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BDS3 Paeds > Management of caries in Permanent teeth > Flashcards

Management of caries in Permanent teeth Flashcards

1
Q

What is the key recommendation for Management of caries in permanent teeth according to SDCEP guidlines?

A
  • Choose least invasive, most feasible management strategy
    Taking into account;
  • Site and extent of lesion
  • Risk of pain or infection
  • Preservation of tooth structure and health of dental pulp
  • Avoidance of treatment-induced anxiety
  • Lifetime prognosis of tooth
  • Orthodontic considerations
  • Occlusal development
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2
Q

What teeth are most vulnerable to decay in childhood?

A
  • Permanent molars
  • Most commonly develops in pits and fissures and proximal surface below contact point
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3
Q

What percentage of children will be affected by MIH appox?

A
  • 15%
  • If first permanent molar assessed as having poor life-time prognosis (caries or MIH) and 2nd molar not erupted yet - in childs best interest to extract first perm and allow 2nd to erupt in place
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4
Q

What are the Key points when Managing caries in permanent teeth in children?

A
  • Develop childs personal plan to prioritise keeping permanent teeth caries free
  • As first and second molars have high index of suspicion for caries, examine thoroughly focusing on pits and fissures and proximal surfaces below contact points
  • Establish what treatment options are appropriate and have child’s best interest at heart
  • Avoid iatrogenic damage to proximal surfaces of adjacent tooth when preparing cavities
  • For a dentinal lesion, choose technique that reduces likelihood of pulpal exposure and maintains structural integrity of tooth
  • When caries or MIH involves first perm molars consider prognosis and planned loss
  • If first perm molar requires restoration, consider temporising it until child’s cooperation sufficient for planned treatment
  • Discuss potential management options with child and parent/carer
  • Agree caries treatment plan
  • Consent from child or parent/carer
  • Carry out treatment
  • When restoring ensure same high standard as adults for longevity and minimise treatment required at later date
  • Dont leave infection intreated
  • Dont leave caries in perm teeth unmamanged
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5
Q

What age can dental amalgam be justified to use on a child?

A
  • 15years and above
  • Unless exceptional circumstances can be justified
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6
Q

What to do with first permanent molars with MIH?

A
  • If carious lesions not severe, not sensitive, don’t require restorations and unlikely to in future then provide enhanced prevention including fissure sealants and monitor
  • If good quality enamel with small defect that require restoration, use adhesive materials (indirect restorations extending onto sound enamel have better longevity)
  • If molars sensitive, use glass ionomer cement as fissure sealant
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7
Q

How do initial occlusal caries in permanent teeth present?

A

Visual diagnosis
- Teeth with noncavitated enamel carious lesions
- White spot lesions, discoloured or stained fissures

Radiographic diagnosis
- Lesion up to enamel-dentine junction or not visible

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8
Q

How to manage initial occlusal caries in permanent teeth?

A
  • Resin fissure sealant (if early then caries unlikely to progress)
  • Clinically review sealant for wear and check integrity at every recall visit with probe
  • If worn top it up
  • If not adherent to tooth, remove and replace
  • If lesion progressed adopt alternative management
  • Radiographically review depending on high or low caries risk
  • If tooth only partially erupted or child’s cooperation insufficient for resin fissure sealant or restoration consider glass ionomer material as temp sealant or restoration
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9
Q

How do moderate occlusal dentinal caries present?

A

Visual diagnosis
- Teeth with enamel cavitation and dentine shadow
- Or cavity with visible dentine

Radiographic diagnosis
- Lesions visible within dentine and may extend to middle third of dentine

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10
Q

How to manage moderate occlusal dentinal caries?

A
  • Selective caries removal or complete caries removal
  • Seal remaining fissures
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11
Q

How do extensive occlusal dentinal caries present in permanent teeth?

A

Visual diagnosis
- Teeth with cavitation (may be extensive) with visible dentine or widespread dentinal shadow

Radiographic diagnosis
- Lesions will extend into inner third of dentine but should still be a clear band of dentine that separated pulp and carious lesion

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12
Q

What is the aim of extensive dentinal occlusal caries?

A
  • To remove caries, avoiding pulpal exposure and provide long lasting restoration
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13
Q

How do you manage extensive occlusal dentinal caries?

A
  • Carry out stepwise caries removal
  • Temporise with obvious temporary material
  • Restore with permanent restoration after 6-12months
  • Seal remaining fissures
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14
Q

How do you avoid exposing dental pulp using a stepwise approach?

A
  • Stepwise approach used where selective caries removal carried out first step
  • After period long enough to allow reactionary dentine to be laid down by pulp in response to irritant stimulus of caries, the remaining decay removed
  • Permanent restoration not provided at first stage as lack of evidence to support it and some concern that wet dentine does not provide sound base for permanent restoration
  • Drying out of lesion may occur
  • If caries extended to pulp, RCT required and long term prognosis of tooth should be considered when treatment planning
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15
Q

How do you managed permanent posterior teeth with proximal caries?

A
  • Hard to diagnose visually and radiographic exam recommend at reg intervals based on caries risk assessment
  • On visible surfaces may be early enamel changes with white spot lesion only detectable upon drying the enamel or more established white spot lesion visible when wet
  • Orthodontic separators may be used to allow visualisation (need child to attend 5 days later)
  • Early diagnosis of lesions before they cavitate may allow them to be managed without operative intervention
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16
Q

How to initial proximal caries present on permanent teeth?

A

Visual diagnosis
- Teeth with white spot lesions or shadowing.
- Enamel intact but this my be hard to detect visually

Radiographic diagnosis
- Caries may be visible in outer third of dentine

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17
Q

What is the aim of detecting initial proximal caries in permanent teeth?

A
  • Use a preventative or minimally invasive approach to slow or arrest caries
  • Reduce risk of permanent molar or premolar requiring multi-surface restoration
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18
Q

How to manage initial proximal caries in permanent teeth?

A
  • Identify and arrest early enamel-only lesions paying attention to mesial surface of first permanent molars
  • Carry out site-specific prevention and monitor with bitewing radiographs
  • Ensure parent/carer fully aware of potential impact on child’s oral health
  • Or seal the lesion
19
Q

How to moderate proximal dentinal caries present?

A

Visual diagnosis
- Enamel cavitation but difficult to detect visually
- May be dentine shadowing

Radiographic diagnosis
- Lesion visible within dentine and may extend into outer or middle third of dentine

20
Q

What is the aim of moderate proximal caries detection?

A
  • Remove enough caries to provide long-lasting restoration
21
Q

How to manage moderate proximal dentinal caries in permanent teeth?

A
  • Carry out selective caries removal or complete caries removal to allow sufficient depth and surface area for restorative material
  • Seal remaining fissures
22
Q

How does extensive proximal dentinal caries present in permanent teeth?

A

Visual diagnosis
- Teeth with cavitation (may be extensive) with visible dentine or widespread dentinal shadow

Radiographic diagnosis
- Lesions may extend into inner third of dentine but don’t reach pulp

23
Q

What is aim of managing extensive proximal dentinal caries?

A
  • Remove caries, avoiding pulpal exposure and provide long-lasting restoration
24
Q

How to manage extensive proximal dentinal caries in permanent teeth?

A
  • Carry out step-wise caries removal
  • Temporise with obvious temporary material
  • Restore with permanent restoration after 6-12months
25
Q

What is the description of first permanent molars of poor prognosis?

A
  • Teeth with moderate to severe MIH, advanced or unrestorable caries, pulpitis with reversible or irreversible symptoms, dental infection, pulpal involvement radiographically or periradicular pathology
26
Q

What is the aim when managing first permanent molars of poor prognosis?

A
  • Ensure all relevant factors considered in decision on how to manage
  • If extraction is needed, the timing is chosen to enable second permanent molars to occupy their spaces to give optimal occlusion
27
Q

How to manage first permanent molars with poor prognosis?

A

Assess whether are of poor prognosis including those with;
- Advanced occlusal or proximal lesions or recurrent caries around existing restorations
- Hypomineralisation that has caused breakdown and cavitation of enamel
- Lingual decalcification with cavitation
- Pulpal signs or symptoms
- Dental infection

  • Take into account all 4 molars, child’s occlusion and stage of dental development (if 2nd erupted yet) and determine whether to request orthodontic assessment or make definitive treatment plan to extract or restore affected teeth
  • Obtain panoramic to determine whether all teeth are present, in good condition and well placed for eruption before extracting any 1st molars
  • If any of remaining teeth are hypodontia (missing), poorly placed, have signs of generalised developmental defect or skeletal discrepancy, refer for specialist paediatric dental or orthodontic opinion before extracting
  • If pain or infection and child can take LA consider only extracting affected tooth before referring for specialist opinion
  • In young children to keep first perm molars free from symptoms until they can be extracted consider temporising, poss using Hall technique approach
  • If in doubt at any stage, temporise teeth, continue prevention and refer child for specialist paediatric dental or orthodontic opinion
28
Q

Why can management of MIH teeth be complicated?

A
  • Children have heightened experience of hypersensitivity and affected first permanent molars can be difficult to anaesthetise
  • Diagnosis of MIH related hypersensitivity should help avoid potentially traumatic experiences with increased dental fear
29
Q

What age should you extract first permanent molars of poor prognosis?

A
  • 8-10 years to allow second permanent molars to erupt into acceptable occlusion with second premolars
30
Q

What factors might influence optimal outcome of first permanent molars with poor prognosis?

A
  • Bifurcation of 2nd perm molars seen to be forming usually around 8.5-10 years
  • 2nd premolars and third molars present on full mouth panoramic radiograph
  • Mild buccal segment crowding present
  • Class I incisor relationship present
31
Q

How do initial caries on permanent anterior teeth present?

A

Visual diagnosis
- Teeth with white spot lesions but no dentinal caries

32
Q

What is the aim for managing initial caries in anterior permanent teeth?

A
  • Use a preventative approach to slow or arrest caries and reduce risk of teeth requiring restoration
33
Q

How to manage initial caries in permanent anterior teeth?

A
  • Carry out site-specific prevention
  • Monitor at each recall visit and if lesion progressing adopt alternative strategy
34
Q

How do advanced caries in permanent anterior teeth present?

A

Visual diagnosis
- Teeth with cavitation or dentinal shadow

35
Q

What is the aim of managing advanced caries in permanent anterior teeth?

A
  • Remove caries and provide long lasting restoration
36
Q

How to manage advanced caries in permanent anterior teeth?

A
  • Completely remove caries and restore
  • Or consider selective caries removal and restore
37
Q

How does pulpitis with reversible symptoms present?

A
  • Pain provoked by cold/sweet stimulus and relieved when removed
  • Pain is intermittent and does not tend to affect child’s sleep
  • Pulp vital
38
Q

What is aim of managing pulpitis in child?

A
  • Remove pain and avoid disease progressing to pulpitis with irreversible symptoms
39
Q

How to manage pulpitis with reversible symptoms?

A
  • Carry out step-wise or complete caries removal, taking care to avoid pulp
  • Place restoration
  • May be necessary to provide temp dressing and review tooth before placing permanent restoration
40
Q

How does pulpitis with irreversible symptoms or dental abscess/periradicular periodontitis present?

A
  • Pain occur spontaneously but if provoked by stimulus its not relived when stimulus removed
  • Pain may last several hours and keep child awake at night
  • Pain may be dull and throbbing, worsened by heat and may be alleviated by cold
  • Affected tooth easily identifiable by patient and tender to percussion
  • May be clinical evidence of sinus, abscess or radiographic evidence of radicular pathology
41
Q

What is the aim of managing child with pulpitis with irreversible symptoms or dental abscess/periradicular periodontitis

A
  • Relieve pain and or source of infection
42
Q

How to manage a child with pulpitis with irreversible symptoms or dental abscess/periradicular periodontitis?

A
  • RCT or extract tooth
  • To relieve symptoms and allow time for long term treatment planning, consider RCT and dressing of root canals before deciding on extraction of permanent tooth
  • In some cases local measures to bring infection under control may be appropriate
43
Q

How do unrestorable permanent teeth present and what is the aim of managing them?

A
  • Much of crown of tooth destroyed by caries or has fractured off so restoration imposs
  • or dental pulp exposed and formed pulp polyp
  • Aim to avoid pain
44
Q

How to manage unrestorable permanent teeth?

A
  • Extract tooth (avoid extractions at child’s first visit if poss)
  • If child unable to cope with extraction (due to learning disability to where behavioural management techniques unsuccessful), temporise root, continue with prevention and refer child for specialise paediatric dental or orthodontic opinion

BDS3 Paeds (13 decks)

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