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bds3 paediatrics > Management of caries in Primary teeth > Flashcards

Management of caries in Primary teeth Flashcards

1
Q

What is the key recommendation for the management of caries in Primary teeth?

A
  • For a child with carious lesion in primary tooth choose least invasive, feasible caries management strategy
  • Take into account time to exfoliation, site and extent of lesion, risk of pain or infection, absence or presence of infection, preservation of tooth-structure, number of teeth affected, avoidance of treatment induced anxiety
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2
Q

What are the steps you as a dentist should take for management of caries in primary teeth?

A
  • Take all factors into account, establish what management options are best for child
    (dental amalgam in primary teeth should be avoided)
  • Bitewings for treatment planning
  • Discuss potential options with child and parent/carer
  • Agree caries treatment plan
  • Avoid operative interventions involving LA until child can cope
  • Use minimally invasive approach to caries management whenever poss
  • Manage primary tooth associated with infection (signs and symptoms of abscess, sinus, inter-radicular radiolucency, non-physiological mobility) either by extraction or pulpectomy or local measures to bring infection under control
  • Avoid iatrogenic damage to proximal surface of adjacent tooth when preparing cavities (Hall technique is useful)
  • Obtain consent from child or parent/carer
  • Carry out treatment
  • Do not leave infection untreated
  • Do not leave caries in primary teeth unmanaged
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3
Q

What are the signs and symptoms of infection/abscess?

A
  • Swelling (intra- or extra-oral), redness, lymphadenopathy
  • Sinus or abscess
  • Pathological mobility or tooth tender to percussion
  • Interradicular pathology radiographically
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4
Q

What to do if there are signs and symptoms of infection/abscess?

A
  • Consider local measures to control infection
  • Extract tooth or pulpectomy
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5
Q

What to do if the tooth is close to exfoliation?

A
  • Non-restorative cavity control or Site-specific prevention
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6
Q

What to do is caries is arrested?

A
  • Enamel is smooth, Dentine is hard and lesion likely to be dark in colour
  • Non-restorative cavity control or site-specific prevention
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7
Q

What to do if caries is active and tooth non-restorable?

A
  • Extract tooth
  • Or try Non-restorative cavity control and review
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8
Q

What to do if caries is active, tooth is restorable and on a radiograph there is clear separation between carious lesion and pulp?

A

Anterior Tooth
Initial lesion - Site specific prevention
Advanced lesion - Selective caries removal, Complete caries removal or Non-restorative cavity control

Molar Tooth
Initial lesion - Fissure sealant or Site specific prevention
Advanced lesion - Selective caries removal or Hall technique

Molar, Proximal
Initial lesion - Site specific prevention or a sealant/infiltration
Advanced lesion - Hall technique or Selective caries removal

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9
Q

What to do if caries active, tooth restorable but no clear separation between carious lesion and pulp?

A
  • Explain uncertain prognosis and consider management options
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10
Q

How do Initial caries in the occlusal surface present?

A

Visual diagnosis
- Teeth with nonactivated lesions (white spot lesions, discoloured or stained fissures)
- May be dentine shadowing or minimal cavitation where enamel is beginning to break down but no dentine is visible

Radiographic diagnosis
- Caries may be visible in outer third of dentine

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11
Q

What to do with initial caries on occlusal surface?

A
  • Seal lesion by placing fissure sealant or carry out site-specific prevention
  • If sealant is placed, monitor at each recall visit, top up sealant if worn or fractured. If lesion progressing adopt alternative management strategy
  • If child unable to accept resin, consider glass ionomer sealant using press finger technique
  • If child unable to accept any fissure sealant, consider sealing using Hall technique
  • Only continue with selected approach if caries has arrested and no evidence progression
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12
Q

How does Advanced caries occlusal present on primary molars?

A

Visual diagnosed
- Teeth with cavitation or dentine shadow and visible dentine

Radiographic diagnosis
- Lesion visible within dentine and may extend into inner third
- Should be clear band of dentine visible that separates carious lesion and pulp

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13
Q

What to do with advanced carious lesion on occlusal surface of primary molar?

A
  • If caries only present on occlusal surface, carry out selective caries removal and restore using composite, resin modified glass ionomer, compomer or glass ionomer
  • If child not cooperative enough for selective caries removal with good adhesive restoration, seal in caries using Hall technique
  • If proximal lesion also present, seal using Hall technique
  • If extensive cavitation or tooth not restorable, consider non-restorative cavity control approach
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14
Q

How does Initial caries present proximally on primary molar teeth?

A

Visual diagnosis
- Teeth with white spot lesions or shadowing

Radiographic diagnosis
- May be enamel lesions but these do not extend into dentine

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15
Q

How to manage Initial caries Proximal on primary molars?

A
  • Site specific prevention and monitor at each recall visit
  • If lesion progressing, adopt alternative management strategy
  • Or consider sealing lesion by placing sealant or resin infiltration and monitor at each recall visit, replacing as necessary to avoid lesion progressing
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16
Q

How do Advanced caries present proximally on primary molars?

A

Visual diagnosis
- Teeth with enamel cavitation and dentine shadow
- Or cavity with visible dentine

Radiographic diagnosis
- Lesions visible within dentine and may extend as far as inner third
- Should be clear band of dentine visible that separates pulp and carious lesion
- Where no clear band of dentine, likely that carious lesion has encroached on dental pulp and pulpotomy necessary

17
Q

How to manage Advanced caries proximally in primary molars?

A
  • Without removing caries, seal in caries using Hall technique
  • Or selective caries removal and restore using composite, resin modified glass ionomer or compomer
  • When symptoms of pain it may be because of food packing or pulpitis with reversible symptoms but diagnosis unsure - Temp dressing placed and patient reviewed 3-7 days later to check symptoms - Resolution of symptoms indicate pulpitis reversible and Hall crown or suitable restoration placed - symptoms worsen then extraction/ pulpotomy
  • If unrestorable, consider non-restorative cavity control (lack of evidence and should be documented in patients records)
18
Q

Why is the Hall technique preferred over restoration?

A
  • Avoids possibility of iatrogenic damage to adjacent teeth from rotary instruments
19
Q

How does Initial caries in anterior teeth present in primary teeth?

A

Visual diagnosis
- Teeth with white spot lesions/ areas of demineralisation confined to enamel

20
Q

How do you manage initial caries in anterior primary teeth?

A
  • Site-specific prevention
  • Monitor at each recall visit and continue this approach if caries has arrested and no evidence of progressing
  • If lesion progressing, adopt alternative management strategy
21
Q

How does advanced caries in anterior primary teeth present?

A

Visual diagnosis
- Teeth with cavitation of dentinal shadow

22
Q

How do you manage advanced caries in anterior primary teeth?

A
  • Selective caries removal and restore using composite, resin modified glass ionomer, compomer, glass ionomer or strip crowns (preffered)
  • Or Completely remove caries and restore
  • Or carry out non-restorative cavity control
23
Q

What is the description of Pulpitis with reversible symptoms?

A
  • Pain provoked by cold/sweet stimulus
  • Relieved when removed
  • Pain intermittent
  • Doesn’t affect child’s sleep
  • Pulp vital and tooth tender to percussion
24
Q

How to manage pulpitis with reversible symptoms in primary teeth?

A
  • Place crown using Hall technique
  • If occlusal lesion then selective caries removal, avoid pulp and restore using composite, resin modified glass ionomer, compomer or glass ionomer
  • When symptoms of pain it may be because of food packing or pulpitis with reversible symptoms but diagnosis unsure - Temp dressing placed and patient reviewed 3-7 days later to check symptoms - Resolution of symptoms indicate pulpitis reversible and Hall crown or suitable restoration placed - symptoms worsen then extraction/ pulpotomy
  • If tooth close to exfoliation, consider applying dressing
25
Q

What is the description of Pulpitis with irreversible symptoms?

A
  • Pain occur spontaneously
  • If provoked by stimulus its not typically relieved when stimulus is removed
  • Pain may last several hours and keep child awake at night
  • Pain may be dull and throbbing, worsened by heat and alleviated by cold
  • No signs or symptoms of infection such as sinuses or abscesses or periradicular pathology
  • Pulp still vital although inflamed
  • Not tender to percussion
26
Q

How to manage Pulpitis with irreversible symptoms?

A
  • If child anxious then gently remove gross debris from cavity and apply corticosteroid antibiotic paste under temp dressing
  • If cooperative, open pulp chamber under local and apply corticosteroid paste directly to pulp then place dressing. Prescribe pain relief then carry out pulpotomy or extract tooth
27
Q

What is the description of dental abscess/periradicular periodontitis in primary teeth?

A
  • Pain if present may be spontaneous, child awake at night and easily localised by child
  • Tooth show increased mobility and tender to percussion
  • Clinical evidence of sinus, abscess or swelling
  • Radiograohic evidence of interadicular pathology
28
Q

How to manage dental abscess/ periradicular periodontitis in primary teeth?

A
  • If child cooperative, extract tooth even if infection is asymptomatic
  • Only in exceptional circumstance if tooth is restorable consider pulpectomy, may require referral
  • In some cases local measures to bring infection under control is appropriate
  • If child uncooperative refer to specialist for treatment
29
Q

What does a radiograph with no clear separation between carious lesion and dental pulp look like?

A
  • Radiograph shows carious lesion that extends to inner third of dentine
  • No clear band of normal looking dentine visible that separated carious lesion and dental pulp
30
Q

How to manage a carious lesion with no clear separation between lesion and dental pulp in primary teeth?

A
  • When no signs or symptoms of pulpal pathology and degree of uncertanity around separation between lesion and pulp consider hall technique
  • Uncertain prognosis discussed with parent/carer
  • If signs and symptoms of pulpal pathology, carry out pulpotomy
31
Q

What are teeth close to exfoliation?

A
  • Teeth that are clinically mobile or radiographically show evidence of root resorption
32
Q

How to manage teeth close to exfoliation?

A
  • Site-specific prevention or non-restorative cavity control
33
Q

When do primary molars exfoliate?

A

First primary - 9-11
Second primary - 10-12

34
Q

How do teeth with arrested dentinal caries present?

A
  • Surface of tooth hard when a ball ended probe drawn across it
  • Often appear black or honey yellow appearance
35
Q

How to manage teeth with arrested dentinal caries?

A
  • Site-specific prevention or non-restorative cavity control
36
Q

How do active dentinal caries present?

A
  • Soft, moist and friable to touch
37
Q

How does an unrestorable primary tooth present?

A
  • Most of crown of tooth destroyed by caries or fractured making restoration imposs
  • Or dental pulp is exposed and formed pulp polyp
38
Q

How to manage unrestorable primary teeth?

A
  • Non-restorative cavity control or extract tooth (esp if associated with infection)
  • Avoid extractions at child’s first visit if poss

bds3 paediatrics (14 decks)

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