Caries Pattern and Diagnosis - Caring for Children and Young People

Question 1

Where are decalcification spots commonly found

Answer 1

Mesial wall of first permanent molar
Smooth surface of teeth at cervical region
Bands on teeth when orthodontic braces are removed

Question 2

Where are pit and fissure caries most commonly found in children

Answer 2

Buccal pits of lower first permanent molars
Palatal pits of upper first permanent molars
Cingulum pit behind upper lateral incisors

Question 3

Which teeth are commonly affected by nursing bottle caries

Answer 3

Maxillary incisors
First molars
Mandibular canines

Question 4

Which teeth are protected from nursing bottle caries and why

Answer 4

Lower incisors due to increased saliva in the lower arch and protection by the tongue

Question 5

What is rampant caries

Answer 5

=>10 new lesions per year

Lower anterior affected

Question 6

Describe the pattern of attack in caries of the primary dentition

Answer 6

Lower molars, upper molars and upper anteriors first
Rare in lower anteriors, and buccal and lingual surfaces
Occlusal caries found more in the second primary molars than the first
Interproximal caries not found until contact develops
Can have enamel hypomineralisation

Question 7

Which teeth are most commonly saved when teeth are removed in the primary dentition

Answer 7

Save canines to guide other teeth in

Usually lower anteriors are saved

Question 8

Describe the caries patten in the mixed dentition

Answer 8

Caries rate in the lower 6s > upper 6s
Found in pits and grooves in the palatal upper 6s, palatal upper laterals and the buccal lower 6s
If found in upper and lower incisors then it is rampant caries

Question 9

What should be checked in an extra-oral examination in children

Answer 9

Facial symmetry

Lymph nodes

Question 10

What should be checked in the soft tissues in an intra-oral examination in children (5)

Answer 10

Oral hygiene
Swellings
Sinuses
Ulceration
Gingival health

Question 11

What should be checked in the hard tissues in an intra-oral examination in children (6)

Answer 11

Teeth present
Occlusion
Loose, missing and extra teeth
Trauma
Dental anomalies
Caries activity - past and present

Question 12

What should be considered when thinking about removing a child’s tooth (6)

Answer 12

Is the tooth restorable
Parent compliance
Stage of dental development
Space management 
Anticipated difficulties
Overall prognosis

Question 13

How may carious teeth be stabilised in children

Answer 13

Prevent pain by arresting restorable lesions and using temporary restorations with IRM or GIC
Hand excavate gross caries and use carisolv to dissolve carious dentine

Question 14

What can be used to prevent crowding when removing a child’s tooth

Answer 14

Band and loop space maintainer

SS crown in a distal shoe

Question 15

When can a distal shoe be used

Answer 15

For removing a second primary molar when the first permanent molar isn’t there
The first permanent molar will then erupt in to the correct space

Question 16

What is the result of early primary tooth extractions

Answer 16

Increased crowding which causes increased tendency for space loss
The earlier removed the higher degree of space loss

Question 17

Give an examples of balancing/compensating extractions

Answer 17

If taking out one primary canine, take out the other in the opposite arch so centreline will be in the middle and won’t shift

Question 18

Which teeth are often used in balancing/compensating extractions

Answer 18

Primary canines

First primary molars

Question 19

What happens if there is early loss of the upper first permanent molars

Answer 19

Loss before complete eruption of 7s causes rotation and mesial movement of the 7s and distal drift of the 5s

Question 20

What happens if there is loss of the lower first permanent molars

Answer 20

Loss after optimum age - tilting 7s

Loss before optimum age - 5s drift distally and rotate

Question 21

How are treatment conditions optimised for children

Answer 21

Pain free LA - topical, warm cartridge
If child doesn’t have lower 6s, can use an intra-papillary infiltration rather than an IDB
Use rubber dam

Question 22

How does rubber dam increase safety

Answer 22

Decreases damage to soft tissues, risk of inhalation and cross-infection

Question 23

How does rubber dam benefit the operator and patient

Answer 23

Increases isolation and moisture control, retraction of gingivae and cheeks
Gives effective inhalation sedation
Increases patient and operator confidence

Question 24

Describe the sequence of restoration in children

Answer 24

Fissure sealants
Preventative restorations
Simple restorations - shallow cervical cavities
Fillings requiring LA but not into the pulp - upper arch first
Pulpotomies/pulpectomies
Extractions