulpitis
o If its irreversible pulpitis

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18
Q

What is reversible pulpitis?

A
  • Short sharp pain with hot/cold,
  • Pain by movement of fluid in dentinal tubules
  • Pulp responding to stimulus
19
Q

What happens during reverse pulpitis ?

A

dentinal tubules exposed  odontoblastic processes being activated

20
Q

What is irreversible pulpitis?

A
  • Pulp inflamed
  • Hot/Cold may initiate pain, once there can last for 30+ mins
  • Pulp irreversibly damaged and not recover
21
Q

What to decide for irreversible pulpitis ?

A

if it’s worth trying to save
o Should we carry out RCT?
o Should we extract?

22
Q

is the tooth worth trying to save?

A
  • How much tooth tissue is remaining?
  • What does patient want to do with tooth?
  • Financial
  • Medical issues>Patient on anticoagulant
23
Q

What is a basic treatment plan for irreversible pulpitis ?

A
  1. Emergency relief of pain & discomfort
  2. Establish healthy oral enviro > Remove cause of disease
  3. Corrective therapy
24
Q

What is corrective therapy?

A

a. Permanent restorations
b. RSD
c. Endodontist treatment

25
Q

How do pulp die?

A

ingress of bacteria

26
Q

What does caries removal aim to do?

A

o remove bacterial threat
o W/o exposing pulp
o Provide restoration that seals cavity against further bacterial assault

27
Q

What is the management of reversible pulpitis?

A
  1. Assess depth of cavity with radiographs
  2. Use LA to numb patient
  3. Place rubber dam
  4. then explore with high speed bur
28
Q

How to see if caries has spread laterally?

A

drill laterally

29
Q

How do we remove affected dentine?

A

slow speed bur and excavator

30
Q

What to check before restoration placement during revers. pulpitis management?

A

removed all infected dentine
o take out affected dentine
o always check ADJ to see if clean

31
Q

How to protect pulp?

A

• create seal before placing restoration with GIC liner (Fuji-liner)
o Do before placing composite/amalgam

32
Q

What is Stepwise excavation technique ?

A
  • Caries removed until feel we are near pulp
  • fill cavity with GIC
  • re evaluate 6 months later and replace restorations if still symptom free and vital
33
Q

How to identify pulpal exposure ?

A
  • Red ring

* May be mistaken by bleeding of gum/red coloured caries

34
Q

for pulpal exposure management, what to do if tooth has symptoms before starting?

A

RCT

35
Q

for pulpal exposure management, what to do if tooth asymptomatic before starting?

A

o Place rubber dam if not already placed
o Wash cavity
o Dry with cotton wool pledget  this tries to stop bleeding

36
Q

What if dentine around pulpal exposure is carious ?

A

RCT

37
Q

What if size of pulpal exposure if >2mm?

A

RCT

38
Q

What if size of pulpal exposure if NOT >2mm?

A

 Place setting calcium hydroxide over exposure and dress with GIC

39
Q

What calcium hydroxide is used in management of deep carious lesion ?

A

o Setting – Dycal, MTA (Mineral trioxide aggregate), Biodentine
o Non- setting – Hypocal or calsept

40
Q

What are the properties of calcium hydroxide ?

A

o Very high pH

o Creates alkaline environment- bactericidal (high toxicity to bacteria)

41
Q

What does calcium hydroxide stimulate?

A
  • odontoblasts to lay down new reparative dentine in dentinal tubules
    o stem cells in pulp tissue to create new odontoblast-like cells to create dentine bridges across pulpal exposure
42
Q

What is direct pulp capping?

A

placing calcium hydroxide

43
Q

when is direct pulp capping most successful?

A

o no symptoms of pulpitis before tooth opened
o Normal vitality responsef
Younger patients w/o previous history of restorative work about tooth in question
o rubber dam placed and no saliva contamination
o exposure is small (under 2mm)
o Exposure is not probed, or blown dry
o Haemorrhage ceases within short time 30-60s & minimal bleeding

44
Q

What can pulp exposure being blown dry cause?

A

damages pulp tissue directly

CSA clinical aspects (13 decks)

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