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BDS2 Clinical > Management of Gross Caries > Flashcards

Management of Gross Caries Flashcards

1
Q

D1

A

caries limited to enamel

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2
Q

D3

A

caries into dentine

- after ADJ not go to point of triangle - goes wide

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3
Q

describe the iceberg of caries experience from peak to base

A

Clinically decantable lesions in dentine D3
- Most epidemiological data dependent on

PLUS clinically detectable ‘cavities’ limited to enamel D2
- Since most used fluoridated toothpaste, less seen now

PLUS clinically detectable enamel lesions with intact surfaces D1

PLUS lesions detectable only with additional diagnostic aids (e.g. FOTI and BWs)

PLUS sub-clinical initial lesions in a dynamic state of progression and regression

  • Never caries free
  • Constant de and re mineralisation
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4
Q

what infected dentine

A

the irreversible demineralized and denatured layer with bacterial invasion

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5
Q

what is affected dentine

A

dentin is partially demineralized (leathery\softer than normal), collagen is not denatured and contains minimal to no bacteria

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6
Q

what has the stronger bond strength affected or infected dentine

A

Bond isn’t so good to affected dentine

Ensure on caries removal good solid bond so restoration doesn’t leak

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7
Q

describe key ethos behind dealing with caries

A

preserve healthy and remineralisable tissue

like helter skelter

  • Top: healthy tooth
  • Slide down - bucket: tooth extracted
Aim to keep tooth high 
- As soon as restore tooth - need replaced inevitably 
- Bigger 
Need replaced quicker
- Need another – bigger
Hit pulp - Non vital 
RCT, Then crown 
Fractured post and tooth
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8
Q

describe the 5 points in the ethos behind dealing with caaries

A

preserve healthy and remineralisable tissue

achieve a restorative seal
- Caries is bacteriological process, Seal in the caries and bacteria so no way of them surviving. Bacteria will die as no food (kill germs)

maintaining pulpal health
- keep tooth alive

maximise restoration success

  • best possible shape for retention
  • not extension for prevention technique
  • Material bonds so less need

carious tissue is removed to create conditions for long lasting restorations
- dont remove means tooth will fall out and caries progress

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9
Q

appearance of gross caries

A

Apple cores
- Older patients on lower incisors and uppers

Radiotherapy pt
- Caries at gingival margin on smooth surface - concerning should be easy to clean

More seen now Underneath canine 13

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10
Q

why is achieving a restorative seal key to dealing with caries

A

Caries is bacteriological process, Seal in the caries and bacteria so no way of them surviving. Bacteria will die as no food (kill germs)

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11
Q

why is maintaining pulpal health key to dealing with caries

A

keep tooth alive

as soon as non-vital more complex Tx and poorer prognosis

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12
Q

what are the 3 stages of dealing with caries

A

Assess reason for caries

Address oral environment

Restore if necessary

  • Tissue removal
  • Restoration placement
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13
Q

why do you need to assess the reason for caries

A

Need numerous fillings
- By the end find more to do, Never ending treadmill of restoring

Need to assess reason

  • Poor cleaning OH
  • Sugar diet
  • High risk of caries
  • Radiotherapy/medications - dry mouth

assess and address before restorations

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14
Q

why do you need to address the reason for caries prior to restorations

A

Reduce amount of restorations needed in future

Poor saliva or high sugar intake need to change balance in mouth to promote remineralisation

Teach good technique for brushing rather than just prescribing high Fluoride

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15
Q

4 reasons for caries

A
  • Poor cleaning OH
  • Sugar diet
  • High risk of caries
  • Radiotherapy/medications - dry mouth
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16
Q

what is the optimal choice for caries removal

A

self cleansing

17
Q

root caries

A

caries (type V)
- Around root on smooth buccal/labial surface

  • Oral hygiene not satisfactory
  • On medication etc

Need to teach OH to be successful

  • Teach to brush teeth
  • Stop progression of disease
  • To hard and arrested caries
18
Q

what do damaged/worn lesions look like but aren’t active carious lesions

A

Hard

Shiny

no pain

tertiary dentine laid down

19
Q

4 stage theory of partial caries removal

A

access cavity

  • you need to see
  • straight line access like endo

remove caries at periphery and ADJ soft
- unsupported enamel

remove infected dentine soft
- if you can, too deep may not want to remove all to protect pulp

maximise cavity for longevity

  • saucer shape = not retentive
  • shape well for material of use
20
Q

3 issues encountered with partial caries removal in real life

A

Saliva
- Harder to see and restore

Patients
- Poor OH, not compliant, not doing ideal practices for restoration

Different materials

21
Q

5 stages in stepwise caries removal

A

Access cavity (you need to see)

Remove caries at periphery and ADJ

Remove infected dentine (if you can)

Maximise cavity for longevity

Difference
- Few months later go back into cavity and restore with more permanent material

22
Q

extra stage in stepwise caries removal

A

Few months later go back into cavity and restore with more permanent material

23
Q

3 ways to encounter the pulp if you expose it

A

Vital

Not hyperaemic

No pain or transient

24
Q

when can you directly pulp cap

A

small amount of bleeding but not profuse and

no pain/intermittent pain

25
Q

3 materials used in direct pulp cap

A

MTA

RMGI (less optimal)

CaOH

Not ledermix/ odotopaste
- Designed to kill pulp
But aim is to maintain pulpal vitality

26
Q

pulpotomy

A

Take pulp out of pulp chamber and leave in base of RCT

Less optimistic for permanent teeth (closed apices)

Sometimes used on wisdom

27
Q

when can you use partial caries removal technique

A

not exposed the pulp, no pulp cap needed

take away all decay

28
Q

RMGI lining for partial caries removal

A

can lead to less irritation

- over caries/deepest point

29
Q

GI/Composite/Amalgam

A

Less likely to have difference in success over RMGI lining, depends on clinical situation

30
Q

when wouldn’t amalgam be used in a clinical situation

A

Smooth surface deep lesion

31
Q

material for Upper left central

Supragingival and Deep lesions

A

composite

32
Q

material for Deep restoration on molar tooth

Box is subgingival

A

amalgam or gold inlay

33
Q

how are partial caries removals reviewed

A

radiographically

34
Q

used of RMGI

A

liner

- vitrebond

35
Q

extra step in stepwise caries removal

A

6 months later re-enter

Remove hardened dentine and restore
- Good seal, remineralise, restore properly

36
Q

what is better stepwise caries removal or Partial caries removal

A

PCR is better – higher vitality and similar failure rates

Pick the easier option

37
Q

comparison of PCR over stepwise

A

PCR: 1 visit
stepwise: 2 visits

vitality (3 years)

  • PCR: 96%
  • stepwise: 83%

failure rate
- similar

BDS2 Clinical (6 decks)

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