Restorative management of caries in the young permanent dentition

Question 1

Which tooth is most susceptible to decay?

Answer 1

Molar

Question 2

What percentage of molars have MIH?

Answer 2

15%

Question 3

What percent account for new pit and fissure lesions?

Answer 3

85%

Question 4

What are the risk factors in the YPD for caries?

Answer 4

1st year Post Eruption:
Deep fissures
PE
Difficult to access
Enamel hypoplasia/hypocalcification

Question 5

How does F work?

Answer 5

Conversion of hydroxyapatite to fluoroapatite leading to decreased demineralisation

Question 6

Where does F work?

Answer 6

Smooth surfaces of teeth

Question 7

What can be used to diagnose caries?

Answer 7

Visual (dry tooth) stains/opacities
Probe (blunt)
Bus

caries detector dyes
electronic
fibre optic transillumination
laser diagnosis

Question 8

What is E1?

Answer 8

Caries in the outer half of enamel

Question 9

What is E2?

Answer 9

Caries in the inner half go enamel up to ADJ

Question 10

What is D2?

Answer 10

Caries onto outer half of dentine

Question 11

Non operative (preventative) management

Answer 11

FS
plaque control OH
F (at home/professional)
Reinforce and maintenance
Resin infiltration

Question 12

FS - resin

Answer 12

isolate and etch
apply
light cure
check for flash and integrity of sealant

Question 13

FS - GIC

Answer 13

• Only when child is pre-cooperative
• resin sealant is indicated but there are - concerns about moisture control
  PE tooth

dry tooth
place gic on finger and hold for 2m
cover with vaseline before moisture contamination.

Question 14

Duraphat application

Answer 14

1. dry teeth in each quadrant to optimise adhesion
2. advise child should eat soft food and should not brush their teeth for the rest of the day

Question 15

What are the advantages/disadvantages of resin sealant?

Answer 15

better retention
technique sensitive
longer time to apply
acts as a barrier only

Question 16

What are the pros and cons of GIC sealant?

Answer 16

poorer retention
easier appl
short appl time
release of F

Question 17

Evidence for FS

Answer 17

Resin sealants reduce caries incidence of 86% after 1y

57% at 48-54m

Decrease viable s.mutans and lactobacilli by 100X

Question 18

How to treat anterior caries

Answer 18

composite resin

(causes, plaque form, defective and rampant caries)

rampant caries - may use GIC as interim measure

Question 19

Ways to treat occlusal caries

Answer 19

Preventative resin restoration
Fissure biopsy
Fissurotomy
Ultra conservative prep
Prophylactic odontotomy
Enameloplasty

Question 20

PRR indications

Answer 20

Incipient occlusal lesion just into dentine. Small class 1

must have a radiograph

Question 21

What is PRR?

Answer 21

The conservative removal of existing carious tissue from a fissure whilst simultaneously preventing further caries in fissures

Question 22

How to carry out a PRR

Answer 22

LA and rubber dam
clean occlusal surface
Fissure is investigated using small high speed diamond
Caries identified and removed from DEJ
No extension into unaffected fissures
Wash and dry cavity
Place thin layer of bonding resin (cure for 20s)
Restore cavity with composite
Incremental cure if needed.
Run FS over all occlusal surface
Cure for 30s
remove rubber dam
check occlusion

Question 23

When can you not use amalgam?

Answer 23

Tx of deciduous teeth
Children under 15
Pregnant or breastfeeding except when deemed necessary due to med needs of pt

Question 24

Approximal enamel lesions

Answer 24

F- varnish and monitor

Question 25

Dentinal or deep caries

Answer 25

selective/complete caries removal, indirect pulp cap, direct pulp cap, pulpotomy, rct, xla

Question 26

What is the progression rate of lesion in the inner half of the enamel on the mesial surface of 6s?

Answer 26

faster progression rate between 6-12y
approx 20% into dentine in 1y
dentine progression is much faster

Question 27

Other caries removal techniques

Answer 27

air abrasion
chem removal
atraumatic restorative techniques
laser