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5th yr- Finals- CSA revision > Management of deep caries > Flashcards

Management of deep caries Flashcards

1
Q

Outline the basic treatment plan for a patient with deep caries

A
  1. Provide emergency relief of pain
  2. Establish a healthy oral environment by doing a diet diary, giving oHI
  3. Corrective therapy to repair the effects of the disease
  4. Replace any missing teeth
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2
Q

What is caries

A

A disease of the hard tissues of the teeth characterised by the demineralisation and proteolytic destruction of the tissues by acids produced by bacteria in dental plaque feeding on dietary carbohydrates

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3
Q

What can you find within the pulp

A
  1. Odontoblasts
  2. Blood vessels
  3. Nerves
  4. Lymphatic system
  5. Stem cells
  6. Connective tissue
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4
Q

What do odontoblasts do

A

They produce dentine

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5
Q

Name the 2 main nerves found in the pulp

A
  1. A alpha
  2. C fibres
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6
Q

Describe A alpha nerves

A
  1. Are myelinated
  2. give a short sharp pain
  3. Fast response
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7
Q

Describe C fibres

A
  1. Unmyelinated
  2. Have a slow response time
  3. Dull throbbing ache
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8
Q

What type of tooth pain are alpha fibres responsible for

A

Tooth sensitivity

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9
Q

What can a build up bacteria cause

A
  1. Gingivitis
  2. Periodontitis
  3. Caries
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10
Q

Name the first stages of caries formation

A

White spot lesion

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11
Q

Are white spot lesions treatable

A

Yes they are the first sign of demineralisation
reversible with good oral hygiene

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12
Q

What can happen if a white spot lesion isn’t treated

A

Brown spot lesions can form

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13
Q

When do brown spot lesions form

A

Repeated demineralisation and remineralisation can lead to pigments from blood and food being inco operated into the enamel

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14
Q

What changes are going through the pulp when white and brown spot lesions form

A
  1. Arterial flow in the pulp increases
  2. Peritubular dentine gets laid down
  3. Affected odontoblasts produce tertiary dentine
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15
Q

What effect does increased arterial flow in the pulp have

A

Causes an increase in the rate of flow of dentinal tubular fluid
Fluid acts to flush out bacterial toxins
this fluid also carries anti bacterial components

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16
Q

What effect does peri tubular dentine getting laid down have on the tooth

A

Make the tubules narrower reducing the flow of fluid and also creating a barrier to bacteria

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17
Q

What happens to the pulp if a white spot lesion isn’t treated

A
  1. Further dentine is laid down to protect the pulp
  2. Cavitation may occur due to undermined enamel
  3. Caries can start to spread lateral at the ADJ
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18
Q

What is affected dentine

A

Demineralised dentine

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19
Q

What is infected dentine

A

Irreversible proteolytic destruction invasion of bacteria

20
Q

What happens once bacteria has reached the dentine

A

You get affected or infected dentine

21
Q

When removing dentine which type of dentine do we want to remove affected or infected?

A

Infected as affected can stay to protect the pulp

22
Q

What happens to the pulp as caries gets closer to it

A

The pulp gets inflamed and blood flow increases
A alpha fibres are also triggered

23
Q

What condition does pulp develop if caries get too close

A

Reversible pulpits

24
Q

How can you treat reversible pulpiitis

A

Remove the caries to allow the pulp to heal

25
Q

What happens if bacteria reaches the pulp

A

Irreversible pulpits

26
Q

What is irreversible pulpitis

A

When the inflammation level of the pulp becomes irreversible
removing caries will not preserve the vitality of the pulp but can treat painful tooth ache

27
Q

What is pulpal necrosis

A

Pulp death

28
Q

Name the last cell that dies in the pulp

A

C fibres

29
Q

What happens when the pulp dies

A

As the pulp dies there is no defence so the bacteria thrive on the dead tissues do the pulp chamber becomes infected

30
Q

How would you manage deep caries if you knew the pulp was vital

A

Treat the caries but try to keep the tooth alive

31
Q

If someone has deep caries and their pulp is dead how would you treat them?

A

Either carry out a root canal treatment or extract the tooth

32
Q

How do we check if pulp is alive or dead?

A
  1. Check symptoms
  2. Clinical appearance
  3. Special tests
  4. Radiographs
33
Q

What are the problems associated with sensitivity testing

A
  1. They are not 100% reliable
  2. Can get false negative or false positive
  3. For EPT the number doesn’t mean anything
34
Q

Describe the clinical appearance of a tooth that may be suffering from pulpal necrosis

A
  1. May have an abscess
  2. Tooth may appear darker
35
Q

What do you need to remember when looking at a radiograph for caries?

A
  1. Caries on a radiographie image may only show 60-80% of the actual caries present
  2. Caries will always be deeper, and more extensive than you think
  3. Deep caries is at least 3/4 of the way to the pulp from the ADJ so high risk of pulp exposure
36
Q

Name the two most common causes of pulp death

A
  1. Bacteria
  2. Dentists
37
Q

How can we reduce the risk of bacteria entering the pulp when we are carrying out treatment

A
  1. Use rubber dam
  2. Remove caries from the walls of the cavity first
  3. Never use high speed for removing caries
  4. On the floor of the cavity only use excavators, gently scape away any caries
  5. Leave affected dentine over the pulp
  6. Use RMGIC liner to seal the affected dentine
38
Q

Describe dental tubules if caries has extended near to the pulp

A

The dentinal tubules will be wide open

39
Q

What can we place onto the base of the cavity to protect the pulp

A

Create a seal before placing restoration with RMGIC liner (Fuji-liner)

40
Q

Can we place RMGIC liner on enamel

A

No only one dentine

41
Q

Name the three types of pulpal exposure

A

1, Iatrogenic- Dentist exposes the pulp during caries removal
2, Carious- Caries has reached the pulp
3, Traumatic- trauma causes fracture of the tooth involving the pulp

42
Q

What should you do if the size of you pulpal exposure is more than 2mm ?

A

Will have to do RCT

43
Q

What should you do if the size of you pulpal exposure is less than 2mm ?

A

Place calcium hydroxide Ca(OH)2 over the exposure and monitor

44
Q

What does calcium hydroxide do in the mouth

A
  1. It creates an alkaline environment which is highly toxic to bacteria
  2. Stimulates odontoblast to lay down new reparative dentine in the dentinal tubules
  3. Stimulates stem cells in the pulp tissue to create new odontoblast like cells to create dentine bridges across plural exposures
45
Q

When is a direct pulp cap most successful

A
  1. Absence of signs or clinical symptoms of pulpits before you start opening the the tooth
  2. If the tooth is isolated
  3. If the exposure is small
  4. If the exposure site is clean and untouched
46
Q

Give some clinical procedures and steps to avoid exposure

A
  1. Use a stepwise excavator
  2. Leave some affected dentine if you are close to the pulp
47
Q

Talk through the stepwise excavation technique

A
  1. Establish sound enamel margins and caries free ADJ
  2. Remove infected dentine and leave a layer of affected dentine
  3. Place layer of calcium hydroxide liner over very deep affected dentine
  4. If cavity cannot be restored in a single visit then restore the whole cavity with RMGIC and review in 6 months

5th yr- Finals- CSA revision (19 decks)

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