restoring carious primary dentition Flashcards
Why restore?
Avoid pain/sepsis/extraction
Restore form/function
Maintain space
Restore aesthetics
How many children have infection?
5% of 5 year olds have dental sepsis
Severe childhood caries=weigh less, 6x likely to have anaemia
What are GA statistics?
31% of all GAs are for caries
25% increase in 10 years
What was ‘the fate of carious primary teeth of children who regularly attended the general dental service’?
Retrospective case-note study 2002
Showed no difference in restored v non restored w pain/sepsis/antibiotics as outcome
Showed majority of x were due to other reasons than pain/sepsis (32%)
What were problems w the study?
Didn’t address first aim
Volunteers
Case notes
Quality of restorations
Regular attenders (18 months)
Includes anteriors (close to exfoliate)
What did the Stephenson paper 2010 show?
Filled teeth less likely to be extracted than unfilled
Teeth in fluoridated areas survive longer
Effect of tx is far greater than the effect of fluoridation
What are barriers to restoring teeth?
Pre cooperative children
Pt anxiety
Skill/attitude of dentist
Parent view of materials
Funding
How can you restore teeth?
Amalgam
Composite
RMGIC
PMC
What are the survival rates of primary restorations?
PMC- 96%
RMGI- 93%
Compomer- 91%
Amalgam- 82%
Composite- 73%
Class I- 92%
Class II- 85%
Do we use amalgam?
Not used for -
Pregnant/breastfeeding women
Children under 15 years
Deciduous teeth
~EU regulation 2017
What are indications for PMC?
Large multi surface restorations
Pulp therapy
Fractures
Dental anomalies
Space maintainer
Do we use LA?
More successful with
Pt in less discomfort
Dentist more confident of not hurting pt
Do we use the Hall technique?
No caries removal or need for LA
Using Hall technique- 88% exfoliated w/o failure
Using conventional- 48% exfoliated w/o failure
Sheffield/Leeds study showed no difference
What are advantages of the hall technique?
Child friendly
Quick
Effective
Cost effective
What are some other techniques of restoring teeth?
Aesthetic crowns- facings can debond and can’t put back on/zirconium crowns need prep and cns affect pulp, they don’t have flex, more expensive
Atraumatic restorative technique ART- remove all caries w hand instrument then fill w RMGI
Carisolv- hypochlorite and proteolytic enzymes, place in cavity and rub on caries to remove (w/o LA)
Non-restorative caries tx NRCT- small prep to make caries self cleansing
Silver diamine fluoride- (+ potassium iodide)- arrests and prevents caries, turns black however
