Caries in Children

Question 1

how would you treat a child in pain due to pulpitits in a vital primary tooth with irreversible symptoms and no evidence of dental abscess?

Answer 1

pulpotomy

Question 2

what factors should you take into account when choosing a caries management strategy in a primary tooth?

Answer 2

• the time to exfoliation
• the site and extent of the lesion
• the risk of pain or infection
• the absence or presence of infection
• preservation of tooth structure
• the number of teeth affected
• avoidance of treatment-induced anxiety

Question 3

what factors should you take into account when choosing a caries management strategy in a **permanent **tooth?

Answer 3

• the site and extent of the lesion
• the risk of pain or infection
• preservation of tooth structure
• the health of the dental pulp
• avoidance of treatment-induced anxiety
• lifetime prognosis of the tooth
• orthodontic considerations
• occlusal development

Question 4

state 3 priorties of the dental team

Answer 4

• to relieve pain or infection if present
• to invoove both the child and their parent/carer in decisions regarding the child’s oral health care
• if caries in the permanent dentition does occur, to diagnose it early and manage it appropriately

Question 5

what elements should be included in a comprehensive assessment of a child if the personal care plan is to be effective in improving the child’s oral health?

Answer 5

• parent/carer motivation and responsibility
• patient history
• clinical examination
• caries risk assessment

Question 6

why does caries affected enamel have a white appearance?

Answer 6

acidic solutions preferentially dissolve prism sheaths in enamel, creating pores
these pres refect light, relfecting it back instead of letting it pass through

Question 7

how would you describe the caries shown?

Answer 7

• matt, opaque chalky white lesion
• suggests only the enamel layer is affected

Question 8

how would you desribe the caries shown?

Answer 8

• opalescent white lesion
• suggests caries has passed enamel dentine junction and infected the dentine

Question 9

how would you desribe the caries shown?

Answer 9

• cavitation visible as dark, carious dentine
• surrounded by an opalescent white halo (where the enamel sub-surface is partially demineralised and refelcts light back)
• white halo isis not affected and appears shiny rather than matte white
• dark halo is due to carious dentine underneath

Question 10

why must teeth be clean and dry for effective caries diagnosis?

Answer 10

if surface enamel pores fill with saliva, they allow light to be transmitted through the enamel

Question 11

how do you tell the difference between active and arrested enamel caries through its clinical characteristics?

Answer 11

• arrested enamel surface will feel smooth to a probe lightly drawn across it
• if the surface feels rough or the probe is felt to drag compared to adjacent sound enamel, the lesion is active

Question 12

what is the difference in appearance of active and arrested dentinal caries?

Answer 12

active- soft lesion, matt in apearance
arrested- harder lesion, may appear shiny
colour is not a reliable indictor

Question 13

give an example of when a panoramic radiograph would be clinically justified

Answer 13

as part of a gre-general anaesthetic assessment

Question 14

what can you use to assess for cavitation if enamel-only proximal lesions are identified?

Answer 14

orthodontic separators

Question 15

how can cusp of carabelli sometimes show on a bitewing radiograph?

Answer 15

a traingle shaped radiolucency seen on the mesial surface
can be mistaken for proximal caries

Question 16

how is initital occlusal caries in primary teeth classifed?

Answer 16

noncavitated, dentine shadow or minimal enamel cavitation
radiograph- outer third dentine

Question 17

how is advanced occlusal caries in primary teeth classified?

Answer 17

dentine shadow or cavitation with visible dentine
radiograph- middle or inner third dentine

Question 18

how is initial proximal caries in primary teeth classified?

Answer 18

white spot lesion or shadow
radiograph- lesion confined to enamel

Question 19

how is advanced proximal caries in primary teeth classified?

Answer 19

enamel cavitation and dentine shadow or cavity with visible dentine
radiograph- may extend into inner third dentine

Question 20

how is initial anterior caries in primary teeth classified?

Answer 20

white spot lesions but no dentinal caries

Question 21

how is advanced anterior caries classified in primary teeth?

Answer 21

cavitation or dentine shadow

Question 22

how is caries with pulpal involvement classified in primary teeth?

Answer 22

any tooth with clinical pulpal exposure or no clear separation between carious lesion and dental pulp radiographically

Question 23

how is caries in a tooth near to exfoliation classified in primary dentition?

Answer 23

clinically mobile
root resorption shown in radiograph

Question 24

how is an unrestorable carious tooth classified in primary teeth?

Answer 24

crown destroyed by caries or fractured, or pulp exposed with pulp polyp

Question 25

how is initial occlusal caries classified in permanent dentition?

Answer 25

noncavitated enamel carious lesions; * white spot lesions * discoloured or stained fissures radiograph- up to the enamel-dentine junstion or not visible

Question 26

how is moderate occlusal caries classified in permanent dentition?

Answer 26

Enamel cavitation and dentine shadow or cavity with visible dentine Radiograph: up to and including middle third dentine

Question 27

how is extensive occlusal caries classified in permanent teeth?

Answer 27

Cavitation with visible dentine or widespread dentine shadow Radiograph: inner third dentine

Question 28

how is initial proximal caries classified in permanent dentition?

Answer 28

White spot lesions or dentine shadow. Enamel intact Radiograph: outer third dentine

Question 29

how is moderate proximal caries classified in permanent dentition?

Answer 29

Enamel cavitation or dentine shadow Radiograph: outer or middle third dentine

Question 30

how is extensive proximal caries classified in permanent dentition?

Answer 30

Cavitation with visible dentine or widespread dentine shadow Radiograph: inner third dentine

Question 31

how is initial anterior caries in permanent teeth classified?

Answer 31

White spot lesions but no dentinal caries

Question 32

how is advanced anterior caries classified in permanent dentition?

Answer 32

cavitation or dentine shadow

Question 33

how is caries with pulpal involvement classified in permanent dentition?

Answer 33

Any tooth with clinical pulpal exposure or no clear separation between carious lesion and dental pulp radiographically

Question 34

when is a permanent tooth classified as unrestable?

Answer 34

Crown destroyed by caries or fractured, or pulp exposed with pulp polyp (pain/infection free)

Question 35

what is molar incisor hypomineralisation (MIH)

Answer 35

hypomineralisation of systemic origin of 1-4 permanent first molars, frequently associated with affected incisors

Question 36

what are the signs/symptoms of MIH?

Answer 36

* sensitive to temperature * painful on toothbrushing * increased caries susceptibility * lesions can range from small white opacities with no breakdown, to large, dark yellow/brown areas that can fracture off

Question 37

where are sinuses usually present?

Answer 37

on the non-attached mucosa adjacent to the attached mucosa

Question 38

name indicators of established dental infection

Answer 38

* tenderness to percussion in a non-exfoliating tooth * alveolar tenderness, sinus or swelling * non-physiological mobility * radiographic signs, including inter-radicular radiolucency

Question 39

which factors must you take into consideration when deciding on management of a carious primary tooth?

Answer 39

* extent of the lesion * site of the lesion * activity of the lesion * time to exfoliation * number of other lesions present in the dentition * the child's medical status * anticipated cooperation of the child * anticipated cooperation of the parent/carer with the preventative interventions and to attend repeat management appointments * the range of clinical procedures the clinician has the skill to provide

Question 40

what does a pulp polyp in a carious primary molar suggest about the canals?

Answer 40

at least one of the root canals is vital and the other canals may be necrotic

Question 41

what are the 4 possible scores when recording plaque levels?

Answer 41

Question 42

which children would you class as being at increased risk of dental caries?

Answer 42

* SIMD score 1-3 * decayed teeth present * missing teeth due to caries * any filled teeth

Question 43

at what age are the effects of dental anxiety most apparent?

Answer 43

< 4 years

Question 44

how can you measure a child's dental anxiety?

Answer 44

the modified child dental anxiety scale (MCDAS)

Question 45

what is the aim of behaviour management?

Answer 45

to promote a positive attitude to dental care and facilitate ongoing prevention and care

Question 46

give examples of behaviour management strategies

Answer 46

* communication * enhancing control * tell show do * behaviour shaping and positive reinforcement * structured time * distraction * relaxation * systematic desensitisation

Question 47

what advice would you give a parent with severe dental anxiety?

Answer 47

another adult should bring the child to appointments- reduces risk of child developing same anxiety as parent

Question 48

if a cooperative child presents with irreverisble pulpitis symptoms in a primary molar, what treatmetn should you consider other than extraction?

Answer 48

pulpotomy

Question 49

what is the treatment for symtoms of pain thought to be due to food packing/reversible pulpitis but diagnosis is uncertain?

Answer 49

place a temporary dressing review 3-7 days later to check symptoms