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BDS2 - operative dentistry > gross caries > Flashcards

gross caries Flashcards

1
Q

what can caries either be classified as

A
  • D1 or D3
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2
Q

what is D1 caries

A
  • caries that only extends into the enamel
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3
Q

what is D3 caries

A
  • caries extending through the enamel and ADJ into the dentine where it extends laterally
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4
Q

how is caries like an iceberg

A
  • there are many more layers to it than what is seen at the surface
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5
Q

what are the stages of the caries iceberg

A
  • bottom = sub-clinical initial lesions in a dynamic state of progression/regression
  • lesions detectable only with additional diagnostic aids (FOTI and BW’s)
  • D1 = clinically detectable enamel lesions with intact surfaces
  • D2 = clinically detectable cavities limited to enamel
  • top = D3 = clinically detectable;e lesions in dentine
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6
Q

what is the bond strength to affected dentine like

A
  • not good
  • need a good bond to prevent leakage and secondary caries forming
  • why you need to remove all affected dentine
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7
Q

what do you want to happen when dealing with caries

A
  • preserve healthy and remineralised tissue
  • achieve a restorative seal
  • maintain pulpal health
  • maximise restoration success
  • carious tissue removed to create conditions for long-lasting restorations
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8
Q

why do you want to preserve healthy and remineralised tissue

A
  • all restorations will need replaced eventually and each time they do the cavity will be made bigger until tooth will just need extracted
  • want to prevent this happening for as long as possible
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9
Q

why do you want a restorative seal

A
  • to seal in bacteria and caries so that there is no more food available for bacteria to eat so they bacteria will die so then the caries will stop
  • want to kill all known germs by a good restorative seal
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10
Q

why do you want to maintain pulpal health

A
  • want to keep the pulp and nerve so that the tooth remain vital for as long as possible as if it is not vital then it is more complex to treat
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11
Q

how do you maximise restoration success

A
  • cavity needs to be best possible shape

- don’t remove any unnecessary tooth tissue

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12
Q

what would happen if all carious tissue wasn’t removed

A
  • restoration would fail and fall out and caries would progress
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13
Q

what is apple core caries

A
  • gross caries in the both central incisors mesially
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14
Q

what caries is worrying

A
  • caries at the gingival margin on smooth surface as this should be easy to clean
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15
Q

what is the ethos in dealing with caries

A
  • assess reason for caries
  • address oral environment
  • restore if necessary
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16
Q

what could be the reason for caries

A
  • don’t clean teeth well enough
  • lots of sugars eaten
  • high risk groups such as those having radiotherapy causing dry mouth
  • those taking medications that cause dry mouth
17
Q

why do you need to address oral environment

A
  • need to assess and address before treatment
  • stop patient needing so many restoration s
  • need to try and change the balance in the patients mouth to cause remineralisation = if not then restorations on patient wi;; become a continuous cycle where you will keep finding more after dealing with the previous
18
Q

what is self cleansing caries removal

A
  • optimal choice

- patients brushing better so that they manage to arrest the caries to stop it progressing

19
Q

where is root caries common

A
  • smooth buccal/labial surface in older patients
20
Q

how can you tell if the caries is arrested or not

A
  • if it looks shiny and is hard then the caries has been arrested and has stopped progressing
21
Q

what is the theory of partial caries removal

A
  • 1 = access cavity (need neat/wide access)
  • 2 = remove caries at periphery and ADJ
  • 3 = remove infected dentine (if you can)
  • 4 = maximise cavity for longevity (shape it well for the material)
22
Q

what are the 3 ways of caries removal

A
  • self-cleansing
  • partial caries removal
  • stepwise technique
23
Q

what is wrong with the theory of partial caries removal

A
  • it is designed by academics

- doesn’t take into account saliva or patients or different materials

24
Q

what is the theory of the stepwise technique

A
  • 1 = access cavity (you need to see)
  • 2 = remove caries at peripheral and ADJ
  • 3 = remove infected dentine of you can
  • 4 = maximise cavity for longevity
25
Q

what is different between partial caries removal and stepwise

A
  • theory of them are the same

- but with stepwise, you restore the tooth with something more permanent a few months after initial treatment

26
Q

when can you do a direct pulp cap

A
  • if you expose the pulp and it is = vital, not hyperaemic (little bleeding but not a lot) and there is no pain or transient
27
Q

what materials are used for direct pulp caps

A
  • MTA
  • RMGH
  • CaOH
28
Q

what materials cannot be used for direct pulp cap

A
  • ledermix (also called odontopaste)

- these can kill the pulp so won’t use

29
Q

when can you do a pulpotomy

A
  • if you expose the pulp and it is = vital, not hyperaemic and there is no pain or transient
30
Q

how do you do a pulpotomy

A
  • remove pulp from chamber and leave in root/canal

- works well for primary teeth, not so proven for closed apices

31
Q

what is the considers for partial caries removal for restorations

A
  • RMGI over caries - could be less irritable
  • use GI when saliva is in the way and cavity is sub gingival as then can’t use composite as its too wet without dam and can’t use amalgam is going to be seen
  • use amalgam when deep restorations in molars
32
Q

when do you review the restoration for partial caries removal

A
  • after few months review radiographically
33
Q

are the restoration considerations for first step of stepwise

A
  • initial restoration

- GI - place then this remove after few months

34
Q

what is done during the second step of stepwise technique

A
  • patient returns after 6 months
  • re-enter the cavity
  • remove the hardened dentine
  • restore with more permanent restoration
35
Q

what is better between PCR and stepwise

A
  • PCR = 1 visit, 96% vitality after 3 years
  • stepwise = 2 visits, 83% vitality after 3 years
  • PCR better
36
Q
  • can you leave some caries at the base of the cavity
A
  • yes, but that is not an excuse to not remove as much caries as you can
37
Q

when would you do stepwise

A
  • would only do if it would work better than PCR as have to access cavity twice which is not ideal
  • depends on the patient

BDS2 - operative dentistry (5 decks)

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