Permanent tooth caries management Flashcards
ILO 2.3a: have knowledge of a range of treatment options relevant to the operative management of dental caries and failed restorations
what is fissure sealant?
protective plastic coating used to seal fissures and pits of teeth, preventing food and bacteria from getting caught in them and causing decay
why are fissures vulnerable to caries?
they are less protected by fluoride as it is not possible to clean the base of fissures with a toothbrush
what materials are used for fissure sealants?
- bis-GMA resin after acid etch
- occasionally GIC
what are indications for fissure sealant?
- children deemed to be of high risk of caries should have their permanent molars and premolars sealed upon eruption
- medically compromised children
- children with learning difficulties
- children with physical and mental disabilities
- if a child is of low risk, they do not need their FPMs sealed routinely, but fissures closely monitored
what does the SIGN 138 and SDCEP guidelines say abour fissure sealants?
seal all pits and fissures of permanent molars in children as soon as possible after eruption
which teeth and parts of teeth should be sealed in children?
- pits and fissures on FPMs
- cingulum pits of upper incisors
- buccal pits of lower molars
- palatal pits of upper molars
what should you do if a child has caries in one FPM?
seal all of the other 3 permanent molars immediately and second permanent molars should be sealed on eruption
what is the fissure sealant placement procedure?
- isolate the tooth with a dental dam or dry guards and cotton wool if not cooperative
- clean the occlusal surface with pumice and water to help bonding if contaminated
- etch enamel for 20 seconds
- wash etch directly into aspirator and dry tooth
- check etched enamel is a chalky white colour/frosted
- add the resin to the depths of the dry fissure pattern using a microbrush
- ensure sealant is at the bottom of the fissure and avoid overfilling
- remove excess with dry microbrush
- light cure the resin for 20 seconds
how would you check the sealant is placed properly?
- use a sharp probe to try and remove it to check it is properly placed
- check for air blows (remove and redo)
- check no material has flowed interproximally (remove with probe and floss)
- check no excess material distal to the tooth in soft tissues
why should you wash the etch into the aspirator? what should you do if the etch touches soft tissues?
- the etch can burn soft tissues if it touches them
- etch also has a bad taste
- if etch touches the soft tissues, wash off immediately and let patient and parents know - if severe burn, send to A&E
when should you review fissure sealant?
- review clinically every 4-6 months
- review radiographically as per caries risk assessment (high risk every 6 months, low isk every 12-18 months)
what is the indication for glass ionomer fissure sealant?
- where good moisture control cannot be achieved - high risk children with partially erupted molars, special needs children, poorly cooperating children
- where there is a high degree of sensitivity due to developmental or hereditary enamel defects (e.g. MIH or amelogenesis imperfecta) where drying the tooth can be painful
what is the procedure for placement of a glass ionomer fissure sealant?
- attempt to dry teeth with air or cotton wool
- apply GI from applicator
- smooth into fissures using gloved finger with petroleum jelly to decrease moisture contamination
- keep finger over GI until it is set
- remove excess
what is a stained fissure?
a fissure that is discoloured brown or black, or there is an area of opaque or slightly off-white enamel but no evidence of surface breakdown
how would you diagnose a stained fissure?
- visual (dry tooth)
- probe
- bitewing radiographs
- electronic
- fibre optic transillumination
- CO2 laser
- air abrasion
greater accuracy with 2 or 3 methods used together
what methods of treatment of a stained fissure are there?
- if investigation reveals caries does not enter the dentine, provide a fissure sealant and monitor
- if the diagnosis is inconclusive, clean the fissure with a small slow speed rose head bur and if material is hard, fissure seal
- if small lesion present, preventitive resin restoration (PRR) or sealant restoration (SR) can be provided - fill with small amount of composite and fissure seal
- if large lesion present, conventional composite restoration required
when wanting to extract FMPs, when will the optimal result be obtained?
- bifurcation of 7s seen forming on an OPT (8.5-10 years)
- 5s and 8s are all present and in good positions on an OPT
- mild buccal segment crowding
- class I incisor relationship
how would you manage more extensive caries in a FPM in a child?
- provide quality composite resin restoration under rubber dam
- if cannot sit through the procedure, bulk fill composite may be useful
- consider preformed metal crowns (PFMC) on FPM as an intermediate restoration
what can be done if a child’s FPM has a bad prognosis but they are too young for extraction?
consider a preformed metal crown (PFMC)
how do you place a preformed metal crown on a FPM?
- no tooth preparation needed
- PFMC needs to be cut to height and crimped for optimal fit
- PFMC will have a sharp margin so needs to be polished so it does not cut gums
- fill PFMC with GI luting cement and partially seat
- fully seat with firm finger pressure or ask patient to bite into place
- remove excess cement
- ask child to bite firmly on the crown for 2-3 minutes or hold crown firmly
what is SDF?
silver diamide fluoride
* colourless liquid - occludes dentinal tubules to relieve sensitivity
* 38% SDF - Riva Star
* 44,800ppm fluoride - promotes remineralisation
* silver - antibacterial
what are the contraindications for SDF?
- signs of infection
- symptoms of infection
- caries into the pulp
- inflamed/ulcerated gingiva
- allergy
what is the procedure when placing SDF?
- place petroleum jelly on soft tissues as SDF can cause temporary stain lasting up to 3 weeks
- place petroleum jelly on the gingiva or Riva Star provides a gingival barrier which comes with a blue paste that you light cure
- place cotton wool rolls for moisure control
- dry the tooth with cotton wool rolls or gauze
- take the SDF capsule from the fridge
- pierce the foil at the top
- carefully apply to the tooth using a microbrush
- leave it to dry for at least a minute
- remove excess SDF with dry microbrush and remove gingival barrier
when should you follow up after SDF placement?
- 2-4 weeks after and assess for caries arrest, reapply if needed
- see if carious tooth tissue has hardened
- see child 3-6 monthly based on caries risk, reapplication 6 monthly or subsequent restoration of the tooth
what are advantages of SDF?
- simple technique for child and dentist
- no handpiece needed - not an aerosol generating procedure
- good evidence for caries arrest in primary dentition
what are the disadvantages of SDF?
- stains teeth black
- temporary stain of soft tissues
- required monitoring
