Exam 5- Class II comp, caries/pulp protection, Class III Flashcards
Anatomy of a Caries: Which layer am I?? Teeming with bacteria, Acts as Nidus* of S.Mutans and Lactobacillus, Soft or leathery…Often, but not always, heavily stained. MUST be removed
Outer Carious Dentin
Outer carious dentin: what does it feel like? Can we leave it in the tooth?
soft, leathery…MUST BE REMOVED!
Anatomy of a Caries: Which layer am I?? Zone of bacterial invasion, Infected with bacteria, Infected Dentin, Collagen is denatured, Caries detecting stains work well here, Color can vary from dark to dentin colored depending on the growth rate of the disease, Cannot be remineralized- must be removed
TURBID LAYER (THE WAR ZONE)
Which layer is the zone of bacterial invasion?
the TURBID layer
Anatomy of a Caries: Which layer am I?? Deepest layer-No bacteria present-Affected Dentin-Advancing front-De-mineralized but collagen cross-linking intact-Capable of remineralization-Can be stained due to porosity & bacterial products-not nec remove
Transparent layer
Which layer of caries can I leave there?
The transparent layer
Does infected dentin contain bacteria?
Yes
Infected/Affected Dentin: Unable to remineralize
Infected Dentin
Infected/Affected Dentin: Able to remineralize
Affected Dentin
Infected/Affected Dentin: Stains with caries detecting solutions
BOTH infected and affected (so caries detecting solution can make us too aggressive!
How long does tertiary dentin take to develop?
20-40 days (schedule patient and check on progress)
Which hormone is released by the still healthy pulp to produce tertiary dentin?
TGF-B1 (Transforming Growth Factor)
Caries is considered _______, it has times of remineralization and demineralization.
Episodic
What is the CRITICAL pH for demineralization?
5.5
Is it necessary to restore white spot lesions?
NO! (check w radiographs tho)
Caries to the ____ SHOULD BE RESTORED! While caries PAST the _____ MUST be restored.
DEJ…DEJ
What do you use to remove the DEEPEST areas of recurrent decay near the pulp?
Hand instruments!
What type of caries are light yellow, soft/moist, and rapidly progressing?
ACUTE caries
What type of caries are darker, leathery and firm, and slowly progressing?
Chronic caries yo
What type of caries are dark brown/black, are very firm (mineralized), are NOT active-so we do NOT remove it!
Sclerotic or Arrested Caries
What type of caries is common in older and immunecompromised patients?
Root Caries
There is more complex ______ when the caries is sub gingival.
Bacteria
WHAT DOES ICDAS stand for???
International Caries Detection and Assessment System
What level of ICDAS is this and What is the Tx? Sound tooth surface,no caries change after air drying (5 sec),No hypoplasia, wear, erosion and other non-caries phenomena.
0…sealant
What level of ICDAS is this and What is the Tx? First visual change in enamel seen only after air drying colored change “thin” limited to the confines of the pit and fissure area
1…sealant
What level of ICDAS is this and What is the Tx? Distinct visual change in enamel seen even when wet, white or colored, “wider” than the fissure/fossa
2…sealant
What level of ICDAS is this and What is the Tx? Localized enamel breakdown, no visible dentin or underlying shadow
discontinuity of surface enamel, widening of fissure
3….Sealant/ PRR
What level of ICDAS is this and What is the Tx? Underlying dark shadow from dentin,+/- localized enamel breakdown;
4….MIR (minimally invasive restoration)
Histology of a LEVEL 1 ICDAS lesion-Depth in the pit and fissure is ____% into the dentin (the rest in the outer enamel).
level 1.0=10% in dentin
Histology of a LEVEL 2 ICDAS lesion-depth of the pit and fissure was ____% into the outer dentin.
50%
Histology if a LEVEL 3 ICDAS lesion-depth is ___% in dentin
77%
Histology of a LEVEL 4 ICDAS lesion- depth is ___% in dentin
88%
What level of ICDAS is this and What is the Tx? Distinct cavity with visible dentin; Frank cavitation involving less than half of a tooth surface
5…MIR
Histology of a LEVEL 5 ICDAS lesion-depth is ___% into dentin.
100%
What level of ICDAS is this and What is the Tx? Extensive distinct cavity with dentin cavity is deep and wide involving more than half of the tooth surface
6…MIR
Histology of a LEVEL 5 ICDAS lesion- lesion depth is ____% into dentin.
100% (inner 1/3 of dentin)
What % are cavitated if the lesion is in the outer 1/2 enamel?
0%
What % are cavitated if the lesion is in the inner 1/2 of enamel?
10.8%
What % are cavitated if the lesion is in the outer 1/2 of dentin?
40.9%
What % are cavitated if the lesion is in the inner 1/2 of dentin?
100 freggin %
What wavelength of light does CariVu (by Dexis) use?
near Infra-Red (non-ionizing)
Requirements for an INDIRECT pulp cap… no Hx of _______ pain
spontaneous
Requirements for an INDIRECT pulp cap… _____ response to thermal stimuli
normal
Requirements for an INDIRECT pulp cap… a _____ pulp
VITAL
Requirements for an INDIRECT pulp cap… a common method for a youngster with incomplete ____ formation.
root
Requirements for an INDIRECT pulp cap…place a thin liner like _______ over a chemical cleansing treatment like ______.
GI….CHX
The DIRECT pulp cap…for a small pulp exposure (
The DIRECT pulp cap…only use if it was due to the ________ and not caries.
operator
The DIRECT pulp cap…tooth should be _____ (hemorrhage) and ________ when thermal tested.
VITAL…asymptomatic
What is the material used for a DRECT pulp cap?
CaOH
What is the material used for an INDIRECT pulp cap?
GI
Using CaOH has a 92% success rate when used after a _______ exposure vs a 33% success rate when used after a ______ exposure.
mechanical…carious
Removing DEEP caries…use a ______ spoon first, then move to the _____er ones.
LARGE…smaller
Normal Dentin Feel-as we move closer to the pulp the dentin normally gets ______.
softer
Carious dentin feel-initally very _____ but then gets harder due to _______. What do we do with this dentin?
soft…sclerosis…LEAVE the sclerotic dentin!
When using my spoon on deep decay, what is my guide to know when I’m done?
quality of the SHAVINGS
Which step do we do first? Liner or bevels/retention?
LINER!!
Which material am I?? Avantages- F- release, chemical bond
G.I.
Which material am I?? Disadv- acid soluble, poor wear resistance
G.I.
Which material am I?? Advantafes- VERY STRONG
Zinc Phosphate
Which material am I?? disadv-Mixing technique senstive
Zinc Phosphate
Which material am I?? advantage-‘sedative’ to the pulp
ZOE…zine oxide Eugenol
Which material am I?? dis-adv- inhibits the setting of composite
ZOE..zinc oxide eugenol
Which material am I?? Advantage- Basic pH, sterile, direct pulp cap technique
Calcium Hydroxide paste
Which material am I?? disadv-breaks down quickly
Calcium Hydroxide paste
Which material am I?? advantage- Basic pH, sterile, hydrophilic, direct pulp cap technique
MTA (mineral trioxide aggregate) ((Portland Cement))
Which material am I?? disadvantage- EXPENSIVE
MTA (mineral trioxide aggregate) why is Portland Cement expensive??
What is an example of CaOH paste?
Dycal
What goes on after the DyCal in a direct pulp cap exposure?
GI
