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Paediatrics > Management of Caries in Primary Teeth > Flashcards

Management of Caries in Primary Teeth Flashcards

1
Q

What management strategies are there for initial occlusal caries in a primary molar?

A

First line treatment- fissure seal the caries.
- Try resin but if the patient is pre-co-operative, then can use GI.

If child unable to tolerate sealant- provide hall crown.

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2
Q

If a PRR is placed, what things should be reviewed at each recall visit?

A

Visually inspect the sealant
Physically inspect with a probe
Radiographic inspection at the interval determined by the caries risk assessment

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3
Q

What management strategies are there for advanced occlusal caries in a primary molar?

A

Must be a clear band of dentine between caries and pulp.

First choice is selective caries removal and restore with composite, RMGI, composer of GI.

If the child is not co-operative enough, then seal with hall crown.

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4
Q

Why should complete caries not be done in a primary molar with advanced occlusal caries?

A

Significantly higher risk of pulp exposure compared with selective caries removal.

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5
Q

What are the management options for initial proximal caries?

A

Site specific prevention at each recall visit and if the lesion is progressing, adopt an alternative management strategy.

Could also place a sealant/resin infiltration.

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6
Q

What are the management options for advanced proximal caries in a primary molar?

A

Gold standard is hall crown.

Selective caries removal and restore with composite, RMGI, compomer or GI.

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7
Q

If there is no clear band of dentine between the caries and the dental pulp, what treatment is required?

A

Likely that the caries has encroached on the dental pulp and pulpotomy is indicated.

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8
Q

What are the management options for a primary anterior tooth with initial caries?

A

Carry out site specific prevention
- monitor at each recap visit and continue until the caries has arrested.

If lesion is progressing, adopt an alternative management strategy.

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9
Q

What are the management options for a primary anterior tooth with advanced caries?

A

Selective caries removal and restore with composite, RMGI, compomer or GI.

Full caries removal or non-restorative cavity control.

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10
Q

What are the management options for a primary tooth with reversible pulpitis?

A

Hall crown

If occlusal lesion then do elective caries removal.

If tooth is close to exfoliation then can place a dressing.

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11
Q

What are the management options for a primary tooth with irreversible pulpitis?

A

Aim- to relieve pain

Initial visit- remove gross debris from cavity, place corticosteroid dressing and temporary dressing over the top.

If co-operation permits, then access pulp chamber, place corticosteroid paste into the chamber and temporary dress.

Prescribe pain relief
- then Pulpotomy or extract the tooth.

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12
Q

What are the management options for a primary tooth with a periradicular periodontitis or abscess?

A

Extract or refer for specialist treatment.

If tooth is restorable- may be able to do a pulpectomy.

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13
Q

What should you do in a tooth where there are is no clear band of dentine seen between the carious lesion and the pulp?

A

If no pulpal signs and symptoms and uncertain about whether clear band of dentine is visible or not- hall crown.

If pulpal symptoms evident- carry out pulpotomy.

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14
Q

If tooth is carious but close to exfoliation, what would you do?

A

Site-specific prevention or non-restorative cavity control.

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15
Q

What would you do in primary teeth with arrested caries?

A

Site specific prevention or non-restorative cavity control.

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16
Q

What is site-specific prevention?

A

Suitable for enamel lesions, white spot lesions, arrested caries in a tooth that is close to exfoliation.

Involves showing the child and the parent the carious lesion ad explaining their role in preventing it from getting any worse or becoming active again.

OHI specifically for that tooth, fluoride varnish application 4 times per year and diet advice.

Monitor the lesion at every recall visit- review within 3 months of initial treatment.
- plaque score.
- If the patient cannot keep the area clean, then consider another approach.

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17
Q

What is the aim of a hall crown?

A

To seal in all caries so that the environment of the plaque biofilm is altered efficiently to slow or even arrest caries progression.

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18
Q

What factors would influence whether or not you provide a hall crown?

A

Must be no signs of symptoms of pulpal involvement
Clear band of dentine between caries and pulp
Enough tooth tissue present to retain the crown
Co-operation of the child
Child and parent on board with the aesthetics

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19
Q

Under what circumstances might you place a Hall crown?

A

Advanced occlusal or proximal caries in a molar tooth.

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20
Q

Describe the Hall technique.

A

Ensure the child is sitting upright.

Assess whether separators are required- if not enough space or broad contact point, then place separator messily and distally to the tooth and arrange appointment 3-5 days later for removal.

Use sticky sticks to ensure crown isn’t lost in the airway and can use gauze to protect the airway as well.

Select the correct size of crown- do not fully seat it.

Place GI luting cement into the crown.

Seat the crown over the tooth- can be pushed down by the operator or child can bite down on a cotton wool roll to fully seat.

Ask the child to open- check it is fully seated evenly throughout the tooth and has gone down below the contacts.

Get the child to bite down hard again.

Remove excess cement and floss contacts.

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21
Q

What post-op instructions are given after a hall crown is placed?

A

May feel quite tight around the gums- this will ease in a few days.

May notice that the gum looks quite white- this is normal and will relieve after a few days.

May feel like the bite has changed- this will also ease within a few days.

22
Q

Under what circumstances would you do no caries removal and give a fissure sealant?

A

Initial lesions occlusal or proximal in primary molars
Initial lesions occlusal or proximal in permanent molars

23
Q

How would you separate the tooth for a proximal fissure sealant?

A

Ortho separators
Wooden wedges

24
Q

What is an alternative technique for initial proximal lesions?

A

Use resin infiltration

Involve isolating the tooth, drying it, etch, apply ethanol to dry out the pores and apply ICON resin which infiltrates into the pores.

25
Q

Why might you opt for selective caries removal and restoration?

A

Advanced occlusal or proximal lesions in a primary tooth.
Advanced lesion anteriorly in primary tooth.
Advanced lesion anteriorly in permanent tooth
Permanent tooth with moderate occlusal or proximal lesion.

26
Q

Why is selective caries removal recommended instead of complete caries removal?

A

Reduces the risk of pulpal exposure.

Reduces the time taken for cavity preparation.

27
Q

What are the differences between selective caries removal and complete caries removal?

A

Probably don’t need LA if you are doing a primary tooth, unless you are cutting sound dentine.

Hand excavation may be good for primary teeth to remove caries.

If occlusal lesion- restore with plastic restoration. If multi-surface lesions- place a Hall crown.

28
Q

Describe the technique of selective caries removal and restoration.

A

Gain access to carious tissue using high speed handpiece- may need LA.

Remove superficial caries using excavator or slow speed until there is no obvious caries left at the ADJ.

Clear the cavity walls to hard “scratchy” dentine to provide a good surface for bonding.

Pulpally- remove carious tissue to give adequate depth for durable restoration without causing a pulp exposure.

Remove any undermined or unsupported enamel.

Place restoration.

Fissure seal any unprotected areas of tooth.

Review as per radiograph risk level.

29
Q

What is Atraumatic restorative technique?

A

Aims to prepare a cavity and carry out a restoration with minimal stress to the child.

30
Q

What is used in the Atraumatic restorative technique?

A

Do not use powered instruments.

Use excavators to remove caries.
Can use enamel chisels or dental hatchet into the breach in enamel/cavity to remove unsupported enamel to gain access to the carious dentine.

Remove caries with excavator.

Dry cavity with cotton wool pledget.

Isolate tooth- cotton wool rolls, gauz, dry guards.

Use high viscosity GI to restore the cavity.
- rub petroleum jelly over it.

Tell patient to avoid eating for an hour after treatment.

31
Q

When should Atraumatic restorative technique be used?

A

Primary tooth with a single surface lesion.

32
Q

What is non-restorative cavity control?

A

Aims to reduce the cariogenic potential of the lesion by altering the environment of the plaque biofilm overlying the carious lesion through bushing and dietary advice.

33
Q

What do you do in non-restorative cavity control?

A

Show lesions to child and parent.

Make them self-cleansable if required.

Ensure the patient and parent know their responsibilities for this.

Diet advice
OHI specific for those lesions
Apply FV 4 times per year

Keep a record of site and extent of the lesion to enable monitoring and alteration of treatment plan if the lesion does not arrest.

Review the lesion after 3 months
- plaque score
- if not arrested- consider extraction if unrestorable.
- If restorable- may consider atraumatic restorative technique, Hall crown.

34
Q

Why might you want to do a pulpotomy in a primary tooth?

A

Irreversible pulpitis
No clear band of dentine between caries and the pulp.
Marginal ridge destroyed.

35
Q

What are the steps involved in a pulpotomy of a primary tooth?

A

Give LA and apply rubber dam.

Remove caries and cut large access cavity using high speed- ensure entire roof of the chamber is cleared.

Remove contents of the pulp chamber using slow-speed Han piece or excavator.

Thoroughly irrigate the chamber with 3 in 1.

Assess bleeding from the pulp- should be bright red.

Identify entrances to root canals.

Place cotton wool pledget soaked in Ferric Sulphate over canals for 20 seconds.
- should have minimal oozing after this- haemostasis should occur within 3 minutes.
- If bleeding doesn’t stop or is of a crimson dark colour- consider pulpectomy or XLA.

Place Calcium hydroxide or ZOE over the pulp stumps.
Place GI over the top and restore with PMC.

36
Q

How often should pulpotomised teeth be reviewed radiographically?

A

Annually.

37
Q

What are the indications for pulp therapy in a primary tooth?

A

Child is less than 9 years old.
Co-operative
Medical history precludes extraction
Missing permanent successor
Necessary to maintain the tooth- space maintainer.

38
Q

What are the contraindications for pulp therapy in a primary tooth?

A

Medical history contraindicated- heart conditions.
Older than 9 years old
Pre-co operative
Poor dental attendance
Multiple grossly caries teeth
Spreading infection
Severe recurrent pain
Advanced root resorption
Cellulitis

39
Q

What is the general rule with regards to marginal ridge breakdown?

A

If greater than 2/3 marginal ridge breakdown- almost always pulp involvement.

40
Q

What is the aim of a pulpotomy?

A

Stop bleeding
Disinfection
Preserve vital pulp apically

41
Q

If a primary tooth has become non-vital and is showing signs of peri-radicular periodontitis/abscess, what would you do?

A

Achieve drainage or XLA.

Excavate caries- may achieve drainage through this way.
- if no drainage achieved- corticosteroid dressing (ledermix) can be placed and temporary material on top (GI).

Do not incise and drain the swelling.

42
Q

When would a pulpectomy be indicated?

A

Non-vital tooth that does not achieve haemostasis during a pulpotomy.

Pulp necrosis and furcation involvement.

43
Q

Describe the procedure of a primary molar pulpectomy.

A

Give LA
Apply dental dam
Access using high speed bur and access the pulp chamber
Coronal pulp extirpation using slow speed round bur
Root canal preparation- 2mm short of apex.
Obturate with CaOH iodoform paste (vitapex).
GIC core
SSC to restore.

44
Q

What would be considered a clinical failure of pulp therapy?

A

Pain
Pathological mobility
Fistula/chronic sinus

Review clinically 6 monthly

45
Q

What would be a radiographic failure of pulp therapy?

A

Increased radiolucency
External/internal resorption
Furcation bone loss.

Review radiographically 12-18 months

46
Q

When should antibiotics be considered?

A

Only if there are systemic signs of infection or if the child is medically compromised.

47
Q

Under what circumstances might you want to do a PFMC in a permanent molar?

A

In a tooth with poor prognosis that is not at the ideal time for extraction.

48
Q

What is the appropriate time to remove first permanent lower molars?

A

Calcification of the bifurcation of lower 7’s.
8’s present and in a good position
Mild buccal segment crowding
Class I incisor relationship

49
Q

During placement of a PFMC, what can you do to protect the airway?

A

Sit the patient upright
Gauze
Dental dam
Sticky sticks

50
Q

After pulpotomy or pulpectomy, what is a PFMC the restoration of choice?

A

High longevity restoration
Good seal
Removed contents of pulpnchamber so dentinal tubules will be very dry- if composite or GI was to be placed, it would be prone to fracture.

Paediatrics (13 decks)

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