Management of gross caries

Question 1

how do we classify caries?

Answer 1

• e1 - outer 1/2 of enamel
• e2 - inner 1/2 of enamel
• d1 - outer 1/3 of dentine
• d2 - middle 1/3 of dentine
• d3 - inner 1/3 of dentine

Question 2

how does gross caries affect the bond strength to dentine?

Answer 2

if affected dentine is left in teeth with gross caries, the bond strength will not be as good as with sound dentine

Question 3

what is the ethos behind dealing with caries?

Answer 3

1. preserve healthy and remineralisable tissue
2. achieve a restorable seal - good bond
3. maintain pulpal health
4. maximise restoration success - cavity prep

Question 4

what is self-cleansing in terms of caries?

Answer 4

• need to consider if the carious cavity is able to be self-cleansed
• optimal choice as less invasive
• over time active caries can become arrested through proper OH, leading to healthier mucosa

Question 5

what is the process of partial caries removal?

Answer 5

1. access cavity
2. remove caries at periphery and ADJ
3. remove infected dentine and leave affected dentine
4. maximise cavity prep for longevity
5. place permanent restoration

Question 6

why may choose partial caries removal?

Answer 6

removing all the caries increases the risk of exposing the pulpal chamber which would then require RCT

Question 7

how does saliva, patients and the dental material affect the longevity of a tooth?

Answer 7

• saliva and moisture control affects the material bond to the tooth
• patient’s motivation and OH affect longevity of a restoration
• the dental material choice and its properties affect longevity

Question 8

what is the process of the stepwise technique of caries removal?

Answer 8

1. access cavity
2. remove caries at periphery and ADJ
3. remove infected dentine and leave affected dentine
4. maximise cavity prep for longevity
5. place a temporary restoration
6. revisit pt. after some time and see if caries has arrested then place permanent restoration

Question 9

what is a direct pulp cap and when would you place one?

Answer 9

a direct pulp cap is indicated when the pulpal chamber is exposed and a material is placed directly over the exposed pulp
* if the pulp is vital,
* if the pulp is not hyperaemic (not inflammed so does not bleed excessively), and
* if the tooth is not painful

Question 10

what are direct pulp cap materials?

Answer 10

• MTA - mineral trioxide aggregate
• RMGIC
• setting CaOH

Question 11

what is a pulpotomy and when would you carry one out?

Answer 11

a pulpotomy is when you remove part of the pulp by the crown and leave the rest intact usually in children’s teeth
* if the pulp is vital,
* if the pulp is not hyperaemic (not inflammed so does not bleed excessively), and
* if the tooth is not painful

Question 12

what is the difference between partial caries removal and stepwise caries removal?

Answer 12

• stepwise caries removal includes 2 visits and PCR includes 1 visit
• there is a 83% vitality of stepwise and a 96% vitality of PCR
• patients may be more unwilling to have stepwise caries removal e.g. dental anxiety