OD In Children

Question 1

Rationale for restoring baby teeth

Answer 1

• Preserve pulp vitality
• Aesthetics
• Maintain arch length
• Restore occlusion
• Maintain function
• Avoid extractions –> space loss, medically compromised
• Control disease

Question 2

When might you choose not to restore endodontically involved primary tooth

Answer 2

Root resorption (pathologic/may also mean about to exfoliate)

Uncooperative child, unrestorable

Child come back with very bad infection, facial swelling etc

Systemic medical conditions eg immunosuppressed, increased risk of infection hence choose exo over RCT

Question 3

Considerations in restoring primary tooth

Answer 3

Tooth factors

• Extent of pulpal pathology
• Restorability
• Arrested lesions
• periodontal support
• Time foe exfoliation

Host factors

• Developmental status of dentition
• Patient cooperation, parental compliance
• CRA
• Systemic medical conditions
• Likelihood of timely recall
• Pathologic root resorption

Question 4

Why is there lee way space

Answer 4

Deciduous molars are wider mesiodistally then permanent premolars. leeway space disappears with mesial drift of teeth

Question 5

Deciduous vs permanent teeth

Answer 5

Deciduous teeth smaller in overall dimension

Increased md:incisocervcal
Short clinical height

Marked cervical constriction, very bulbous

Question 6

OD significance of anatomy primary posterior teeth

Answer 6

Marked cervical constriction at neck contributed by bulge of enamel at cervical ridge –> lose floor of proximal box very quickly

Broad and flattened contact area –> harder to clear

Larger pulp in relation to tooth size, easier to pulp expose. Mesial pulp horns are closer to surface than distal pulp horns

Question 7

Extraction of primary molars things to note

Answer 7

Roots more flares to accommodate developing tooth under

Roots are more slender so easier to fracture, even though children’s bones softer and more pliable. Slow, controlled elevation required

Question 8

Advantages of amalgam

Answer 8

Ease of manipulation
Low cost
Durable
Reduced technique sensitivity

Question 9

Limitations of amalgam

Answer 9

Extent of caries. Caries cannot go beyond line angle; if it goes beyond line angle, when you condense it will just fracture

Require increased preparation vs CR

Unaesthetic

Environmental concerns

Question 10

Cause of fracture of AR class II isthmus

Answer 10

• Insufficient bulk
• Large proximal box, narrow isthmus
• Excessive flare of cavosurface margin

Question 11

Advantages of GIC

Answer 11

• Chemical bonding to dentine and enamel
• Thermal expansion similar to that of tooth
• Biocompatibility
• Fluoride release
• Decreased moisture sensitivity vs CR

Question 12

Form for class V in deciduous teeth

Answer 12

Contour must recreate the cervical bulge (plaque retentive)

Question 13

Classification of PRR

Answer 13

A: suspicious pits and fissures, caries removal limited to enamel, using slow speed round bur

B: incipient lesion in dentine, prep is small and confined

C: need for greater exploratory prep

Question 14

What is disking

Answer 14

create self cleansing surface for primary anterior teeth

remove carious enamel/outer layer of dentine without restoration using interproximal bus, then high fluoride application

Question 15

indications of disking and fluoride

Answer 15

Primary anterior teeth (lower more common than upper)

teeth near exfoliation but not loose yet

shallow and wide caries hence filling would drop out

Question 16

Indications for stainless steel crown

Answer 16

grossly broken down but still restorable
hypoplastic
high caries risk
previous pulp therapy 
other restorative methods would fail
Abutment for space maintainer

Question 17

contraindications for stainless steel crown

Answer 17

unresolved pulpal pathology
tooth exfoliating within 6-12 months
uncooperative child
nickel allergy

Question 18

how much of contact to clear for SSC vs class II

Answer 18

Class II: light pass through

SSC: explorer can pass through

Question 19

why is there minimal buccal and lingual reduction for SSC prep

Answer 19

these surfaces are needed for retention’ mainly the buccal due to large cervical constriction which SSC flexes to fit

Question 20

where should margins of SSC be placed

Answer 20

1-2mm subgingival. if you leave crown margins at the gingival margin, will get recurrent caries

Question 21

problems with ssc

Answer 21

may be aspirated/lost/swallowed during preparation

may obstruct/impact permanent teeth eruption

difficult to fit when there is significant space loss eg mesial drift

Question 22

What are the techniques for minimally invasive dentistry

Answer 22

Atraumatic restorative technique
interim therapeutic restoration
38% silver diammine fluoride
Hall technique

Question 23

what is atraumatic restorative technique

Answer 23

traditionally don’t use handpiece

minimally clean the DEJ which is where occlusal caries spread along

Question 24

What is IRT

Answer 24

Interrim therapeutic restoration
Restore and prevent further caries in very young patients, uncooperative patients

traditional cavity prep/placement of traditional restoration not possible. use GIC, to replace when child is older

Maximum removal of peripheral caries and form good seal so that can lay down tertiary dentine and caries free in the future

Question 25

Potential adverse effects of SDF

Answer 25

Tooth cavities stained black permanently (healthy tooth structure will not be stained)

tooth coloured fillings may discolour

accidental application on skin/lips –> brown/white stain which resolves in 1-3 weeks

risk of tooth decay progression if no changes to OH habits

Question 26

contraindications to use of SDF

Answer 26

Silver allergy

Ulcers

Question 27

Considerations in restorative material for primary teeth

Answer 27

Number of tooth surfaces affected by active/incipient caries
RCT
Ant vs post
Caries risk
Patient ability to cooperate, will resto be good quality?
Anticipated parental compliance (regular fluoride application, meticulous care)
Likelihood of timely recall eg space maintainer

Question 28

Disadvantages of gic

Answer 28

Long setting time
Brittle
Susceptible to erosion and wear

Question 29

Adv and disadvantages of CR

Answer 29

Aesthetic, conserve tooth structure

Moisture and technique sensitive
Longer time to set
Recurrent decay due to polymerisation shrinkage

Contra for high caries risk, poor moisture control