Restorative Management of Permanent Teeth in Children (Young Permanent Teeth) Flashcards
Which teeth are the most prone to decay in the young permanent dentition?
first permanent molars
What percentage of children will have molar-incisor hypomineralisation?
15%
What percentage of all new carious lesions in adolescents are pit and fissure lesions?
85%
What is the halo effect of fluoride?
the surface of the tooth becomes resistant to acid dissolution due to integration of fluoride but the subsurface has increased porosity
What can the halo effect lead to?
occult caries
What are occult caries?
the tooth surface looks intact, but radiographs show caries beneath the surface
Why is having fluoride present in the mouth as the permanent teeth are erupting important?
the fluoride will be incorporated into the hydroxyapatite crystals as the teeth fully mineralise within the first year of being erupted
What are risk factors for pit and fissure caries?
deep caries, first year of eruption, partially erupted teeth, teeth being difficult to access, MIH
Can you always seen the full extent of caries clinically in the mouth?
no, often they seem small in the mouth but are much larger upon a radiograph
How do you diagnose caries?
visualize tooth by drying it, use a blunt probe to feel the suspected area, bite wing radiographs
What are some preventative techniques used to stop prevent pit and fissure caries from developing?
resin fissure sealants, GIC fissure sealants, fluoride varnish
What are the three situations in which you would use GIC fissure sealants instead of resin fissure sealants?
when child is pre-cooperative, when there are concerns about moisture control, when teeth are partially erupted
What is needed to ensure a good resin fissure sealant placement?
isolation of the tooth and moisture control
What can too much fluoride varnish lead to?
acute/mild toxicity
How long after placement of fluoride varnish should a child refrain from eating?
minimum of 20mins
Which children would benefit from additional fluoride?
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
Why is it important to take a radiograph before placing a fissure sealant?
to ensure you are not unexpectedly placing the sealant over caries
What are some benefits to using resin sealants compared to GIC sealants?
better retention and longer lasting
What are some cons to using resin sealants compared to GIC sealants?
very technique sensitive, take longer to apply, act as a barrier only
What are some benefits to using GIC sealants compared to resin sealants?
easier application, shorter application time, release of fluoride in addition to sealing
What are some cons to using GIC sealants compared to resin sealants?
poorer retention and faster to wear down
In addition to reducing caries incidence in children and adolescents, what other benefit have studies shown sealants can provide in the oral cavity?
they reduce the number of viable bacteria that initiate or progress caries by 100-fold
What is the aim of non-operative caries management?
aim to remineralise or arrest the lesion
When would you undertaken operative management over non-operative management?
if there is cavitation or if the remineralization methods have not worked and caries has progressed
What are some causes of anterior caries in the young permanent dentition?
poor OH, defective tooth formation, rampant caries
What is the best material to restore anterior caries?
composite resin
When would you use GIC over composite resin to restore anterior caries in the young permanent dentition?
if there are rampant caries, poor OH and poor gum health as an temporary measure until oral health improves
How do you manage occlusal caries into enamel in the young permanent dentition?
site specific prevention and review
How do you manage occlusal caries into dentine in the young permanent dentition?
selective or complete caries removal and restore the lesion
What is the main technique used to restoring occlusal caries into dentine in the young permanent dentition?
preventive resin restoration
What are indications to use a preventive resin restoration?
small occlusal lesions just into dentine, small class 1 lesions
What is a preventive resin restoration?
removing the carious tissue and restoring the lesion, then placing a fissure sealant over the top to prevent any further fissure caries
What should you do if the cooperation in a child is inadequate but they have pit and fissure caries?
fissure seal and inform the patient and parent that further treatment is needed, monitor closely, treat with PRR when cooperation improves
What materials can you use for a class 1 restoration in young permanent teeth?
resin modified GIC, compomer, composite
How would you manage interproximal enamel lesions in the young permanent dentition?
fluoride varnish and monitor
How would you manage interproximal dentine lesions in the young permanent dentition?
restore the tooth or extract
Why are we not keen on trying everything to save young permanent first molars that have a large carious lesion?
because if we extract it at the right time, the 7’s will erupt and fill the gap
What are five things that can indicate restoration failure?
secondary caries, restoration fracture, marginal deficiencies, wear and tear, post-op sentitivity
What percentage of lesions into the inner half of enamel on the mesial surface of first permanent molars progress into dentine in 1 year?
20%
If you have an at risk patient and suspect caries what should you do?
take bitewings
If you diagnose pit and fissure caries into enamel only what should you do?
fissure seal and monitor
If you diagnose pit and fissure caries into dentine what should you do?
remove caries, restore cavity with composite, monitor and fissure seal over the top
If you took bitewings on an at risk patient due to suspected caries but see no caries on the bitewing what should you do?
fissure seal
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?
before the 7’s roots bifurcate
If you patient has deep caries in a tooth, no pain and no tooth crowding what should you do?
indirect pulp cap with a good coronal seal - preformed metal crown
If your patient has deep caries in a tooth, pain, no tooth crowding what should you do?
if pulpitis, perform a pulpotomy. if non-vital perform an RCT or extract
If your patient has deep caries in a tooth but has tooth crowding what should you do?
consult orthodontics
