Managing Deep Caries

Question 1

How can you Diagnose Deep Caries? (3)

Answer 1

• pain history
• clinical and radiographic exams
• sensitivity tests

Question 2

How does Deep Caries Appear on a Radiograph?

Answer 2

dark spot

Question 3

How does Caries Appear as it Progress’

Answer 3

white spot
brown spot
cavity

Question 4

How do you Conduct a Sensitivity Test?

Answer 4

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

Question 5

What Should You DEFINITELY Avoid when Managing Deep Caries?

Answer 5

AVOID PULP EXPOSURE

Question 6

What are the Options for Management? (3)

Answer 6

• 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

Question 7

What do you do if there is Pulpal Exposure?

Answer 7

remove all the caries

options
- direct pulp capping or pulpotomy

Question 8

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

Answer 8

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%

Question 9

What is a Pulpotomy? - include success rate.

Answer 9

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%

Question 10

How can You Preserve a Healthy Pulp?

Answer 10

seal the cavity with bioactive properties

Question 11

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

Answer 11

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

CaSi - bioactive, helps pulp to heal, good result

Question 12

How Often Should You See the Patient?

Answer 12

6-12months up to 5 years

Question 13

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

Answer 13

• look for responsive pulp tissue
• no pain

Question 14

Why Should Teeth be Restored?

Answer 14

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

Question 15

In Deep Caries, When should Soft Dentine be Left?

Answer 15

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

Question 16

Define Deep Caries.

Answer 16

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

Question 17

Define Extreme Deep Caries.

Answer 17

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

Question 18

Give and Explain 4 Ways to Manage Deep Carious Lesions?

Answer 18

**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