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Adult Restorative > Gaining Access and Removal of Carious Tissue > Flashcards

Gaining Access and Removal of Carious Tissue Flashcards

1
Q

What are dental caries and name some characteristics of them

A
  • reversible but progressive disease
  • Initiated by bacteria in a plaque biofilm
  • Fermenting Carbohydrates
  • Producing Acid
  • Demineralsing Inorganic Component
  • Proteolytic destruction of organic component
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2
Q

Name some isolation techniques that can be used for dental procedures

A
  • Rubber dam
  • Cotton wool rolls
  • Dry guards
  • Aspiration
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3
Q

What probe/explorer should be used when examining carious regions

A

Round/bell-ended not sharp

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4
Q

What are the 3 main sites that caries develop at

A
  • Pits and fissures/cingulum
  • Approximal below contact area between teeth
  • Smooth surface
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5
Q

What scores can be given for caries severity

A

0-4

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6
Q

Describe the features and histology of a 0 ICDAS score caries

A

No/slight change in enamel translucency after prolonged (>5s) air drying

Histology - No enamel demineralisation or narrow zone opacity

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7
Q

Describe the features and histology of a 1 ICDAS score caries

A

Opacity/discolouration of enamel hardly visible on wet tooth, visible after air drying

Histology - enamel demineralisation outer 50%

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8
Q

Describe the features and histology of a 2 ICDAS score caries

A

Opacity/discolouration visible without air drying. No clinical cavitation visible

Histology - enamel demineralisation inner 50% through to outer 1/3 dentine

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9
Q

Describe the features and histology of a 3 ICDAS score caries

A

Localised breakdown in opaque/discoloured enamel +/- greyish discolouration/shadowing or underlying dentine

Histology - Demineralisation of middle to inner 1/3 dentine

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10
Q

Describe the features and histology of a 4 ICDAS score caries

A

Gross cavitation in opaque/discoloured enamel exposing underlying dentine

Histology - Demineralisation of inner 1/3 dentine towards pulp

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11
Q

What do different ICDAS approximate caries scores appear as on Bitewing Radiographs

A

0 - Sound on bitewing
1 - Radiolucency confined to enamel
2 - Radiolucency in enamel up to EDJ
3 - Radiolucency in enamel and outer half of dentine
4 - Radiolucency in enamel and reaching inner half of dentine

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12
Q

Describe the different classes of Black’s classification of caries

A 
1 - pits and fissures
2 - Posterior inter/aproximal caries
3 - Anterior inter/aproximal caries
4 - Incisal edge
5 - Cervical lesion/smooth surface caries
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13
Q

What kinds of caries are bitewings good and bad for

A
  • Good for inter proximal caries

- Less good for occlusal

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14
Q

What kinds of caries can dental panoramic homographs good for

A
  • Can show occlusal caries well

- Not routine for caries detection

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15
Q

What kind of caries can periodical radiographs be used for

A
  • Assessment of apical status

- Not routine for caries detection

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16
Q

IF there is a large caries lesion or there is suspect that the vitality of the tooth has been affected what special investigations are there

A

Sensibility testing - not vitality testing - tests nerve supply - usually related to blood supply and therefore vitality

  • Thermal testing - endofrost
  • Electronic pulp tester - 0-10 - strong nerve supply, higher values = higher nerve loss
  • Test cavity but this is last resort as it will heart patient
17
Q

What preventative management strategies are there for caries

A
  • OH
  • Fluoride
  • Diet advice
18
Q

What operative management strategies are there for caries

A
  • Gain access
  • Identify sound and carious tissue
  • Excavate caries
  • Modfiy cavity for restorative material
  • Restore
19
Q

What are the aims for enamel preparation when treating caries

A
  • Gain access to full extent of lesion
  • Remove demineralised/weakened and unsupported enamel
  • Create sound peripheral margin to seal with restorative material
20
Q

What equipment do we use in enamel preparation

A
  • Air-rotor - spin very fast and is dangerous
  • Diamond or Tungsten Carbide burs
  • (Hand chisels not used anymore)
21
Q

What do we need to know about the caries before we begin dentine removal

A
  1. Anatomical extent - lateral extent from EDL and overlying pulp
    - Histological depth - caries infected vs caries affected vs sound dentine
22
Q

What is caries infected dentine

A

Bacteria has progressed into dentine and has been demineralised and there’s been proteolytic dissolution of the collagen substructure - must be removed

23
Q

What is caries affected dentine

A

Where dentin has begun to be demineralised but collagen fibres are still largely there so you may be able to remineralise the dentine

24
Q

What do we do when removing caries in sequence

A
  1. Access through enamel
  2. Identify EDJ
  3. Identify caries-infected/affected/sound dentine
    - Clear EDJ
  4. Clear caries infected dentine
  5. Clear from periphery to the centre
  6. Decision when to leave caries affected dentine - as long as good seal, carbs can’t reach bacteria
25
Q

What equipment might we use for dentine removal

A
  • Slow handpiece (<5000rpm)
  • steel rose head burs
  • hand excavators
26
Q

Why do you want to use the largest bur that you can to get into the cavity for dentine removal

A
  • Small bur = uneven cavity surface
27
Q

Describe the differences between caries-infected, affected and sound dentine visually

A

Infected - Dark brown
Affected - Paler brown/translucent
Sound - Yellow/white

28
Q

Describe the differences between caries-infected, affected and sound dentine upon feeling it

A

Infected - soft/sticky
Affected - Sticky/flaky/scratchy
Sound - Scratchy

29
Q

Describe the differences between caries-infected, affected and sound dentine using dyes (not used a lot)

A

Fusayama dyes - can penetrate deeper into affected dentine leading to overpreparation

30
Q

What is retention

A

The property of a cavity to resist displacement of the restoration in the direction of its placement

31
Q

What is resistance

A

The property of the cavity to resist displacement of the restoration in any other direction

32
Q

What other methods of caries removal are there

A
  • Air abrasion
  • Cavitron - vibrating tips - tends to be used to remove calculus now
  • Carisolv - solution put into tooth, left in there, softens carious dentine but doesn’t affect sound dentine and then scoop out
  • Lasers

Adult Restorative (14 decks)

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