Restorative work in Primary teeth Flashcards
What are the four stages of pulpal disease?
Normal, Inflamed, Necrotic, Infected
What are the four different terms for pulp status?
Healthy, Reversibly Inflamed, Irreversibly Inflamed, Pulp Necrosis
Why is it important to know about pulpal pathology in primary teeth?
there is early pulpal involvement from decay etc due to the larger pulp horns relative to tooth size
What are the ways primary pulp can respond to caries?
pulp regeneration, reparative dentine, pulpal inflammation
Why is it important to diagnose pulp status?
to determine the most appropriate treatment option
What are some ways it is difficult to diagnose pulp status in primary teeth?
lack of correlation between clinical symptoms and histological evidence, unreliable tests
What is the only method to get a precise diagnosis of pulp status?
histological examination
How do we diagnose pulp status?
symptoms, clinical findings, special investigations
What are symptoms of reversible pulpitits?
pain on stimulus, pain stops when stimulus is removed, pain is sharp, painkillers work, pain doesn’t linger
What are symptoms of irreversible pulpitits?
spontaneous pain, constant pain, pain lingers, painkillers don’t work, pain is a dull throbbing ache, pain disrupts sleep
What are some clinical findings for irreversibly inflamed teeth?
discoloured, over 1/2 the tooth broken down, over 2/3 the marginal ridge broken down, pain when you touch the tooth, sinus, intra or extra oral swelling
What are the special investigations you can complete to asses pulp status in primary molars?
radiographs, mobility, TTP
What can you assess on radiographs regarding pulp status?
extent of caries, any inter-radicular radiolucency, external or internal resorption
What can you assess with mobility?
whether the mobility is pathological or physiological
What can you assess with the TTP?
differentiate between food impaction and peri-radicular pathology
Does vitality testing have any benefit in primary teeth?
no
When assessing teeth what are the two pathways for treatment?
restore or extract
What medical factors can indicate you should try and restore the tooth?
bleeding disorders, if the patient would be at risk under GA
What medical factors can indicate you should extract the tooth?
immunocompromised patients, patients with cardiac disorders and at risk of infective endocarditis
What are some behavioural and social factors to consider when determining whether to restore or extract a tooth?
dental awareness, motivation, pattern of attendance, age of the child, how long the tooth will last
What are some dental factors to consider when determining whether to restore or extract a tooth?
if the patient has gross dental neglect or any acute infection, time to natural exfoliation of the tooth, effect on developing dentition, if the patient has hypodontia
If the tooth is due to exfoliate within a year, what are your recommended treatment options?
provisional restoration or extraction
If the tooth is due to exfoliate later than a year, what are your recommended treatment options?
retain the tooth with a definitive restoration
What are the options for pulp therapy for vital teeth?
pulp capping, pulpotomy
What are the options for pulp therapy for non-vital teeth?
pulpectomy, extraction
When do you perform vital pulp therapies?
if there is a restorable crown, if there is no radiographic pathology, reversible pulpitis, if there are no sinus or abscesses
What is pulp capping?
a method of maintaining the vitality of the pulp by placing a dressing
What is the aim of pulp capping?
to promote pulpal healing
what are the two type of pulp capping?
direct or indirect
What is direct pulp capping?
medicament placed directly onto pulp
What is the aim of direct pulp capping?
to promote dentine bridge formation and preserve vitality
What medicament is commonly used for direct pulp capping?
Calcium Hydroxide
Is direct pulp capping recommended for carious primary molars?
no
When is direct pulp capping recommended for primary molars?
if the exposure is iatrogenic
What are the aims of indirect pulp capping?
arrest caries, allow for formation of reactionary dentine, promote pulp healing and preserve vitality
What are indications of indirect pulp capping?
deep carious lesion, no signs of pulpal pathosis
What is indirect pulp capping?
placing a dressing on to residual dentine left over a nearly exposed pulp
What is the most important part of indirect pulp capping?
getting a good coronal seal
Why can you get inter-radicular radiolucency?
there are accessory foramen between the roots and the toxins from pulp can leach into the area causing bone resorption
What is pulpotomy?
removal of the coronal part of the pulp tissue
What is the aim of a pulpotomy?
maintain the vitality of radicular pulp
What is the haemostatic agent used in pulpotomy?
ferric sulphate
How does ferric sulphate stop bleeding?
causes agglutination of blood proteins - improves clotting
What is the aim of a desensitising pulpotomy?
to reduce pulpal inflammation or symptoms to facilitate subsequent pulp therapy
What are some indications for densensitising pulpotomy?
hyperalgesic pulp and poor patient compliance
What dressing do you use in a desensitising pulpotomy?
ledermix then GIC
How long can you leave the temp GIC restoration after desensitising pulpotomy before placing a definitive restoration?
1-2 months
What is a pulpectomy?
extirpation of soft tissue content from the coronal pulp chamber and root canals
What are the indications for pulpectomy?
evidence of irreversible pulpitits or pulpal necrosis
What indicated success of pulp therapy at follow up appointments?
absence of signs or symptoms of pathology
What indicates failure of pulp therapy at follow up appointments?
worsening or increase in symptoms, radiolucencies
What are the keys to success for pulp therapy?
accurate diagnosis, good technique, restoration with a good coronal seal
What is the easiest way to get a good coronal seal with primary teeth?
pre-formed metal crown
What question is important to ask the parent about the child’s pain?
Is your child kept awake with tooth ache at night?
Can you use GP in primary teeth?
no
Why can you not use GP in primary teeth?
GP doesn’t resorb but primary roots do
Where is most decay found in primary teeth?
interproximally
Why is it important to treat extensively decayed primary teeth?
the infection can affect adult teeth
What is classed as obvious caries?
caries visible upon clinical examination
What percentage of 5 year olds in england, wales and northern ireland have obvious caries experience?
40%
Does the percentage of children with obvious caries increase or decrease as they age?
decrease
Do the majority of children with obvious caries have many restoration or no restorations?
no restorations
For the 5 year olds with tooth decay, what is the average number of teeth affected?
3-4
What is the average cost of a tooth extraction in hospital for a child aged under 5?
£836
How should you diagnose caries in children?
clinical examination using good lighting and 3 in 1, radiographs
Can radiographs be used instead of a good clinical exam and history?
no, they are additional
What are the best radiographs that can be used to assess caries?
bitewings
Why can you not see most of the interproximal caries clinically in primary teeth?
there are broad contact areas
How often should bitewing radiographs be taken in high caries risk children?
every 6 months
When do you stop taking bitewings every 6 months for high caries risk children?
when no new or active lesions are apparent and the individual is no longer high caries risk
How often should bitewing radiographs be taken in moderate caries risk children?
once a year
How often should bitewing radiographs be taken in low caries risk children?
every 12-18 months for primary dentition, every 2 years for permanent dentition
Why do we complete restorations in primary teeth?
eliminate disease, prevent pain, avoid infection, preserve space, maintain function
What percentage of 5 year olds have dental pain due to caries?
12%
What percentage of DMFT in UK 5 year olds go untreated?
86%
What is the average DMFT score for UK 5 year olds?
1.1
What are some problems that may occur when trying to restore primary teeth?
children can’t concentrate or cooperate for long periods of time, may be scared of the dentist, may not understand all the reasons to complete the treatment, the childs mouth is smaller and access can be poor, moisture control can be more difficult, child may have mobile teeth
What is the clinical significance regarding restorations due to the narrow occlusal table of primary teeth?
buccal-lingual width of the cavity needs to be reduced
What is the clinical significance regarding restorations due to the broad, flat contact areas of primary teeth?
there are problems diagnosing caries as they are harder to see clinically
What is the clinical significance regarding restorations due to the thinner enamel and dentine layers of primary teeth?
caries progresses to pulp faster
Where are most caries located in primary teeth?
interproximally
How are most interproximal lesions detected in primary teeth?
radiographically
What are the potential materials that can be used for restoring caries in primary teeth?
composites, GIC, Resin modified GIC, Compomers, Preformed Metal Crowns
What are advantages to using composites to restore primary teeth?
adhesive, aesthetic, good mechanical properties
What are disadvantages to using composites to restore primary teeth?
good moisture control is needed, expensive, has no fluoride leaching therefore is not preventative
What is the setting reaction for standard GIC?
the acid-base reaction between glass and poly acid
What is the setting reaction for dual cure GIC?
the acid-base reaction between glass and poly acid as well as a light activated free radical polymerisation
What are advantages to using GICs to restore primary teeth?
adhesive, good aesthetics, flouride leaching which means they are preventative
What are advantages to using Light cure GIC over standard GIC to restore primary teeth?
they are command set
What are characteristics of conservative restorative technique for GIC prep?
optimise tooth integrity, reduce load on restorative material, preserve pulp status, reduce risk of further caries
When is GIC not recommended?
for long term restorations or for large cavities
How do you place the GIC in a primary tooth?
remove caries with slow handpiece, place cavity conditioner, place a matrix band, place GIC, allow to set with minimal disturbance for 2-3 mins
What are benefits to placing unfilled resin over GIC?
protects the GIC during final setting
What are some disadvantages to using GIC to restore primary teeth?
mechanical properties are not as good as resins, poor resistance to wear, not as durable as resins
What are compomers?
polyacid modified composites
What are advantages to using compomers to restore primary teeth?
good handling properties, radio-opaque, better mechanical properties than GIC
What are disadvantages to using compomers to restore primary teeth?
less fluoride leaching than GIC, there is resin polymerisation contraction, need a primer
What are indications for the use of preformed metal crowns?
inter-proximal cavities, 2 or more carious surfaces on a tooth, primary teeth that have been root treated, young children
What are contra-indications for the use of preformed metal crowns?
a non vital tooth, small occlusal cavities, older children, parental preference
What is the restorative technique of choice for primary dentition?
preformed metal crowns
