deep caries stuff Flashcards
defn of ECC
- 1 or more decayed (non cavitated or cavitated lesion), missing (due to caries) or filled tooth surfaces in any primary tooth in a child under the age of 6 (AAPD 2014)
defn of sECC
- 1 or more cavitated, missing or filled smooth surfaces in primary max anterior teeth from ages 3-5 OR
- any sign of smooth surface caries in a child <3 yo OR
- > = 4/5/6 dmfs in 3/4/5 yo
amount of toothpaste suitable
<3 yo: smear layer (0.1mg)
>= 3yo: pea size (0.25mg)
brushing advice for kids of different ages
0-6 months: no teeth, clean gums using cloth
6-8 months: brush teeth
5-7 yo: have manual dexterity to brush
breast feeding advice
<1 yo: breast milk has less sugar than formula so its protective
> 1 yo: able to eat other foods so breast milk actually increases caries risk
recommend:
0-6 months: exclusive breast feeding
6-12 months: continue along with intro of complementary foods
radiographic intervals for low, moderate and high risk based on AAPD
Low risk:
- primary dentition: 18 months
- permanent dentition: 24 months
Moderate risk:
12 months
High risk: 6 months
recall for DPC
3 months then 6 months take xray check pulp and continued root dev
indications for pulpotomy
- carious/mechanical/traumatic pulp exposure in primary tooth
- inflammation/infection deemed to be confined to coronal pulp and radicular pulp is deemed to be vital (able to control bleeding)
possible complications resulting from pulpotomy
- premature exfoliation
- pulpal calcification
- internal resorption
- enamel defects in succedaneous teeth eg Turner’s hypoplasia
what 3 medicaments can be used for vital pulpotomy of primary teeth
1) 1/5 dilution of formocresol
- decrease PA and furcation RL, decrease tissue irritation, decrease cytotoxicity
- but possible toxicity, diffusion into systemic system
- high success rate
2) ferric sulphate
- ferric ion complex seals cut blood vessels, giving hemostasis
- very acidic
- success rate similar to formocresol
3) mineral trioxide aggregate
- biocompatible, promote tissue healing
- expensive
- success rate equal/higher than formocresol
possible complications of pulpectomy in primary teeth
- possible flare up: to redo if there are s/s
- premature exfoliation
- over retention
- enamel defects in succadeneous teeth
criteria of root canal filling materials for primary tooth and what are some examples of materials used
criteria
- antiseptic
- adheres to canal walls
- does not shrink
- does not discolour teeth
- * resorbs with root of primary tooth
materials used:
- ZOE (resorbs slower than tooth but this is inconsequential)
- iodoform
- CaOH2 with iodoform (Vitapex)
method for pulpectomy of primary tooth
need to clean short of full length to prevent damage to underlying tooth germ
- baseline x ray and vitality tests
- normal endo just that establish WL 1-2mm short of apex
recall 1 week, 3 month, 6 month then annually until tooth exfoliates
indications for pulpect in primary tooth
- irreversible pulpitis/ pulp necrosis
- radicular pulp involved and infected
indications for cvek pulpotomy
- vital young permanent tooth
- small carious exposure <2mm in which pulp hemorrhage can be controlled in 1-2 mins
- traumatic exposure 4mm or less in which pulp hemorrhage controlled
aim of non vital pulp treatment for permanent tooth with open apex, indications and types of tx
aim: promote formation of hard tissue barrier at apex to allow placement of root filling
indications: irreversible pulpitis/ pulp necrosis
tx:
- revascularisation
- apexification
- apical plug
associated problems with pulp tx for immature permanent teeth
- lack of apical stop to condense GP
- “blunderbuss” apex which makes it difficult to obturate
- thin walls of immature root may fracture if apicectomy is attempted
technique for apexification
- access, WL 1-2mm short of radiographic apex
- canal debridement and irrigation w naocl
- fill canals to apex with non setting caoh2 paste
- place CP and seal cavity with TD
- repeat procedure 1 month later then 3 monthly until apical stop forms
- at 1 month, leave alone if no s/s; at 3 monthly recalls, keep replacing the caoh2
- once apical barrier forms about 6-18 months, fill canal using GP and sealer
- if walls are thin, fill with thermoplastic GP or MTA
technique for apical plug
- debride and put non setting caoh2
- at 1 week recall visit, remove caoh2 dressing from canal
- if no exudate, place MTA plug of 3-5mm thick at apical region
- place a wet sponge/ paper point and seal with TD for 1 week to let MTA set
- if no s/s , fill with thermoplastic GP and restore tooth
what is triple ab paste made of and what is it used for
made of metro, ciprofloxacin, minocycline
- minocycline causes the yellow discoloration
it is used to induce continued root development
- for teeth with poor prognosis where MTA plug or apexification may not work eg very short roots, large open apex or very thin walls
more recently, aim for revascularisation with double ab paste without minocycline and has similar success rates
why do WSL occur
and what is a WSL that appears without drying
because we lose minerals in enamel rods, which become smaller, creating space between them.
when we dry these spaces, they lose water and look opaque when we shine a light on them (looks different)
if a WSL occurs without drying, means that it is an arrested lesion. remineralization occurs on the surface but on the inside, there are still smaller, demineralised enamel rods with space in betwen them and water cant enter or exit this space and so it will appear white
AAPD CAT guidelines for radiogaphs
6 months for high risk patients
12 monthly for moderate risk
18 monthly for low risk, primary dentition patients
24 months for low risk, permanent dentition patient
but w3e think that this is excessive and we dont actually follow them
