PEADS - Caries management Flashcards
Is caries present more in the E’s or D’s
E’s
If there is caries in the upper and lower anterior region, what is this classed as?
Uncontrolled caries
What are some methods of detecting caries?
Always dry the tooth first. FOTI Magnification and good lighting Orthodontic separators for IP Radiographs
What are things to ask in the PDH, when trying to find out about the patient’s compliance?
Have they had any treatment before
Regular attender
Have they had a GA
How do they find the dentist
I/O exam of the child
Soft tissues, soft and hard palate, tongue, FOM Dentition - chart teeth Occlusion Guidance Trauma Dental abnormalities Carious teeth
How would you evaluate the dentition? what 6 things should you consider?
SADRCP: Space maintenance Associated difficulties Dental development Restroablity Compliance of parent and child Prognosis
Two examples of space maintainers?
Band and loop
Distal shoe
Early loss of primary teeth can cause what? in the permanent dentition.
Crowding
What is the prognosis of the teeth dependant on?
The spread and activity of the caries
Then the prevention and motivation of the patient
When is the best time to lose the FPM’s?
When the bifurcation of the roots of the 7’s happens.
Emergency treatment options?
Caries excavation and sedative dressing
Pulpotomy or pulpectomy
Puss drainage
Ex under LA with or without sedation
When is IV sedation only indicated?
For 12 years and older
Gives some techniques for reducing pain when giving LA
Topical first
The wand
Chasing technique - interpapillary injection before a palatal
Warm cartridge
What is the sequence of restorations (6)?
FPSFPE Fissure sealants Prevention restorations Simple fillings (shallow cavities) FIllings requiring LA Pulpotomies and pulpectomies Ex
What are some characteristics of primary crowns?
Smaller, thinner with broader contact points
Pulp horns are also much closer to the surface
How much marginal ridge breakdown must there be before pulpal involvement?
2/3
How far does caries extend into dentine before there is pulpal involvement?
2/3
What are the 5 different ways to manage caries in children?
1) Full caries removal and restorations
2) Partial caries removal and restoration
3) No caries removal
a) FIssure sealants
b) Hall crown technique
4) No caries removal
a) Providing prevention alone
b) Providing prevention and making the tooth self-cleansing
5) Ex or review with Ex if pain or sepsis develops
Should GI be used for permanent restorations?
No only temporary. Use RMGI if more permanent.
What are some signs in the mouth and around the tooth that could indicate sepsis?
Abscess Sinus Pain Inter-radicular radiolucency (around furcation of bone) non-physiological mobility
Tx for teeth with severe pain and the chance of sepsis?
Ex or pulpectomy
Restorative material options for primary molars?
Composite or compomer (need good co-operation and isolation)
GI - temp
RMGI
SSC
1) Complete caries removal and restoration method?
GIve child LA
Remove caries completely
Place appropriate indirect pulp cap and restorative material.
What are some possible indications for the use of SSC?
Impaired OH Two carious surfaces High caries Developmental defects Space maintenance Pulpotomy and pulpectomy
Method for placement of SSC?
Give LA
Removal of all caries and placement of indirect pulp cap.
Tooth prep, reduce the tooth mesial to distal and occlusal.
Fill SSC with GI cement and place it down firmly.
Remove any excess
What are some advantages of partial caries removal?
Shown to be effective in the hospital setting
Less risk of a pulpal exposure
Less time on Prep
No LA required
Disadvantages of partial caries removal?
Leaving active disease and if not sealed properly can progress.
Not shown to be effective in GDP
2) Method for partial caries removal and restoration?
No LA
Remove caries down to the EDJ.
Then place restoration, fissure seal it in.
Closely monitor and follow up with radiographs
What might you do with a pre-co-operative child for 3)a no caries removal with a fissure sealant?
Place GI FS with the finger technique.
Then vaseline on top.
Try to keep mouth dry till set
Replace every few months
How to make a lesions self-cleansing?
Have to open up the cavity and allow the patient to access it with their toothbrush. Also, apply FV to the area.
What is a way of detecting early caries on the mesial surface of FPM?
Orthodontic separators, allow you direct vision to the site.
How might your manage caries on the distal surface of the E’s in order to protect the FPM?
Hall crown
Ex of E
Caries removal and restoration
If there is … then remove caries and place the conventional restoration. (management of fissure caries)
Microcavitation
Shadowing under enamel
Dentinal caries
When is the best time to Ex the 6’s (lowers)
If there is a poor long-term prognosis of the 6’s. Then appropriate removal at the right time is indicated.
At approx 8-9yrs of age, the calcification of the bifurcation of the 6’s and ideally presents of premolars and 8’s
