Restorative Management of Permanent Teeth in Children (Young Permanent Teeth)

Question 1

Which teeth are the most prone to decay in the young permanent dentition?

Answer 1

first permanent molars

Question 2

What percentage of children will have molar-incisor hypomineralisation?

Answer 2

15%

Question 3

What percentage of all new carious lesions in adolescents are pit and fissure lesions?

Answer 3

85%

Question 4

What is the halo effect of fluoride?

Answer 4

the surface of the tooth becomes resistant to acid dissolution due to integration of fluoride but the subsurface has increased porosity

Question 5

What can the halo effect lead to?

Answer 5

occult caries

Question 6

What are occult caries?

Answer 6

the tooth surface looks intact, but radiographs show caries beneath the surface

Question 7

Why is having fluoride present in the mouth as the permanent teeth are erupting important?

Answer 7

the fluoride will be incorporated into the hydroxyapatite crystals as the teeth fully mineralise within the first year of being erupted

Question 8

What are risk factors for pit and fissure caries?

Answer 8

deep caries, first year of eruption, partially erupted teeth, teeth being difficult to access, MIH

Question 9

Can you always seen the full extent of caries clinically in the mouth?

Answer 9

no, often they seem small in the mouth but are much larger upon a radiograph

Question 10

How do you diagnose caries?

Answer 10

visualize tooth by drying it, use a blunt probe to feel the suspected area, bite wing radiographs

Question 11

What are some preventative techniques used to stop prevent pit and fissure caries from developing?

Answer 11

resin fissure sealants, GIC fissure sealants, fluoride varnish

Question 12

What are the three situations in which you would use GIC fissure sealants instead of resin fissure sealants?

Answer 12

when child is pre-cooperative, when there are concerns about moisture control, when teeth are partially erupted

Question 13

What is needed to ensure a good resin fissure sealant placement?

Answer 13

isolation of the tooth and moisture control

Question 14

What can too much fluoride varnish lead to?

Answer 14

acute/mild toxicity

Question 15

How long after placement of fluoride varnish should a child refrain from eating?

Answer 15

minimum of 20mins

Question 16

Which children would benefit from additional fluoride?

Answer 16

children where their general health would be jeopardized by caries, high caries risk children, children with occlusal caries in one permanent molar, children with deep fissures

Question 17

Why is it important to take a radiograph before placing a fissure sealant?

Answer 17

to ensure you are not unexpectedly placing the sealant over caries

Question 18

What are some benefits to using resin sealants compared to GIC sealants?

Answer 18

better retention and longer lasting

Question 19

What are some cons to using resin sealants compared to GIC sealants?

Answer 19

very technique sensitive, take longer to apply, act as a barrier only

Question 20

What are some benefits to using GIC sealants compared to resin sealants?

Answer 20

easier application, shorter application time, release of fluoride in addition to sealing

Question 21

What are some cons to using GIC sealants compared to resin sealants?

Answer 21

poorer retention and faster to wear down

Question 22

In addition to reducing caries incidence in children and adolescents, what other benefit have studies shown sealants can provide in the oral cavity?

Answer 22

they reduce the number of viable bacteria that initiate or progress caries by 100-fold

Question 23

What is the aim of non-operative caries management?

Answer 23

aim to remineralise or arrest the lesion

Question 24

When would you undertaken operative management over non-operative management?

Answer 24

if there is cavitation or if the remineralization methods have not worked and caries has progressed

Question 25

What are some causes of anterior caries in the young permanent dentition?

Answer 25

poor OH, defective tooth formation, rampant caries

Question 26

What is the best material to restore anterior caries?

Answer 26

composite resin

Question 27

When would you use GIC over composite resin to restore anterior caries in the young permanent dentition?

Answer 27

if there are rampant caries, poor OH and poor gum health as an temporary measure until oral health improves

Question 28

How do you manage occlusal caries into enamel in the young permanent dentition?

Answer 28

site specific prevention and review

Question 29

How do you manage occlusal caries into dentine in the young permanent dentition?

Answer 29

selective or complete caries removal and restore the lesion

Question 30

What is the main technique used to restoring occlusal caries into dentine in the young permanent dentition?

Answer 30

preventive resin restoration

Question 31

What are indications to use a preventive resin restoration?

Answer 31

small occlusal lesions just into dentine, small class 1 lesions

Question 32

What is a preventive resin restoration?

Answer 32

removing the carious tissue and restoring the lesion, then placing a fissure sealant over the top to prevent any further fissure caries

Question 33

What should you do if the cooperation in a child is inadequate but they have pit and fissure caries?

Answer 33

fissure seal and inform the patient and parent that further treatment is needed, monitor closely, treat with PRR when cooperation improves

Question 34

What materials can you use for a class 1 restoration in young permanent teeth?

Answer 34

resin modified GIC, compomer, composite

Question 35

How would you manage interproximal enamel lesions in the young permanent dentition?

Answer 35

fluoride varnish and monitor

Question 36

How would you manage interproximal dentine lesions in the young permanent dentition?

Answer 36

restore the tooth or extract

Question 37

Why are we not keen on trying everything to save young permanent first molars that have a large carious lesion?

Answer 37

because if we extract it at the right time, the 7’s will erupt and fill the gap

Question 38

What are five things that can indicate restoration failure?

Answer 38

secondary caries, restoration fracture, marginal deficiencies, wear and tear, post-op sentitivity

Question 39

What percentage of lesions into the inner half of enamel on the mesial surface of first permanent molars progress into dentine in 1 year?

Answer 39

20%

Question 40

If you have an at risk patient and suspect caries what should you do?

Answer 40

take bitewings

Question 41

If you diagnose pit and fissure caries into enamel only what should you do?

Answer 41

fissure seal and monitor

Question 42

If you diagnose pit and fissure caries into dentine what should you do?

Answer 42

remove caries, restore cavity with composite, monitor and fissure seal over the top

Question 43

If you took bitewings on an at risk patient due to suspected caries but see no caries on the bitewing what should you do?

Answer 43

fissure seal

Question 44

At what point in the development of the 7’s do you need to extract the 6’s by if you want the 7’s to move and erupt to fill the gap left by the 6’s?

Answer 44

before the 7’s roots bifurcate

Question 45

If you patient has deep caries in a tooth, no pain and no tooth crowding what should you do?

Answer 45

indirect pulp cap with a good coronal seal - preformed metal crown

Question 46

If your patient has deep caries in a tooth, pain, no tooth crowding what should you do?

Answer 46

if pulpitis, perform a pulpotomy. if non-vital perform an RCT or extract

Question 47

If your patient has deep caries in a tooth but has tooth crowding what should you do?

Answer 47

consult orthodontics