Managing Deep Caries Flashcards

1
Q

How can you Diagnose Deep Caries? (3)

A
  • pain history
  • clinical and radiographic exams
  • sensitivity tests
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2
Q

How does Deep Caries Appear on a Radiograph?

A

dark spot

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3
Q

How does Caries Appear as it Progress’

A

white spot
brown spot
cavity

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4
Q

How do you Conduct a Sensitivity Test?

A

electric pulp test and ethyl chloride
- patient should feel it go cold

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5
Q

What Should You DEFINITELY Avoid when Managing Deep Caries?

A

AVOID PULP EXPOSURE

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6
Q

What are the Options for Management? (3)

A
  • 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
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7
Q

What do you do if there is Pulpal Exposure?

A

remove all the caries

options
- direct pulp capping or pulpotomy

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8
Q

What is Direct Pulp Capping? - include both classes and success rate.

A

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%

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9
Q

What is a Pulpotomy? - include success rate.

A

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%

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10
Q

How can You Preserve a Healthy Pulp?

A

seal the cavity with bioactive properties

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11
Q

what is the Function of CaOH and CaSi with the pulp.

A

CaOH - stimulates pulp to produce mineralised tissue
- problem = porous and soluble

CaSi - bioactive, helps pulp to heal, good result

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12
Q

How Often Should You See the Patient?

A

6-12months up to 5 years

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13
Q

What Should You Look for in the Recall with the Patient? (2)

A
  • look for responsive pulp tissue
  • no pain
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14
Q

Why Should Teeth be Restored?

A
  • arrest lesion activity
  • restore function, form and aesthetic
  • maximise longevity of the tooth
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15
Q

In Deep Caries, When should Soft Dentine be Left?

A

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

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16
Q

Define Deep Caries.

A

radiographic evidence of caries reaching the inner third or inner quarter of dentine but still within a well-define zone of radioopaque dentine.

the infected demineralised dentine is separate from the pulp

17
Q

Define Extreme Deep Caries.

A

radiographic évidence of caries penetrating the entire thickness of dentine without a radiopaque zone separating the lesion from the pulp

Pulp exposure is unavoidable during operative treatment

18
Q

Give and Explain 4 Ways to Manage Deep Carious Lesions?

A

**1. Non-selective removal to hard dentine
- complete caries removal
- hard sound dentine remains
= considered over treatment

**2. Selective removal to firm dentine
- leaves leathery dentine pulpally
- still some resistance to excavator
- cavity margins, peripheral dentine are sound
= treatment of choice

**3. Selective removal to soft dentine
- soft carious tissue left over the pulp
- peripheral enamel and dentine are prepared sound

**4. Stepwise Excavation
- carious tissue removal in 2 stages/visits
- first - soft carious tissue is left over tooth, whilst peripheral dentine is prepared to hard dentine
= a provisional restoration of GIC or composite
- second - lesion is re-entered and further excavation on pulpal aspect for definitive restoration