Paediatric Dentistry - Operative Flashcards
how would you stop an enamel caries lesions progressing and promote remineralisation s
show parent the lesion and explain treatment and why it is successful
demonstrate effective brushing of the lesion
give dietary advice
apply fluoride varnish to the lesion 4x yearly
keep record of site and extent of lesion
when would you review an enamel caries lesion to see if arrested or not
if after 3 months the active lesions are not arrested consider alternative strategy
when is the hall technique useful
a primary tooth with advanced lesions in occlusal or proximal surface
when is the hall crown technique only suitable
when there is clear unaffected dentine between the lesion and the pulp
list the steps in the hall technique
ensure child is sitting upright
assess whether separators are required - requires 2nd visit 3-5 days later to remove them and fit the crown
ensure airway is protected (gauze)
select correct size of PMC
ensure PMC is well filled with GIC
seat PMC over the tooth - get child to bite down
ask child to open - check crown is seated evenly
remove excess cement and clear contacts with floss
avoid excess cement reaching tongue
what is Icon technique
the tooth is isolated, etched using ethanol to dry out the pores that have been created and then unfilled, low viscosity resin is flowed into pores blocking them
what is ART and what is it suitable for
atraumatic restorative technique - using hand instruments to prepare cavity and restored using GIC
suitable for primary teeth with single surface lesions
what is the stepwise caries removal technique
place LA and gain access
remove all caries on cavity walls
over the pulp - selectively remove caries as to not expose the pulp
use temp restoration - one thats different colour
wait 6-12 months and place LA and remove temp restorations
remove any remaining carious tissue until hard dentine reached
place permanent restoration
how to make a lesion cleansable
no LA unless subgingival
using high speed or hand instruments remove undermined enamel to make lesion accessible to toothbrushing
resulting cavity depends on extent of the lesion
what is the technique for conventional crown placement in primary teeth
give LA
protect airway
remove caries - if pulpal exposure is a risk place indirect pulp cap
occlusal reduction
cut mesial and distal slices
select correct size of crown
cement in place with GIC and clear contacts
what are contraindications of pulp therapy in deciduous teeth
teeth that are close to exfoliation
children who are pre-cooperative or immunocompromised
what is the technique for a pulpotomy
give LA
cut access cavity making sure entire roof of pulp chamber is clear and consider rubber dam
remove contents of pulp chamber with slowspeed or hand excavator
irrigate pulp chamber with saline
identify entrances to canals
if still bleeding place cotton wool dampened in ferric sulphate (deciduous only)
if bleeding cannot be controlled progress to pulpectomy
remove cotton wool and place MTA or ZOE cement
fill cavity with ZOE cement and then place PMC
when is balancing extractions indicated in primary dentition
one C is to be extracted
one C has exfoliated prematurely
centre line shift developing after extracting one D
when are balancing extractions not usually indicated in primary dentition
loss of primary incisors
loss of Ds unless centre line shift develops
loss of Es
at what age is extraction of 6s most favourable
8-10 years
