PEADS - Caries management

Question 1

Is caries present more in the E’s or D’s

Answer 1

E’s

Question 2

If there is caries in the upper and lower anterior region, what is this classed as?

Answer 2

Uncontrolled caries

Question 3

What are some methods of detecting caries?

Answer 3

Always dry the tooth first.
FOTI 
Magnification and good lighting 
Orthodontic separators for IP
Radiographs

Question 4

What are things to ask in the PDH, when trying to find out about the patient’s compliance?

Answer 4

Have they had any treatment before
Regular attender
Have they had a GA
How do they find the dentist

Question 5

I/O exam of the child

Answer 5

Soft tissues, soft and hard palate, tongue, FOM
Dentition - chart teeth 
Occlusion
Guidance
Trauma 
Dental abnormalities 
Carious teeth

Question 6

How would you evaluate the dentition? what 6 things should you consider?

Answer 6

SADRCP:
Space maintenance 
Associated difficulties 
Dental development 
Restroablity 
Compliance of parent and child 
Prognosis

Question 7

Two examples of space maintainers?

Answer 7

Band and loop

Distal shoe

Question 8

Early loss of primary teeth can cause what? in the permanent dentition.

Answer 8

Crowding

Question 9

What is the prognosis of the teeth dependant on?

Answer 9

The spread and activity of the caries

Then the prevention and motivation of the patient

Question 10

When is the best time to lose the FPM’s?

Answer 10

When the bifurcation of the roots of the 7’s happens.

Question 11

Emergency treatment options?

Answer 11

Caries excavation and sedative dressing
Pulpotomy or pulpectomy
Puss drainage
Ex under LA with or without sedation

Question 12

When is IV sedation only indicated?

Answer 12

For 12 years and older

Question 13

Gives some techniques for reducing pain when giving LA

Answer 13

Topical first
The wand
Chasing technique - interpapillary injection before a palatal
Warm cartridge

Question 14

What is the sequence of restorations (6)?

Answer 14

FPSFPE
Fissure sealants 
Prevention restorations 
Simple fillings (shallow cavities)
FIllings requiring LA 
Pulpotomies and pulpectomies 
Ex

Question 15

What are some characteristics of primary crowns?

Answer 15

Smaller, thinner with broader contact points

Pulp horns are also much closer to the surface

Question 16

How much marginal ridge breakdown must there be before pulpal involvement?

Answer 16

2/3

Question 17

How far does caries extend into dentine before there is pulpal involvement?

Answer 17

2/3

Question 18

What are the 5 different ways to manage caries in children?

Answer 18

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

Question 19

Should GI be used for permanent restorations?

Answer 19

No only temporary. Use RMGI if more permanent.

Question 20

What are some signs in the mouth and around the tooth that could indicate sepsis?

Answer 20

Abscess 
Sinus 
Pain 
Inter-radicular radiolucency (around furcation of bone)
non-physiological mobility

Question 21

Tx for teeth with severe pain and the chance of sepsis?

Answer 21

Ex or pulpectomy

Question 22

Restorative material options for primary molars?

Answer 22

Composite or compomer (need good co-operation and isolation)
GI - temp
RMGI
SSC

Question 23

1) Complete caries removal and restoration method?

Answer 23

GIve child LA
Remove caries completely
Place appropriate indirect pulp cap and restorative material.

Question 24

What are some possible indications for the use of SSC?

Answer 24

Impaired OH 
Two carious surfaces 
High caries 
Developmental defects 
Space maintenance 
Pulpotomy and pulpectomy

Question 25

Method for placement of SSC?

Answer 25

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

Question 26

What are some advantages of partial caries removal?

Answer 26

Shown to be effective in the hospital setting
Less risk of a pulpal exposure
Less time on Prep
No LA required

Question 27

Disadvantages of partial caries removal?

Answer 27

Leaving active disease and if not sealed properly can progress.
Not shown to be effective in GDP

Question 28

2) Method for partial caries removal and restoration?

Answer 28

No LA
Remove caries down to the EDJ.
Then place restoration, fissure seal it in.
Closely monitor and follow up with radiographs

Question 29

What might you do with a pre-co-operative child for 3)a no caries removal with a fissure sealant?

Answer 29

Place GI FS with the finger technique.
Then vaseline on top.
Try to keep mouth dry till set
Replace every few months

Question 30

How to make a lesions self-cleansing?

Answer 30

Have to open up the cavity and allow the patient to access it with their toothbrush. Also, apply FV to the area.

Question 31

What is a way of detecting early caries on the mesial surface of FPM?

Answer 31

Orthodontic separators, allow you direct vision to the site.

Question 32

How might your manage caries on the distal surface of the E’s in order to protect the FPM?

Answer 32

Hall crown
Ex of E
Caries removal and restoration

Question 33

If there is … then remove caries and place the conventional restoration. (management of fissure caries)

Answer 33

Microcavitation
Shadowing under enamel
Dentinal caries

Question 34

When is the best time to Ex the 6’s (lowers)

Answer 34

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