Restoring the carious primary dentition Flashcards
Why restore?
- avoid pain
- avoid sepsis
- avoid extraction
- restore form
- restore function
- maintain space
- restore aesthetics
Impacts - pain stats and consequences
14% of 5 year olds and 20% of 12 year olds in
England had experienced toothache within last 6
months
• Difficulty eating (e.g. biting food, getting stuck
in teeth, eating slowly, giving up on meals)
• Loss of sleep (tiredness at school)
• Time off school
• Problems with tooth-brushing
• Interference with social activities
Impacts - infection stats and consequences
• 5% of UK children aged 5 years have dental sepsis
• Severe early childhood caries can contribute to
failure to thrive
• Preschool children with severe early childhood caries
weigh less and are smaller than peers
• Children with severe early childhood caries are 6
times more likely to have iron-deficiency anaemia than
peers
GA
- 58,000 children admitted with caries
- £31% of all GAs
- £30 million
- 25% increase in 10 years
“The fate of carious primary teeth of children who regularly attend the general dental service” aims, method
• Describe the approach to the care of primary teeth in the GDS • Describe the outcome of the care of primary teeth in the GDS • Retrospective case-note study (case controlled study)
“The fate of carious primary teeth of children who regularly attend the general dental service” results
• No difference in the restored vs unrestored outcome with pain or sepsis
or antibiotics as an outcome
• Majority of those extracted were done so for reasons other than pain or sepsis
(32%)
“The fate of carious primary teeth of children who regularly attend the general dental service” problems
- Didn’t address first aim
- Ga vs LA extraction not recorded
- Volunteers
- Case notes
- Diagnosis
- Quality of the restorations
- Regular attenders
- Includes anteriors
Restoration survival - filled, unfilled and fluoridated
1) filled teeth less likely to be extracted than unfilled teeth 2) teeth in fluoridated areas survive longer than those from nonfluoridated areas 3) the effect of treatment is substantially greater than the effect of fluoridation status
Barriers to treatment
- Pre-cooperative children
- Patient anxiety
- Skill / attitudes of the dental professional
- Parent view of materials
- Funding
Survival rates of different materials
- Conventional PMC 96%
- RMGI 93%
- Compomer 91%
- Amalgam 82%
- Composite 73%
- MRMGI 57%
- Rubber dam 94% v 78%
- Class I 92%
- Class II 85%
Amalgam
Article 10[2]- From 1 July 2018, dental amalgam shall not be used for dental treatment of: • Pregnant or breastfeeding women • Children under 15 years • Deciduous teeth except when deemed strictly necessary by the dental practitioner based on the specific medical needs of the patient.
Conventional PMC
- Large multi-surface restorations
- Pulp therapy
- Fractures
- Dental anomalies
- Space maintainer
LA
Restorations placed with LA more successful
Hall technique stats
101 children 17 GDPS 184 teeth (73%) • 96 conventional • 97 HT Exfoliated no failure 88 v 48
Biological vs conventional vs prevention
95.8% Sheffield (Hall technique) v 95.3% Leeds (conventional)
-i.e. both techniques work
97% v 94% (data from America 2015 giving same result)
Advantages of hall technique
- Child friendly
- Quick
- Effective
- Cost effective
Cariesolv and ART
ART:
Used in parts of the world without electricity
Remove caries (complete caries removal)
Put GIC in cavity and in occlusal fissures
Cariesolv:
-hypochloride + proteolytic enzymes
-put in cavity and agitate carious dentine
-dissolves carious dentine
-only for use in teeth with cavities
Non-restorative caries treatment (NRCT)
• Try to maintain contact • If necessary make a chamfer preparation • F varnish & OHI • HT>NRCT=conventional
Aesthetic and Anterior crowns
PMCs with veneers on them are £30 instead of £5 for posteriors
-lose veneer frequently –> becomes silver crown which pt didn’t want
Zirconia crowns
-now flex so can’t do Hall technique
-prep is quite disruptive as Zirconia doesn’t take feather edge
Aesthetic crowns not used in CCDH, preps are very large and very expensive
Evidence for indirect pulp cap
- Indirect pulp cap 94.4% (6)
- Direct pulp cap 88.8% (4)
- Pulpotomy 82.6% (31)
Fiction trial
Around 1500 children
Biggest RCT ever done in dentistry
Around 70 dental services and quite a few dental schools
1 arm biological (diet advice, OHI advice, fluoride application) i.e. no operative dentistry + Hall technique or composite GIC to seal in caries
Other arm conventional i.e. LA and drilling out decay as well as prevention
Results –> no difference between the two (biological arm should have won)
40% of children had pain and sepsis
These results could be due to late diagnosis because of recluctancy to take x-rays by dentists
Diagnosis
Success relies on diagnosis
• Meticulous clinical exam
• Radiographs
