Gross Caries Flashcards
What is a d1 lesion
clinically detectable enamel lesions with intact surfaces
What is a d2 lesion
clinically detectable cavities limited to enamel
What is a d3 lesion
clinically detectable lesions in dentine
What is caries infected dentine
Caries-infected dentin is a superficial necrotic zone of vastly demineralized substrate with degenerated collagen fibrils that lost their cross-linking
What is caries affected dentine
Caries-affected dentin is considered a variation of reactionary dentin, formed in reaction to bland stimuli like caries, presenting small alterations in the cross-linking of its collagen fibrils
How does caries affected dentine contrast with sound dentine
By the mineralized precipitates within the tubules
composite bond isn’t great to affected dentine
Why do we want a good restorative seal
We want to seal in caries and bacteria so there is no way of them surviving
need to take away the source of food so they die
Why do we want to maintain the pulp
if it becomes non vital then it is a more complex treatment with a worse prognosis
Why do we want to remove carious tissues
to create conditions for long lasting resotrations. It will fall out otherwise and caries will progress
Why is gross caries on smooth surfaces worrying
due to easy accessibility
What are the 3 aims when dealing with caries
achieving a good restorative seal
maintaining pulpal health
maximise restoration success
What is the ethos behind dealing with caries
- assess reason for caries
- address oral environment
- restore if necessary
What do we look at when addressing oral environment
Looking at diet, risk of caries, etc
want to try and change the balance in the mouth to promote remineralisation
Why should you be cautious when prescribing high fluoride items
Doesn’t prevent decay - NEED TO BRUSH PROPERLY, fluoride may encourage laziness
Who is root caries often present in
older px
If you change the oral environment what can happen to a carious lesion
remineralise into an arrested carious lesion
What is the theory behind partial caries removal
access cavity
remove caries at periphery and adj
remove infected dentine
maximise cavity for longevity
What is the issue with partial caries removal
saliva makes it hard to see
not suitable for all materials
What is the theory for stepwise technique
- access cavity
- remove caries at periphery and ADJ
- remove infected dentine (if you can)
- maximize cavity for longevity
What makes stepwise technique different from partial caries removal
w Only diff is few months later is you go back into the cavity later and you restore is later with something more permanent
When do you do a direct pulp cap
if you expose the pulp and it is
- vital
- not hyperaemic
- no pain or transient
What are the materials used for a direct pulp cap
MTA
RMGI
CaOH
not ledermix
What can you do a pulpotomy
same conditions for direct pulp cap
What is pulpotomy not so proven for
closed apices
What material do you use for partial caries removal
depends on clinical situation
sub gingival means moisture contamination risk so not composite
don’t want amalgam for aesthetics in smooth surface
deep restoration for molars - amalgam is good
What is step 1 in stepwise caries removal
put RMGI over caries
What is step 2 in stepwise caries removal
6 months later reenter
remove hardened dentine
and restore
Which is better, partial caries removal or stepwise technique
both have same failure rate but PCR has higher vitality rate
not much difference - do the easiest done
