Gross caries

Question 1

when we are thinking about gross caries what classification are we talking about

Answer 1

D3 (clinically detectable lesions in dentine)

Question 2

What is the ethos behind dealing with gross caries

Answer 2

• preserve healthy and remineralisable tissue
• achieving a restorative seal
• maintaining pulpal health
• maximise restoration success
• carious tissue is removed to create conditions for long-lasting restorations

Question 3

what does it look like

Answer 3

• dark patches radiographically

- lots of decay visible

Question 4

How do you deal with caries

Answer 4

1. assess reason for caries
2. address oral environment
3. restore if necessary (tissue removal, restoration placement)

Question 5

what does caries look like which has arrested

Answer 5

dark and shiny

Question 6

what is the theory for partial caries removal

Answer 6

1. access cavity (you need to see)
2. remove caries at periphery and ADJ
3. Remove infected dentine (if you can)
4. maximise cavity for longevity

Question 7

what is the theory for stepwise technique

Answer 7

1. access cavity (you need to see)
2. remove caries at periphery and ADJ
3. Remove infected dentine (if you can)
4. maximise cavity for longevity

Question 8

what is the difference between partial caries removal and stepwise technique

Answer 8

stepwise= a few months later go back into cavity and restore with something more permanent

Question 9

when can you do direct pulp cap

Answer 9

If you expose the pulp and it is:

• vital
• not hyperaemic
• no pain or transient

Question 10

what materials are used for direct pulp cap

Answer 10

• MTA
• RMGI
• CaOH

Question 11

what material is not used for direct pulp cap and why

Answer 11

ledermix

- anything designed to kill pulp stay away from pulp cap

Question 12

when do you do a pulpotomy

Answer 12

If you expose the pulp and it is:

• vital
• not hyperaemic
• no pain or transient

n.b. not so proven for closed apices

Question 13

Is there much difference between using RMGI, GI/composite/ amalgam with partial caries removal

Answer 13

after it goes over a lining, probably not

Question 14

what is the lining material of choice

Answer 14

resin modified glass ionomer

Question 15

How would you do the stepwise technique

Answer 15

1. take out as much caries without exposing the pulp
   - RMGI over caries (GI?)
2. 6 months later, re-enter and remove hardened dentine (good seal should give this), restore properly

Question 16

what is better, partial caries removal or stepwise?

Answer 16

PCR better for vitality than stepwise (96% vs 83%)

failure rates are equal

(not a huge amount of difference between the two)

Question 17

Summarise this lecture

Answer 17

• For gross caries, you can leave a little but its not an excuse to not remove as much as you can.
• Need to keep vitality
• Do PCR over stepwise
• Pulpotomy can consider