restorative management of the primary dentition Flashcards
why is it important to restore the primary dentition?
-dental health affects general wellbeing and health
-dental infections have a detrimental effect on health
-can cause physical, mental and emotional effects
-especially in those with learning difficulties
-dental pain can be detrimental to health of child
why would you restore a tooth?
-prevent pain
-prevent irriversible pulpitis
-restore form
-restore function- speech/eating
-restore aesthetics
-acclimatisation- anxious or behavioural problems- best to get them used to it early
-maintain space- teeth may end up erupting at unusual angle e.g lower 5s erupting lingually
-untreated dental infections could cause sepsis or infections of permanent tooth germs leading to deformities such as turners teeth (enamel hypoplasia)
-avoid GA- traumatic and costly
-avoid GA in medically compromised pts eg bleeding disorders
how does primary morphology affect caries and restorations?
-dentine and enamel are less mineralised than permanent dentition- so caries progressive more quickly
-pulp horns are relatively larger compared with permanent- risk pulp exposure during restorations- higher on mesial aspect
how do primary teeth differ to permanent?
-smaller
-enamel and dentine is less mineralised
-enamel is thinner
-dentine is relatively thinner
-pulp is relatively larger
-pulp horns closer to surface
-contact points are flater and wider
why does caries progress quicker?
-thinner enamel
-relatively thinner dentine
-less mineralised enamel and dentine
-pulp is relative larger- closer to surface
how does primary pulp respond to caries progression?
-can produce secondary dentine- but progression is often to rapid
how many root canals do primary molars have?
usually 3 but can vary
where are the root canals positioned in lower primary molars?
MB ML D
where are the root canals positioned in upper primary molars?
MB DB P
how would you compose a tx plan?
-relieve pain
-prevention at home- OH and diet
-professional prevention- fluoride/FS
-stabalise caries
-restore
-pulp therapy
-extractions
discuss consent for tx
under 16s require parental consent - explain to parents in a way they understand using clinical and radiographic aids
-however, gillicks competence principal states that if a child understand pros/cons of procedure and is competent to consent- that can be accepted
what is needed to diagnose reversible and irreversible pulpits?
-take history of pain
-full examination
-radiographs
what is the likely history for reversible pulpits?
-pain from sweet/hot/cold
-pain relieved when stimulus removed
-short duration
-often occurs when eating/drinking
what is the likely history for irreversible pulpitis?
-pain remaining after stimulus removed
-prolonged and constant pain
-pain keeping you awake at night
-pain removed with analgesics
what would be seen upon exam with reversible pulpits?
-early carious lesion
what would be seen upon exam with irreversible pulpitis?
-extensively broken down marginal ridge
-sinus
-intr-oral swelling
-lymphadenopathy
-raised temp
what would be seen on radiograph for reversible pulpits?
-caries into dentine
what would be seen on radiograph for irreversible pulpits?
-caries into/close to pulp
restore or extract?
-enough tooth tissue- restore
-type of pulpits
-prev extractions?- restore as may affect function- hypodontia
-avoid GA- restore
-compliance of pt
-maintain space- avoid drifting eg lingual 5s
when should you extract?
-balancing for function
-poor compliance for long appts
-poor parental support
-poor attendance- may end up in pain
when would you temporise a tooth?
-to relieve pain asap and arrange for further restoration/extraction
-relive sharp edge
what should a temporary filling do?
-relive pain
-not be detrimental to pulp
-not affect future restoration
-provide a good seal
-used for one or two teeth at a time
describe stabilisation of teeth
-when poor OH and high amounts of active caries
-remove as much disease as poss round ADJ
-temporary filling to all necessary teeth until careful consideration is made on restoring/extracting
-buys time for cooperation/restore restorable teeth before extracting others
-prevents progression in other teeth when focusing on one
where is a good starting pt for treatment of children/
buccal maxillary- as painless LA can be given
when is it ok to give idb/more painful injection?
-when compliance has improved and pt is cooperative
-when pt confidence/trust and understanding has improved
what should be integrated before and throughout tx? and why?
-prevention or new lesions will form during tx
what is the typical sequence for caries tx for children?
-relieve pain-temp dressing
-at home prevention-OH and diet
-professional prevention-FS/FV
-acclimatise-simple rest-max first
-complicated rest, pulp therapy, extrcations
-IDB- whole q if poss
-anteriors
how is restoring the primary dentition affected by morphology?
-thinner enamel-progresses quicker-closer to pulp
-pulp horns closer to surface
- use small bur
what two factors help make you choose a material for a restoration?
-tooth factors- extent of caries and shape of cavity-will material stay.
-pt factors- moisture control, compliance/cooperation, aesthetics expectations, stabilise caries to prevent fast progression
what is the main method for restoring molar tooth but what is the downfall?
hall technique- not aesthetically pleasing
discuss occlusal caries in children
-occlusal caries less common as shallow tissues/pits
-compomers, composites or GI
-dependent on moisture control/isolation
what does the Minamata treaty state?
no amalgam in deciduous teeth since July 2018
what are the most common types of caries in molars of primary teeth?
-proximal- use ssc
where would drilling into a primary molar be less risky?
middle of fissure system as won’t contact pulp horns which are higher mesially
why is proximal cavities less likely to be preformed using conventional restorative techniques?
- likely to contact pulp horns
-little room for deep boxes
-July 2018- no primary amalgams allowed
what is the gold standard for proximal caries in primary molars? and why?
hall technique-sec
-avoid LA
-avoid pulp exposure
-no moisture control needed
-maintains arch space
-avoid GA
-strength
-durability
-wear
how is stainless steel crown maintained?
morphology- cervical constriction and gingival bulb
what class are proximal caries?
class II
when would you use ssc?
-large class II cavity
-badly broken down teeth
-dental anomalies
-following pulpotomoy
what is the first stage of primary crown prep?
choose size- marked tooth and position on buccal of crown
-measure mesiodistal width to get correct size
what are the two methods for crowns?
-conventional technique and prep
-halls technique
what is the technique for conventional technique and prep?
-remove caries
-use crown prep bur and slice medial, distal and occlusal aspect to allow crown to fit.
-aqua cem into crown and place crown
-remove excess cement
-check occlusion
what should you look our for when prepping for crown?
shoulders- crown won’t seat fully
how do you know you have selected the correct crown?
-should bounce- tight to tooth but if finger removed crown would spring back
why is hall technique ideal?
-no la
-no caries removal
-no prep
-easier for pt and operator
what is the hall technique ?
-choose crown size
-prep child by practicing biting technique
-fill crown with GI cement
-place crown on tooth and ask child to bite down
-wipe excess cement
-check occlusion
-occlusion likely high- advise parent and pt that this will return to normal as child alveolar bone malleable
what does anterior caries indicate in pre-school age?
bottle mouth caries- children going to bed with milk/juice which is washing over teeth throughout the night
what does anterior caries indicate in >3 yo?
high caries risk
in a pre-cooperative pt how would you treat anterior restoration?
-GI cement
in a cooperative pt-what is the ideal material for anterior restorations?
composite resin
what is discing in primary teeth?
self cleansing cavities- use disc to flatten edges of cavity to smooth it- no longer retentive- can arrest lesion
what are the downsides for using composite in primary teeth?
-bonding to thinner/less enamel/dentine
-cooperation
-moisture control-will not bond
what are the positive/negative for using glass ionomer cement?
pos
-good bonding- no moisture control
-good for stabilisation/temporisation
neg
-evidence of fluoride release are minimal
-little strength and not durable for proximal cavities
-poor aesthetics primary teeth
discuss rubber dam use in children?
-preferred over cotton wool
-gold standard for isolation-conventional comp resin rest and pulpotomy
-protect from inhalation and intake of medicaments
what are other methods of moisture control?
-cotton wool
-dry gaurds
-saliva ejector
-suction
when can LIA not be used for primary teeth?
-always es and sometimes ds
what needle is used for IDB?
short for <7s
long for >7s
what is the max dosage for prilocaine with felypressin?
1/11th cartridge per kg
what is the technique for IDB for children?
-angle of mandible is more obtuse to ID foramen is lower
-id foreamen is at or just above the occlusal plane
-barrel at opposing primary molars
