SDCEP caries management Flashcards
what should be taken into account when deciding caries management of a deciduous tooth (3)
time to exfoliation
risk of pain or infection
number of teeth affected
co-operation of child
treatment of choice for child with pulpitis pain in a vital tooth with irreversible symptoms and no evidence of dental abscess
pulpotomy
benefits of the hall technique
no LA
no tooth preparation
to risk of iatrogenic damage
what tooth is suitable for no caries removal and hall technique
primary tooth with advanced lesion on proximal surface
can also be done for advanced occlusal lesion
aim of hall technique
completely seal a carious lesion so that the environment of the plaque biofilm is altered sufficiently to slow or even arrest caries progression
process of hall technique
- have child sitting upright
- assess if separators requires, if so, place then 2nd appointment 3-5 days later
- select size of PMC
- fill crown with glass ionomer luting cement
- seat crown - can be assisted by child biting on cotton wool roll over the tooth
- remove excess cement and clear contacts using floss
what teeth are suitable for no caries removal and seal with a fissure sealant
primary or permanent teeth with an initial occlusal (or proximal lesion)
name an example of an atraumatic restorative technique
hand excavation
how much caries is removed in selective caries removal
no obvious caries at ECJ
clear cavity walls till hard dentine
pupally, clear caries until adequate depth for durable restoration (in deep lesions this may been soft dentine is left)
tooth suitable for a pulpotomy
- pulpitis with irreversible symptoms (vital tooth)
- primary molar with advanced carious lesion with no clear band of dentine separating caries and pulp (vital tooth)
pulpotomy technique (primary teeth)
- give LA and ideally place dam
- access cavity and caries removal
- remove coronal pulp with slow speed or excavator
- irrigate with saline
- arrest haemhorrage with pledget soaked in ferric sulphate
- ZOE cement over stumps and to fill cavity
- restore with PMC
contraindications for endodontics in primary molars
poor co-operation
space closure desired by orthodontics
advanced root resorption
severe-recurrent pain
pus in pulp chamber
when would pulpectomy of a primary molar be done
- excellent co-operation
- long time till exfoliation
- no successor
primary pulpectomy technique
- access
- coronal pulp extirpation
- root canal preparation
- obturation using calcium hydroxide iodoform paste (vitapex)
- create a GIC core
- crown
what medical history precludes an extraction in children
bleeding disorders
coagulopathies
(endodontic treatment preferred)
what medical history precludes pulp treatment in children and why
cardiac problems
immunocompromised
chance pulp treatment wont work, extraction preferred as less chance of developing infection
how often should bitewings be taken in children
standard risk - every 2 years
increased risk - every 6 -12 months
(SDCEP guidelines)
what age should bitewings start being taken
4-5 years old
partial (cvek) vs complete pulpotomy
partial - removal of 2-3mm coronal pulp (permanent teeth only)
full - removal of entire coronal pulp to level of canal orifices
pulpotomy technique in permanent teeth
1.LA, dam and access
2. remove 2-3mm coronal pulp (Cvek) with slow speed
3. arrest haemhorrage with saline soaked pledget
- if no bleeding or prolonged bleeding progress to full pulpotomy -
4. setting calcium hydroxide over exposed pulps
5. GIC (vitrebond) lining
6. seal with definitive restoration
direct pulp cap indications and process
exposure <2mm
exposure <24 hours
control bleeding with saline soaked pledget
place layer of setting calcium hydroxide
restore
pulpectomy in permanent immature tooth
- LA, dam and access
- irrigation with sodium hypochlorite (little to no prep required)
- apexification using MTA
- seal MTA with sealer
- obturate with GP
- seal with RMGIC
- restore
discuss stepwise caries removal
visit one:
LA and access with highspeed, clear till no obvious caries at ECJ
use slow speed or excavator to clear cavity walls to hard dentine
pulpally clear caries until adequate thickness for durable restoration
place temporary restoration e.g fuji triage
wait 6-12 months (tertiary dentine formation)
remove temporary restoration
remove carious dentine until hard dentine reached (be mindful of pulp)
may require indirect pulp cap
restore with definitive restoration
what lesions would stepwise caries removal be appropriate for
extensive occlusal and proximal lesions in permanent teeth
what lesions are suitable for selective caries removal and restoration
primary - advanced anterior and occlusal
permanent - moderate occlusal and proximal
what lesions are suitable for complete caries removal and restoration
permanent teeth - moderate lesions at all sites
discuss site specific prevention as a means of caries management
can be used for initial lesions on all sites of primary teeth and for occlusal and proximal lesions of permanent teeth
also primary teeth close to exfoliation and arrested caries
- brushing demonstration
- FV 4x year
- dietary advice
