Caries management Flashcards
(45 cards)
caries managament options
- no caries removal - hall crown
- no caries removal - FS
- selective caries removal and restore
- pulpotomy
- XLA
- complete caries removal and restore
- prevention only
- non restorative cavity control and prev
how rto manage a symptomatic primary tooth with signs of infection
- intraradicular radiolucency
- non physiological mobility
- sinus
- pain kept up at night
- ttp
- lymphadenopathy and associated swelling
treat - pulpectomy / XLA
initial caries sign in a primary molar
- clinical
- Rg
- non cavitated - staining/white spot/discoloured/dentine shadowing
- caries into initial 1/3 of dentine
management of initial caries of primary molar
-fissure sealant
top up and review at every appt, check visually and with probe
-GI sealant if bis-GMA too difficult
-hall techniquead
advanced occlusal caries in primary molar
signs -clinical/Rg
-teeth with visible shadowing/cavitation
Rg - bitewing, caries extends to inner third, clear band of dentine should separate pulp and caries
advanced occlusal caries in primary molar, management ops
why not complete caries removal
- selective caries removal and restore
- hall technique (also if proximal lesion)
- if non restorative - self cleanse
- > risk of pupl exposure
signs of reversible pulpitis in a child
sensitive to cold/sweet, short lasting pain, not kept up at night or TTP
management of reversible pulpitis in a child
-place hall crown
-if occ = selective caries removal
- if food packing/unsure of diagnosis then place a temp dressing (ZOE?) and check symps 3-7 days later. If better - hall crown/restoration.
If worse XLA/PULPOTOMY
irreversible pulpitis symps in a child
sTILL VITAL BUT INFLAMED NOT TTP kept up at night tender to cold/hot/sweet pain spontaneous lasts after stimulus applied
management of irr pulpitis in a child
if anxious - remove debris and apply antibiotic corticosteroid paste under temp dressing
- if good co-op - PULPOTOMY
symps in dental abscess/Periradicular periodontitis
kept up at night spontaneous pain sensitive to hot/cold/sweet long lasting pain sinus/swelling association TTP increased mobility
-Rg - increased sign of intrarradicular pathology
management of dental abscess/periradicular periodontitis
PRIMARY
- drain inf through pulp, hand excavate
- if tender place corticosteroid paste
- even if asymp, XLA tooth
- if restorable = pulpectomy
PERMANENT
- drainage through pulp
- access pulp chamber and remove necrotic tissue
- ST drainage if swelling
indications for a primary molar pulpotomy
- irreversible pulpititis (vital pulp)
- advanced lesion with no clear dentine band (Rg)
Pulpotomy technique steps
-LA and dam
- caries removal/access
-remove pulp (round slow speed/sp exc)
-irrigate pulp with sterile water (3in1)
-identify canal orifices
Max primary molars = 2b,1p
Mand primary molars = m/d canals
-assess haemostasis - cotton pledget and ferric sulphate (30s-2min)
if no bleed/major dark bleed = pulpectomy
-remove pledget and place MTA/ZOE/ns CaOH on stumps and floor
-fill cavity with ZOE and place SSC
- annual review
when to carry out a balancing XLA
If c of poor prognosis - avoid midline shift
premature exf of c
when NOT to carry out a balanced XLA
primary incisors
primary D loss - unless c centreline shift
primary E loss
identify initial caries lesion in perm molar
visual - white spot lesion, stain in fissures
Rg - lesion up to ADJ/not visible
initial caries management in perm molars
FS
PRR
review at every appt for top up, check with probe
identify moderate carious lesion
visual - probe, dark stain, shallow cavitation
Rg - bitewing - extend to mid 1/3 dentine
management of moderate carious lesion in perm molar
selective caries removal and restore
seal other teeth
identify extensive occlusal caries
teeth with cavitation, widespread dentinal shadow
management of extensive occlusal lesion in perm tooth
stepwise caries removal, avoid pulpa exposure
1. caries removal (superficial) - enough to allow effective marginal seal
2. temp restoration - inhibit further progression and allow reactionary dentine to be laid down
3 6-12mth later re-enter cavity and restore tooth (temp will have allowed reactionary dentine to further distance from pulp.
how can proximal caries be identified and subsequently be seen more easily in children
-Initial- white spot lesion/dentine shadowing especially distal of E/mesial of 6,
Rg - outer 1/3 dentine
-moderate - enamel cavitation/dentine shadowing
Rg - extend to outer/mid 1/3 of dentine
-extensive - cavitation/visible dentine
Rg - reach inner 1/3 of dentine but not reach pulp
use of ortho separator (5 days)
management of proximal caries in perm molars
- initial - arrest enamel only lesions, site specific prevention, seal lesion
- mod - selective caries removal/complete caries removal, seal remaining fissures
- extensive - stepwise caries removal
