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Deep Caries Management Flashcards

1
Q

Why is it advantageous to maintain tooth vitality?

A
  • Cells in pulp assist prevention of bacterial invasion into pulp
  • Pulp can initiate immune response
  • Sensory function so issues with teeth more noticeable
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2
Q

Describe 3 caries removal strategies in deep cavities

A
  1. Non selective caries removal
  2. Selective caries removal
  3. Stepwise selective caries removal
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3
Q

Describe the major guiding principles of caries removal

A
  • Preserve non demineralised tissue
  • Peripheral seal
  • Avoid pain and discomfort
  • Maintain pulpal health
  • Maximise longevity of tooth
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4
Q

Describe the difference between regular selective caries removal and stepwise selective caries removal

A
  • Selective removal is removal of all caries to hard dentine at periphery and soft / firm dentine at depth of cavity
  • Stepwise is removal of soft dentine to allow for temporisation and reopen cavity in 6-12 months to complete removal to firm dentine
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5
Q

Name 5 management strategies for pulpal disease

A
  1. Indirect pulp cap
  2. Direct pulp cap
  3. Partial pulpotomy
  4. Full pulpotomy
  5. RCT (pulpectomy)
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6
Q

Describe indirect pulp capping as a treatment option

A
  • 1 stage complete caries removal to hard dentine
  • Soft dentine left on pulpal aspect if necessary to maintain dentine barrier
  • Placement of a biomaterial onto a thin layer of dentine
  • Restoration over the biomaterial
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7
Q

Name 3 materials which may be used to maintain pulp vitality in indirect pulp capping

A
  1. Calcium silicate cements
  2. Calcium hydroxide
  3. GIC
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8
Q

Describe ideal properties of biocompatible material used in indirect pulp capping

A
  • Radio-opaque
  • Good bacterial seal
  • Promotion of tertiary dentine formation
  • Bacteriosidal and bacteriostatic
  • Adhere to dentine and restorative material
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9
Q

Why is MTA not often used as a pulp capping material?

A

It has a very long setting time and may discolour teeth

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10
Q

What are 2 commonly used pulp capping materials?

A
  1. MTA

2. Biodentine

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11
Q

When can an indirect pulp cap be used?

A

When pulp has not been exposed

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12
Q

Name 2 reasons pulp exposure may occur

A
  1. Iatrogenic or traumatic damage (class I0

2. Deep caries (class II)

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13
Q

What is the major difference in terms of pulpal status between class I and class II pulpal exposure?

A
  • In class I exposure there is no deep caries and pulp is assumed to be normal
  • In class II exposure there is deep caries and pulp is assumed to be inflamed
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14
Q

Name 2 contraindications to direct pulp cap

A
  1. Irreversible pulpitis

2. Necrotic teeth

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15
Q

Describe 4 indications which must be met for direct pulp cap

A
  1. Pulp exposed
  2. Vital tooth with reversible pulpitis diagnosis
  3. Normal radiographic appearance
  4. Controlled haemorrhage (<5 minutes to haemostasis)
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16
Q

Name 2 calcium silicates

A
  1. Biodentine

2. MTA

17
Q

Name 4 things to think about for an optimal direct pulp capping outcome

A
  1. Exposure size may not be critical
  2. Haemorrhage control is essential
  3. Colour of bleeding may give indication of inflammation
  4. Elimination of intra oral bacteria
18
Q

Describe 2 ways it is possible to tell if a direct pulp capping procedure has succeeded

A
  1. Positive vitality test - Continue monitoring up to 4 years
  2. No clinical or radiographic signs or symptoms of irreversible pulpitis
19
Q

Why may partial pulpotomy be more appropriate in vital permanent teeth than full pulpotomy?

A
  • Inflammation is compartmentalized in infected pulps so can remove diseased tissue while retaining healthy tissue
  • Selectively remove pulp and dress wound to promote biological response to preserve vitality
20
Q

Name 4 indications for partial pulpotomy

A
  1. Exposure during caries removal
  2. Vital coronal pulp
  3. Reversible pulpitis
  4. Haemostasis not possible in under 5 minutes (DPC not possible)
21
Q

What is the difference in removal of pulp tissue between partial pulpotomy, complete pulpotomy and pulpectomy?

A

Partial pulpotomy - Small portion of coronal pulp removed
Complete pulpotomy - Removal of entire coronal pulp
Pulpectomy - Removal of all pulpal tissue including pulp in the roots

22
Q

Name 2 treatment options for necrotic pulp

A
  1. Pulpectomy

2. Extraction

23
Q

Name 6 contra indications to root canal treatment

A
  1. Inadequate access
  2. Poor oral hygeine
  3. Patient medical state / attitudes
  4. Tooth not restorable
  5. Advanced periodontal disease
  6. Root fracture

Conservation (27 decks)

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