restorative management of caries in the young permanent dentition

Question 1

type of caries that accounts for 85% of new lesions in adolescents

Answer 1

pit and fissure

Question 2

why is there less smooth surface caries

Answer 2

fluoride

Question 3

6 reasons caries (esp pit and fissure caries) is common in adolescents

Answer 3

• 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

Question 4

3 basic ways to detect caries

Answer 4

• visual (dry tooth)- stains/ opacities
• probe/ explorer (just to remove food/ debris)
• bitewing radiographs

Question 5

2 ways to apply GIC and when to use each

Answer 5

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)

Question 6

how to apply duraphat

Answer 6

• 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

Question 7

5 groups who benefit from fluoride varnish/ indications

Answer 7

• 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)

Question 8

resin sealant v gic sealant (also see table prev lecture)

Answer 8

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)

Question 9

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

Answer 9

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

Question 10

what to use to restore anterior caries 2, considerations of both

Answer 10

• 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

Question 11

what is PRR

Answer 11

preventive resin restoration:

conservative removal of existing carious tissue from the fissure whilst simultaneously preventing further fissure caries

Question 12

stages of PRR 11

Answer 12

• 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

Question 13

pros of using GIC instead of composite for PRR (GSR) 2

Answer 13

improved bond to tooth (chemical not micromechanical)

fluoride leaching preventive effects

Question 14

cons of using GSR over PRR

Answer 14

GIC not as long-lasting

Question 15

what to do it you can’t do PRR due to unco-operative child

Answer 15

fissure seal/ use GIC and replace with PRR when pt is compliant

Question 16

2 main materials used for class I restoration in young permanent teeth

Answer 16

amalgam

composite

Question 17

2 ways to diagnose interproximal caries

Answer 17

• bitewings

- orthodontic separators - review in 5 days to visualise

Question 18

5 ways restorations can fail

Answer 18

secondary caries
fracture
marginal deficiencies
wear
-post-op wear and sensitivity

Question 19

what area of caries is quicker advancing in children age 6-12
clinical significance of this

Answer 19

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

Question 20

how to check if caries prevention has worked

Answer 20

take bitewings. carious area should be more radio-opaque than it was before

Question 21

when is caries reversible/ irreversible

Answer 21

reversible: early enamel caries

irreversible (no remineralisation): caries in to dentine

Question 22

are small or large restorations more successful in young permanent teeth?

Answer 22

small

Question 23

4 alternative techniques to drilling to remove dental caries

Answer 23

• air abrasion
• chemical removal
• atraumatic restorative technique (ART)
• lasers

Question 24

what did ricketts 2006 cochrane review say about caries management

Answer 24

better to do ultraconservative prep and seal well than complete caries removal

Question 25

3 causes of anterior caries

Answer 25

plaque accumulation
defective formation
rampant caries