Managing Deep Caries Flashcards
How can you Diagnose Deep Caries? (3)
- pain history
- clinical and radiographic exams
- sensitivity tests
How does Deep Caries Appear on a Radiograph?
dark spot
How does Caries Appear as it Progress’
white spot
brown spot
cavity
How do you Conduct a Sensitivity Test?
electric pulp test and ethyl chloride
- patient should feel it go cold
What Should You DEFINITELY Avoid when Managing Deep Caries?
AVOID PULP EXPOSURE
What are the Options for Management? (3)
- complete and non-selective caries removal
- one stage selective caries removal - 70-90% success rate - caries removed from periphery
- 2 stage stepwise excavation
- caries removed from periphery
- soft caries can be left when its on the pulp floor - deeper causes exposure
- open lesion after 6 month and remove remaining carious tissue
- fill with calcium silicates
What do you do if there is Pulpal Exposure?
remove all the caries
options
- direct pulp capping or pulpotomy
What is Direct Pulp Capping? - include both classes and success rate.
biodentine and rubber dam on a vital pulp
Class I = no preoperative presence of deep caries lesion so exposure can be due to injury or surgery
Class II = if there is preoperative presence of deep caries
Success Rate - 80-90%
What is a Pulpotomy? - include success rate.
leaving partial or full coronal pulp tissue, continue if there is consistent bleeding
- remove pulp tissue
- stop bleeding with Sodium Hypochlorite
- if bleeding doesn’t stop, will require a RCT
Success Rate = 80-90%
How can You Preserve a Healthy Pulp?
seal the cavity with bioactive properties
what is the Function of CaOH and CaSi with the pulp.
CaOH - stimulates pulp to produce mineralised tissue
- problem = porous and soluble
CaSi - bioactive, helps pulp to heal, good result
How Often Should You See the Patient?
6-12months up to 5 years
What Should You Look for in the Recall with the Patient? (2)
- look for responsive pulp tissue
- no pain
Why Should Teeth be Restored?
- arrest lesion activity
- restore function, form and aesthetic
- maximise longevity of the tooth
In Deep Caries, When should Soft Dentine be Left?
in the pulpal 1/3 or 1/4 dentine
when it appears soft and leathery
it can be lifted with excavator BUT it doesn’t deform