restorative management of caries in the young permanent dentition Flashcards
type of caries that accounts for 85% of new lesions in adolescents
pit and fissure
why is there less smooth surface caries
fluoride
6 reasons caries (esp pit and fissure caries) is common in adolescents
- early permanent dentition more at risk bc child doesn’t know how to brush teeth
- first year of eruption:HA not FA crystals (maybe has effect)
- deep fissures
- partly erupted
- difficult to access (esp posteriors- gag reflex)
- enamel hypoplasia or hypocalcification
3 basic ways to detect caries
- visual (dry tooth)- stains/ opacities
- probe/ explorer (just to remove food/ debris)
- bitewing radiographs
2 ways to apply GIC and when to use each
first: isolate, etch, wash and dry, apply sealant
if doesn’t work/ child unco operative: small blob of fuji triage on finger and apply directly to tooth (self cure)
how to apply duraphat
- isolate and dry tooth
- apply a small amount of fluoride varnish using a small brush (warn that it tastes of bananas)
- advise that the child should eat soft food and should not brush their teeth for the rest of the day
5 groups who benefit from fluoride varnish/ indications
- children with impairments where general health would be jeopardized by caries
- high risk caries children
- occlusal caries in 1 permanent molar (seal the other non-carious molar)
- deep fissures
- doubt about caries status of a fissure (+ monitor)
resin sealant v gic sealant (also see table prev lecture)
resin: better retention but technique sensitive, longer time to apply, acts as a barrier only, radiopaque (gd)
GIC sealant: F- release, easy short application but poorer retention, radiolucent (bad)
treatment of:
a. occlusal fissures (caries free, high risk child)
b. occlusal enamel caries
c. occlusal caries with minimal dentine involvement
d. occlusal caries with deep dentine involvement
e. interproximal caries
f. incisal edge trauma
g. cervical caries
a. occlusal fissures (caries free, high risk child): fissure sealant
b. occlusal enamel caries: fissure sealant + prevention
c. occlusal caries with minimal dentine involvement: preventive resin restoration PRR
d. occlusal caries with deep dentine involvement: composite resin + pulp cap
e. interproximal caries: composite, amalgam
f. incisal edge trauma: composite
g. cervical caries: composite, resin modified GIC
what to use to restore anterior caries 2, considerations of both
- composite BUT breaks down in acidic conditions eg with plaque, which would be present with anterior caries
- GIC as temp, but pt may not return and 2 treatments necessary
what is PRR
preventive resin restoration:
conservative removal of existing carious tissue from the fissure whilst simultaneously preventing further fissure caries
stages of PRR 11
- LA and rubber dam
- clean occlusal surface
- investigate fissure using small high speed diamond bur
- caries identified and removed from ADJ
- no extension in to unaffected fissures
- wash and dry cavity
- place thin layer of bonding resin (20s cure)
- restore cavity with composite (incremental cure if needed)
- run fissure sealant across all occlusal surface (30s cure)
- remove rubber dam
- check the occlusion
pros of using GIC instead of composite for PRR (GSR) 2
improved bond to tooth (chemical not micromechanical)
fluoride leaching preventive effects
cons of using GSR over PRR
GIC not as long-lasting
what to do it you can’t do PRR due to unco-operative child
fissure seal/ use GIC and replace with PRR when pt is compliant
2 main materials used for class I restoration in young permanent teeth
amalgam
composite
2 ways to diagnose interproximal caries
- bitewings
- orthodontic separators - review in 5 days to visualise
5 ways restorations can fail
secondary caries fracture marginal deficiencies wear -post-op wear and sensitivity
what area of caries is quicker advancing in children age 6-12
clinical significance of this
inner half of enamel of mesial surface of first permanent molar (6)
20% progress in to dentine in 1 year , then caries in dentine progresses faster than in adults
how to check if caries prevention has worked
take bitewings. carious area should be more radio-opaque than it was before
when is caries reversible/ irreversible
reversible: early enamel caries
irreversible (no remineralisation): caries in to dentine
are small or large restorations more successful in young permanent teeth?
small
4 alternative techniques to drilling to remove dental caries
- air abrasion
- chemical removal
- atraumatic restorative technique (ART)
- lasers
what did ricketts 2006 cochrane review say about caries management
better to do ultraconservative prep and seal well than complete caries removal
3 causes of anterior caries
plaque accumulation
defective formation
rampant caries
