OD in children

Question 1

Why control caries in primary teeth?

Answer 1

Control disease (teeth tend to fall out at 10-12, if early caries then prolly wont survive)

Preserve pulp vitality, preventing pain, sepsis and damage to permanent teeth

Restoring function, occlusion

Maintaining arch length for permanent teeth

Medical conditions that warrant delay of exo (extensive chemo causing low WBC/platelet counts etc)

Aesthetics..?

Scared of exo?

Question 2

Tooth factors influencing restorability

Answer 2

Restorability
Extent of pulpal pathology
Arrested lesions (do they rly need to be restored in problem pts?)
Perio support (v rarely an issue)

Question 3

Host factors influencing restorability

Answer 3

Developmental status of dentition (is the tooth gna exfoliate soon?)
Caries risk
Compliance
Space loss

Question 4

How do primary teeth differ from permanent teeth?

Answer 4

Fewer in number
Smaller (except that primary molars > permanent premolars)
Whiter
Presence of mammelons in permanent teeth
Mesiodistal : incisocervical is 1:1 in primary teeth, permanent teeth usually incisocervical > mesiodistal dimensions
Posterior primary crowns are more bulbous with narrower occlusal tables
Crown, pulp and root morphology

Question 5

Crown morphology of primary anterior teeth

Answer 5

Shorter clinical crown
Relatively larger MD : axial crown length ratio, looks fat esp when worn
Marked cervical constriction
Contact points v broad and flat

Question 6

Morphology of primary posterior teeth

Answer 6

Roots more divergent
Very bulbous, constriction marked all round

Question 7

General structure and morphology of primary teeth

Answer 7

Enamel thinner, whiter, cervical enamel rods slope occlusally and end at cervix instead of being oriented gingivally

Dentine thinner

Pulp larger wrt tooth size, mesial pulp horns closer to surface than distal pulp horns

Roots more slender, more flared, more accessory canals esp in floor

Very hard to see PA lesions as they commonly overlap with permanent tooth follicles
But easier to see furcal lesions

Question 8

Restorative modalities

Answer 8

Amalgam
CR
GIC
SS crowns
Composite strip crowns
Minimally invasive: disking/fluoride, SDF, hall technique, interim therapeutic restorations

Question 9

Considerations influencing the material to use

Answer 9

Number of surfaces affected
RCT?
Anterior or posterior?
Caries risk
Patient compliance, likelihood of timely recall, cooperation with treatment

Question 10

Amalgam advantages

Answer 10

Ease of manipulation
Durability
Relatively low cost
Reduced technique sensitivity
High survival rates

Question 11

Amalgam disadvantages

Answer 11

Poor esthetics
Environmental concerns

Question 12

When to use amalgams

Answer 12

Class I, IIs, V for primary and permanent teeth

Question 13

AR Class I cavity prep

Answer 13

Width 1mm
Depth 1.2-1.5mm
Narrow width following fissures
90 degree cavosurface margins
No unsupported enamel
Buccal and lingual undercuts for retention
Rounded internal line angles

Question 14

AR Class II cavity prep

Answer 14

Occlusal-gingivally parallel to long axis of tooth
Buccal and lingual undercuts
Axial walls follow contour of tooth and long axes of cusps
Gingival floor beneath contact point, break contact but cannot pass explorer tip through
1mm MD width

Question 15

Common failures for AR

Answer 15

Cavity prep too wide, too deep, nicking neighboring teeth
Restoration has voids, overcarved, not polished, polished off natural tooth
Fracture of isthmus of class II due to insufficient bulk, proximal box too large and isthmus too narrow, cavosurface margin too flared

Question 16

Advantages of GIC

Answer 16

Chemical bonding to enamel and dentine
Thermal expansion similar to tooth structure
Biocompatible
Fluoride release
Decreased moisture sensitivity wrt resins

Question 17

Disadvantages of GIC

Answer 17

Lower strength

Question 18

When to use GIC

Answer 18

Class I, II, III, V restorations in primary teeth
Class III,V restorations in permanent teeth
Caries control for high risk px, restoration repair, temporary dressing, ART

Question 19

Advantages of CR

Answer 19

Aesthetics, conservative tooth preps
Strong evidence that CR is successful for class I restorations in primary teeth

Question 20

Disadvantages of CR

Answer 20

Takes longer to place
Very moisture sensitive
Technique sensitive
Polymerization shrinkage causes recurrent decay
Contraindicated for high caries risk pts
Need to bevel for esthetics and retention

Question 21

Types of CR

Answer 21

Different filler sizes
Flowable vs packable

Question 22

When to use CR

Answer 22

Class I, II, III, IV, V
Strip crowns
PRR

Question 23

What is disking and fluoride?

Answer 23

Removing carious enamel/outer layer of dentine without restoration, then applying concentrated fluoride

Question 24

Advantages of disking and fluoride

Answer 24

Simple
Inexpensive
Requires minimal cooperation

Question 25

When to use disking and fluoride

Answer 25

Primary anterior teeth, esp lower
Teeth near exfoliation but not loose yet
Shallow wide caries in uncooperative px

Question 26

Advantages of composite strip crowns

Answer 26

Aesthetics

Question 27

Disadvantages of composite strip crowns

Answer 27

Cooperation needed
Expensive
Moisture isolation imperative
Not indicated for grinders

Question 28

Steps for composite strip crown

Answer 28

LA rubber dam
Choose color and size
Cut strip crown along gum margin then create a hole on distal w explorer to allow excess composite to flow out
Caries free and prepare tooth
Vitrebond and pulp therapy as needed
Reduce incisally 2mm and clear contacts
Feather/light chamfer, suprag
Etch prime bond, fill crown w composite and fit
Remove excess
Cure facial and palatal
Score palatal surface with sickle scaler or bur, peel off strip crown
Polish

Question 29

Advantages of stainless steel crowns

Answer 29

Biocompatibility
High strength
Moisture control not impt
Lower 5 year failure rate than class II AR restorations

Question 30

Disadvantages of stainless steel crowns

Answer 30

Poor esthetics
Gingival inflammation
Increased chairside time
Made out of nickel-chromium: Nickel allergy?

Question 31

Indications of SSC

Answer 31

Posterior teeth
Grossly worn down but still restorable
Previous pulp therapy, not a lot of tooth structure left
Hypoplastic molars
High caries risk
Other restorative materials will fail

Question 32

Contraindications of SSC

Answer 32

Unresolved/severe perio/periapical pathology
Exfoliating within 6-12 months
Uncooperative child that cannot be held down
Allergy to nickel

Question 33

SSC steps

Answer 33

LA
Caries free
Occlusal reduction 1.5mm
Proximal reduction w feather edged margin
Minimal buccal and lingual reduction for retention
Trial fit size, margin should be 1-2mm subg, seat w a click and not easily removed, no catch w explorer
Close crown margins w crimpers
Cement with GIC cement by filling crown and seating
Remove excess
Floss

Question 34

Problems w SSC

Answer 34

Difficult to fit when there is significant space loss
May impact or obstruct adjacent permanent tooth eruption
May be swallowed/aspirated/lost during prep

Question 35

Minimally invasive dentistry types

Answer 35

Atraumatic restorative technique (ART)
Interim therapeutic restorations (ITR)
SDF
Hall technique

Question 36

What is ART

Answer 36

Just use spoon excavator, remove caries then fill with IRM or GIC

Question 37

What is ITR

Answer 37

Postpone the traditional cavity prep and placement of traditional cavity restorations by placing GIC to prevent further decalcifications and caries

Used for v young, uncooperative, or special needs patients

Question 38

What is hall technique

Answer 38

Used for class II lesions where px is not cooperative
Push crown down without prepping or removing decay, j starve the bacteria to arrest the decay
Put separators between the teeth for 2-3 days to create space