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Clinical Knowledge 2 > Management of Caries in Children > Flashcards

Management of Caries in Children Flashcards

1
Q

What is the first priority of dental care in children?

A

keep 6s and 7s free from both occlusal and approximal caries

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2
Q

What is the next priority for dental care in children?

A

reduce the risk of any caries in primary dentition resulting in pain or sepsis before the tooth exfoliates

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3
Q

What is the caries pattern in young permanent dentition?

A
  1. pits and fissues
  2. interproximal
  3. buccal/cervical/labial
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4
Q

In mixed dentition caries rates are higher in what first molars?

A

higher caries rate in lower 6s compared to upper 6s

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5
Q

Caries in incisors is usually an indication of …

A

uncontrolled caries

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6
Q

What pits/grooves are most likely to be affected in mixed dentition?

A
  • palatal upper 6s
  • palatal upper laterals
  • buccal lower 6s and 7s
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7
Q

What is the most affected tooth in the permanent dentition with caries?

A

first permanent molars

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8
Q

What is MIH ?

A

molar- incisor hypomineralisation
developmental condition that has to do with quality of enamel; enamel not mineralised sufficiently

enamel defects seen in molars and incisors

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9
Q

What is the consequence of MIH?

A
  • increased caries risk
  • can cause extensive breakdown of the 6s
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10
Q

What treatment should you consider for MIH of 6s with poor prognosis?

A

extraction
allow 7s to erupt into the space

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11
Q

How can you clinically assess the presence of caries in an examination?

A
  • visual- clean, dry tooth, good eyes, blunt probe (blunt probe to remove desposits from fissures)
  • orthoseperators
  • DIAGNOdent, cariesd detector dyes
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12
Q

What adjunctive diagnostic tools can be used to diagnose caries?

A
  • radiographs
  • sensibility tests- nerves
  • vitality testing- blood supply
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13
Q

It is possible for an exagerrated response to a sensibility test. True or false

A

true

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14
Q

What are the indications of PRRs?

A
  • microcavitation
  • shadowing under enamel
  • dentine caries visible radiographically
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15
Q

State an advantage and disadvantage of PRRs

A

Advantage:
* may prevent future restorations

Disadvantage:
* needs careful long term monitoring and repair of fissure seals

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16
Q

Indications for PRRs are decreasing to prevent the loss of healthy tooth tissue. What is a better alternative?

A

high quality fissure sealant

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17
Q

When is a GI sealant with the “press finger” technique indicated?

A

for uncooperative children
instances where moisture control is difficult to obtain

as opposed to resin sealant where moisture control is imperaative

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18
Q

Briefly outline the press finger technique using GI

A
  • place a small amount of GI on one finger tip and vaseline on the other
  • if possible wipe tooth with cotton wool roll
  • firmly apply finger tip with GI to the the tooth surface to be sealed
  • keep finger in place for 2 minutes
  • place 2nd finger in the mouth and rapidly switch fingers
  • cover GI with vaseline before moisture contamination
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19
Q

How can you manage an enamel-only aproximal lesion in permanent molars?

A
  • use orhtoseperators (take a week to work)
  • apply fluoride varnish and monitor carefully
  • inform patents and reinforce preventive advice
  • demonstrate floss

> > icon resin infiltration- microinvasive technology to fill demineralised enamel in one procedure?

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20
Q

What is an advantage and disadvantage to using fluoride vanish to manage enamel- only aproximal lesions?

A

Advantage:
avoid class 2 restoration- destruction of tooth tissue and difficult for child and clinician

Disadvantage:
not proven

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21
Q

When is step-wise caries removal and restoration and appropriate in children?

A

suitable for a permanent tooth with extensive lesion on occlusal or proximal surfaces

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22
Q

What is the aim of stepwise caries removal ?

A

avoid pulpal exposure by selectively removing caries from the cavity walls

allows reactionary dentine to be laid down before the removal of the rest of the infected dentine

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23
Q

How is the stepwise procedure carried out?

A
  • selective removal of caries from cavity walls
  • sealing the remaining caries with adhesive restoration
  • waiting 3-6 months for reactionary dentine to be laid down and then completing caries removal to hard dentine
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24
Q

When is the optimal time for extraction of the maxillary 6?

A

8.5-10

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25
Q

What is the consequence of sub-optimal extraction of maxillary 6s?

A

mesial rotation of 7s (mesial tilt)
distal drift of the 5s

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26
Q

What is the optimal time for extraction of the mandibular 6s?

A

loss before the optimum age of??

what is the optimum age?

8.5-10 years old

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27
Q

What is the consequence of extraction of mandibilar 6s before the optimum age?

A

5 drifts distally and rotates

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28
Q

What is the consequence of the extraction of mandibular 6s after the optimum age?

A

mesial tilting of the 7s

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29
Q

What age should you ideally extract permanent molars?

A

8.5 - 10 years old

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30
Q

What are the positive indicators for an extraction of first permanent molars?

A
  • 8.5 - 10 years old
  • furcation of second permanent molars
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31
Q

What is the benefit of extracting 6s when furcations are present on 7s?

A

allows 7s to erupt into acceptable occlusions with the 5s

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32
Q

As of 2017, ___% of 5 year old children in the NW have obvious decay experience

A

35%
highest of any other region in England

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33
Q

Why is caries progression in primary dentition rapid?

A
  • smaller tooth
  • larger pulp chambers
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34
Q

Primary teeth have broad contact areas. What is the consequence of this?

A

difficult to diagnose caries

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35
Q

There is early radicular pulp involvement in primary dentition as a result of caries. True or false

A

True

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36
Q

What are the characteristics of affected dentine?

A

firm
leathery

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37
Q

What does the pulp to in order to protect itself from bacterial ingress?

A

lays down reparative dentine

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38
Q

Outline reasons why pulpal involvment can occur quicly in primary dentition

A
  • small teeth, large pulp chambers
  • broad contact areas
  • irreversible pathological changes before pulp exposire
  • early radicular pulp involvement (pulp in the root canals)
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39
Q

How will caries arrest ?

A

if they are starved of carbohydrate

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40
Q

Caries progresses rapidly in primary teeth. True or false

A

true

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41
Q

Give an example of an effective method of starving carious lesions

A

preformed metal crown cememted with GI

provides a very effective seal and fluoride reservoir

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42
Q

State the most and least successful pulp capping techniques in children

A

most successful- indirect pulp capping
least sucessful- direct pulp capping

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43
Q

What type of teeth are less likely to respond to a vital pulpotomy? What should you consider if competent enough to try?

A

teeth with inflammed radicular pulp

consider a pulpectomy

(most likely to be an extraction)

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44
Q

When is a lateral oblique radiograph indicated in children?

A

if there is no cooperation for bitewings

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45
Q

How would you go about taking a lateral oblique radiograph?

A
  • neck is extended to bring the mandble away from the cervical spine
  • central ray is directed between the spine and the angle of the mandible
  • teeth and jaws adjacent to the casette are imaged
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46
Q

What is the main cause of early childhood caries/bottle caries?

A

sleeping with a bottle

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47
Q

What teeth are mainly affected by ECC?

A

maxillary anterior teeth
1st molars

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48
Q

Why is ECC less common in canines?

A

this is because they erupt later

49
Q

What is the management of ECC?

A
  • only water at night
  • fluoride varnish
  • switch from bottle to cup
  • fluoride toothpaste
50
Q

What are the principle strategies for management of caries in the primary dentition?

A
  • no caries removal, seal with crown using hall technique
  • no caries removal, fissure seal
  • selective caries removal and restoration- remove caries from walls, adequate depths of restorative material)
  • pulpotomy
51
Q

When should fissure sealants be used?

A

when caries is 1/3 into dentine

52
Q

Selective caries removal was previously known as…

A

partial caries removal

53
Q

List other options for managment of caries in primary dentition that are less supported by evidence

A
  • site specific prevention- no caries removal, active prevention
  • non-restorable caries control- no caries removal, modify cavity and make lesion cleansable, apply fluoride
  • complete caries removal and restoration
  • extractionr, or review with extraction if pain or infection develops
54
Q

When should dental amalgam not be used?

A
  • deciduous teeth
  • children under 15
  • pregnant/breastfeeding women excepted deemed to be strictly necessary by DP based on specific medical needs of the patient
55
Q

What are the disadvantages of complete caries removal and restoration?

A
  • risk of pulpal exposure
  • LA use
  • good moisture isolation required
56
Q

Why would you consider extractions for carious Ds?

A
  • this is because they are particularly small teeth
  • large pulps
  • thin enamel
  • so caries can affect/extend into the pulp quite quickly
  • if caries >2mm into dentine then consider extraction
57
Q

What are the advantages of selective caries removal and restoration?

A
  • reduced risk of pulpal exposure compared to complete caries removal and exposure
  • less need for LA
  • possible to remove caries with only hand instruments (ART)
58
Q

What does ART stand for?

A

atraumatic restorative technique

59
Q

What is a disadvantage of selective caries removal and restoration?

A

marginal seal must be effective
- must remove all caries on the margin

60
Q

What does ART involve?

A

removal of caries with hand instruments and filling with RMGIC

61
Q

What does the use of ART depend on?

A
  • removal of soft caries
  • good seal
  • fluoride release
62
Q

What methods can you use to restore primary incisors?

A
  • handbuilding
  • strip crowns
63
Q

What are strip crowns and how do you use them?

A
  • act as a template
  • they are filled with composite
  • place the filled strip crown on the etched and bonded tooth
64
Q

What techniques involve no caries removal but sealing of the caries with a restoration?

A
  • fissure sealant
  • halls technique
65
Q

What are the advantages of using a fissure sealant?

A
  • no LA required
  • no prep
  • no risk of pulpal exposure
  • no adjacent tooth damage
66
Q

When can preformed metal crowns be used?

A
  • hall crown technique
  • following pulp treatment
67
Q

What is present on the buccal surface of stainless steel crowns used for the halls technique?

A
  • the tooth in palmer notation
  • size of the stainless steel crown
68
Q

What way can you ensure that you choose the right crown?

A

callipers can be used to measure the mesial-distal size of the tooth you intend to restore

69
Q

What should you do on the first appointment when implementing the hall technique?

A

use othrodontic seperators to contacts

70
Q

What does the second appointment fot the hall technique entail?

A
  • no LA
  • clean food debris and plaque from cavity
  • cement pre-formed stainless steel crown with GI
  • warn child and parent of “high bite”/occlusal interference, child may need calpol
71
Q

What are the indications of the hall technique?

A
  • class I non cavitated/cavitated lesion if pt is unable to tolerate conventional treatment
  • class II lesions, cavitated or non cavitated
72
Q

What are the contraindications of the hall technique?

A
  • signs or symptoms of irreversible pulpitis
  • clinical signs of pulpal exposure
  • periradicular pathology
  • unrestorable teeth using conventional methods- not able to hold the crown
73
Q

You should never leave caries without preventive measures, restoring or extracting the tooth. True or false

A

true

74
Q

When modifying a cavity to become self-cleansing, what other preventive measures should you implement?

A
  • diet
  • plaque control- TBI
  • fluoride application
75
Q

What are some reasons to justify restoration of the primary teeth

A
  • easier to disrupt biofilm on restored teeth as opposed to broken down/cavitated teeth
  • resolve symptoms
  • limit the damage of caries
  • ensure adequete function
  • restore aesthetics
  • maintain natural space available for developming permanent dentition r
76
Q

What dental factors should you consider when managing caries in primary dentition?

A
  • signs and symptoms
  • tooth close to exfoliation- root development
  • hypodontia
  • early loss of other primary teeth
  • number of carious teeth
77
Q

What treatment shouldy you consider for a tooth with a carious lesion that is close to exfoliation and symptom free?

A
  • leave tooth
  • reinforce preventive advice
78
Q

What is hypodontia?

A

absence of permanent teeth

79
Q

What is the most common permanent tooth missing?

A

lower 5s
45, 35

80
Q

If there is no obvious biofilm present on the surface of carious teeth (with arrested caries), what treatment can you provide?

A
  • leave teeth
  • reinforce with preventive measures
81
Q

What treatment is indicated for in the presence of infection (e.g. sinus)?

A

extraction is likely to be indicated

82
Q

What are the treatment options for caries with pulp involvment for primary dentition?

A
  • indirect pulp cap
  • pulpotomy
  • pulpectomy
  • preformed metal crowns?
  • extraction
83
Q

What improved the success rates for pulpotomy and pulpectomy procedures?

A

placement of a pre-formed metal crown for a seal

84
Q

What is a pulpotomy?

A

minimally invasive treatment that involves the removal of the coronal pulp tissue

85
Q

Why are pulpectomies less likely to be indicated as a treatment for primary dentition?

A
  • rubber dam must be place as use of files
  • root development/exfoliation?; is there enough root for this treatment?
86
Q

What is a pulpectomy?

A
  • similar to a root canal
  • involve extirpation of the radicular pulp
87
Q

What are some contraindications for extractions when deciding whether to retain or extract teeth?

A
  • increased crowding, retaining decidious teeth can help improve this
  • the earlier a tooth is lost, the more space there is lost
88
Q

What is a balancing extraction?

A

extraction of contralateral tooth

extraction of the contralateral C (after one C extraction) to prevent centre line shift

89
Q

When are balancing extractions indicated?

A
  • one C is to be extracted due to dental disease
  • one C has exfoliated early to to eruption of the permanent later incisor
  • centre line shift developing following extraction of one D
90
Q

When are balancing extractions not usually indicated?

A
  • loss of primary incisors
  • loss of Ds unless centre line shift developing
  • loss of Es
91
Q

What are indications for an extraction in recurrent infections?

A
  • recurrent infection
  • prevent unnecessary use of analgesics and antibiotics
  • missing school
  • difficulty eating
  • damage to permanent successor
92
Q

When should you leave teeth with only preventive measures? Give examples of preventive measures

A
  • asymptomatic teeth close to exfoliation (>2/3 root resorption)
  • arrested caries with no sign of infection (clinical and radiographical)

Diet
Toothbrushing
Fluoride varnish

93
Q

What is the sequeale (consequence) of early loss of primary teeth?

A
  • space loss
  • crowding/impaction of permanent teeth
  • early or late eruption of permanent teeth depending on stage of development
  • damage to permanent teeth - rare- only if wrong extraction technique is used
94
Q

When are success rates high for indirect pulp capping?

A
  • when the pulp is not inflammed
  • coronal restoration is sealed
95
Q

Why are indirect pulp caps less successful when the pulp is inflammed?

A
  • calcium hydroxide appears to encourage internal resorption if the pulp is inflammed
96
Q

What is an effective alternative material for indirect pulp caps?

A

glass ionomer
however, no long term studies

97
Q

Pulpitis is _______ whilst an abscess is ________.

A

inflammation
infection

98
Q

Inflammation does not necessarily mean that there is infection. True or false

A

true

99
Q

Direct pulp capping has a low success rate regardless of the size of the exposure. Why is this?

A

internal resorption is more common when placed over inflammed tissue

100
Q

Why may you be better performing a pulpotomy as your first line treatment as opposed to direct pulp cap ?

A

this is because if pulp capping fails, subsequent pulp treatments are likely to fail

101
Q

What is a vital pulpotomy?

A

vital, inflammed tissue is removed from the pulp chamber
medicament is then placed over radicular pulp stumps
coronal restoration is placed

102
Q

What medicament is placed over pulp stumps in a vital pulpotomy? Give examples of more novel medicaments used in a vital pulpotomy

A

Ferric sulphate then ZOE
MTA
Biodentine

103
Q

The success of a vital pulpotomy is dependent on…

A

the extent of the pulpal inflammation

104
Q

Out of MTA and biodentine, which one has the better setting time?

A

biodentine

105
Q

Outline the steps required for a pulpotomy

A
  • assess need to save tooth
  • radiograph
  • LA
  • rubber dam (saliva control) however more common not to have rubber dam in pulpotomy
  • remove all caried from EDJ
  • remove all soggy dentine
  • remove the lid of pulp chamber completely
  • remove as much soft dentine as possible
  • remove pulp from pulp chamber using sharp large excavator or large round slow speed bur
  • gently compress pulp remnants with dry cotton pledget
  • bleeding should stop in a few minutes
  • place cotton wool pledget moistened with ferric sulpgate in pulp chamber
  • leave for 20 seconds and remove
  • pulp remnants will have black residue- dry gently
  • pack pulp chamber gently with ZOE cement to leave no voids
  • restore cavity with GI
106
Q

If bleeding does not stop after the removal of the coronal pulp in a pulpotomy, what is this an indication of?

A

radicular pulp inflammation

107
Q

When radicular pulp inflammation is suspected, what are the indicated treatment options?

A
  • pulpectomy
  • extraction **
108
Q

Give examples of pulpotomy medicaments

A
  • formocresol
  • calcium hydroxide
  • ledermix
  • ferric sulphate
  • biodentine
109
Q

Why is formocresol not gain regulatory approval for use today?

A

highly toxic

(fixes pulp tissue)

110
Q

What is formocresol composed of ?

A

formaldehyde and tricresol in glycerine and water

111
Q

CaOH is an effective medicament because…

A

it promoted biological healing

112
Q

What is ledermix composed of ?

A

1% triamcinolone
3% chlortetracyline

113
Q

What is the benefit of ledermix?

A
  • obtundant effect (lessens pain)
  • bactericidal
  • inhibits osteoclast activity
114
Q

What is the benefit of ferric sulphate?

A
  • haemostatic
  • high clinical success rate
  • less toxic than formocresol
115
Q

What are the indications of a pulpotomy?

A
  • preservation of the tooth is considered necesssary
  • large proximal lesiosn with involvement of marginal ridge- radiograph shows caries extends further than 2/3 of dentine
  • no radicular pulpitis

if there is marginal ridge involvement then it is also likely that there is pulpal involvement

116
Q

How can you rule out radicular pulpitis?

A
  • no history of spontaneous pain
  • bleeding easily controlled when pulp is removed
  • no abscess or fistula
117
Q

Outline the process of a pulpectomy?

A
  • pre-operative radiograph
  • acces pulp chambers as for pulpotomy
  • identify root canals
  • no working length radiograph is taken (cooperation??)
  • debride canals with hand files (rubber dam) staying within canal by 2mm
  • copious irrigation with CHX (?NaOCl?)
  • paper points to dry canal
  • fill canals with vitapex/ZnO/CaOH
  • restore with GI

zinc oxide eugenol and preformed metal crown

118
Q

What is vitapex composed of?

A
  • iodoform and calcium hydroxide paste
119
Q

What is substantivity in dentistry?

A

prolonged association between a material and a substrate

e.g. CHX more substantive than NaOCl

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