Management of deep caries Flashcards
What are the three diagnoses regarding deep caries?
Reversible pulpitis, irreversible pulpitis and necrotic pulp.
What would you conduct on irreversible pulpitis and a necrotic tooth?
Irreversible pulpitis - RCT
Necrotic - RCT/extraction
How is reversible pulpitis classified?
Pain comes with stimulus and resolved quickly, not spontaneous and controlled with analgesics.
How is irreversible pulpitis diagnosed?
Severe, spontaneous pain, keeps patient up at night, not controlled with analgesics.
How is necrosis diagnosed?
May be in just one canal so can lead to mixed symptoms patient may not even have any pain.
How do we examine this?
Dry tooth, good light, palpate and percuss, probing, vitality tests.
All new patients need a bitewing but may need a periapical to see apex of the tooth
Can a brown spot lesion be reversed?
Yes until it has cavitated
How much of caries present can a radiograph show?
60-80% so caries will always be deeper and more extensive than on the X-ray.
What is deep caries?
At least 3/4 of the way to the pulp from the ADJ, high risk of pulpal exposure so tell patient.
How do we protect the pulp after removing caries?
Pulp capping with CaOH after a partial pulpotomy removing part of the pulp or just pulp capping.
What is stepwise excavation?
Remove soft dentine until affected dentine, leave it place CaOH and temporary filling and leave for some months. Remove the filling make sure caries has stopped and place permanent restoration.
DO THIS WHEN NEAR EXPOSURE
What is affected dentine?
not demineralised just discoloured
What is sclerotic dentine?
Protective for the pulp, no invasion of pulp, increases mineral content, more resistant to attack.
What is reactionary dentine?
Lays more dentine to be more resistant to attack
What colours indicate progress of caries?
Light yellow - actively progressing
Light brown - slowly
Dark - slowly/arrested
What do we place after pulp capping?
Biodentine - maintains pulpal vitality and stimulates formation of tertiary dentin
What is a pulpotomy?
Removing a layer or two of to the full orifice level. Can be partial or full.
What are the two types of direct pulp capping?
Class 1 - no preoperative presence of deep caries - iatrogenic/traumatic exposure
2 - preoperative presence of deep caries/pulp inflamed - has a worse prognosis
What is the series of stages you should go through in managing deep caries?
Direct pulp capping - partial pulpotomy - full/more pulpotomy/ RCT - stop when bleeding stops, use sodium hypochloride to help stop bleeding
What should the restoration be?
Seal the cavity, biocompatible and should have bioactive properties - induce pulp to repair
What can you use as pulp capping materials?
CaOH - stimulates pulp to repair but is porous and not the best handling
Calcium silicate cements - bioactive - MTA, biodentine, bioceramics
When do we review the restoration?
every 6-12 months up to 4 years, look or near to normal pulp, no pain and continuation of root formation.
