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BDS3 Caries Symposium > Caries management for children and yp strategies at the tooth level > Flashcards

Caries management for children and yp strategies at the tooth level Flashcards

1
Q

What are the possible management strategies for caries in the primary dentition? (5)

A
  • Complete caries removal and restoration
  • Partial caries removal and restoration
  • No caries removal. seal with restoration
  • No caries removal, provide prevention alone or after fist making the lesion self-cleansing
  • Extraction, or review with extraction if pain or sepsis develops
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2
Q

What are the possible treatment options for a occlusal, non-cavitated lesion? (4)

A
  • Complete caries removal and restoration
  • Partial caries removal and restoration
  • No caries removal, seal caries with fissure sealant
  • No caries removal, provide prevention alone (this option is only appropriate if no alternative is feasible)
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3
Q

What are the possible treatment options for a occlusal, cavitated lesion? (5)

A
  • Complete caries removal and restoration
  • Partial caries removal and restoration
  • No caries removal and seal caries with hall crown
  • No caries removal and provide prevention alone*
  • No caries removal and make the lesion self-cleansing and provide prevention*
  • (* indicates that this option is only appropriate if no alternative is feasible)
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4
Q

What is the Hall technique?

A
  • When we are using a ore-formed metal crown but there has been NO caries removal
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5
Q

What are the possible treatment options for an approximal, early dentinal lesion? (4)

A
  • Complete caries removal and restoration
  • Partial caries removal and restoration
  • No caries removal, seal caries with hall crown (favourite option)
  • No caries removal, provide prevention alone (this option is only appropriate if no alternative is feasible)
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6
Q

What are the possible treatment options for approximal, advanced lesions? (5)

A
  • Complete caries removal and restoration
  • Partial caries removal and restoration
  • No caries removal, seal caries with Hall crown
  • No caries removal, provide prevention alone*
  • No caries removal, make lesion self cleansing and provide prevention*

(* this option is only appropriate if no alternative is feasible)

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7
Q

What are the possible treatment options for anterior cavitated lesion? (3)

A
  • Complete caries removal and restoration
  • Partial caries removal and restoration
  • No caries removal, provide p revention alone
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8
Q

What are the possible treatment options for a grossly carious unrestorable tooth, without signs or symptoms of pain or sepsis? (2)

A
  • No caries removal, provide prevention alone

- Extraction or review, with extraction if pain or sepsis develops

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9
Q

When managing caries in the primary dentition you need to choose management options that balance what?

A
  • Balance a reduction in the risk of pain or sepsis from the tooth in the future with the child’s ability to accept treatment now
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10
Q

What material should you not use for permanent restorations in the management of caries in primary teeth?

A
  • Glass ionomer
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11
Q

How should you manage a tooth that is associated with sepsis (signs or symptoms of abscess, sinus, inter-radicular radiolucency, non-physiological mobility)? (3)

A
  • With either a pulp therapy or an extraction; do not leave sepsis untreated
  • Closely monitor lesions managed with prevention only
  • DO NOT leave active caries in primary teeth unmanaged
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12
Q

Can you leave active caries in the primary dentition unmanaged?

A

NO

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13
Q

Explain the technique for complete caries removal and restoration?

A
  • Give LA before commencing cavity prep as this will require sound dentine to be cut
  • Gain access to caries using a high speed handpiece, leaving a wall of enamel to protect the adjacent tooth
  • Remove caries with a slow speed handpiece and excavators. (be aware of pulp chamber anatomy to reduce the risk of pulpal exposure)
  • Prepare approximal cavity margins with gingival margin trimmers to prevent iatrogenic damage to the adjacent teeth
  • Place the restoration:
  • If at risk of pulpal exposure, place an indirect pulp cap
  • Do not use conventional GI materials for restoration of a Class II cavity due to the unacceptably high failure rate.
  • Composite, compomer, RMGI and preformed metal crowns may be suitable, the particular material choice depending on the cavity
  • Class II cavity = interproximal cavity
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14
Q

What are the regulations on amalgam. No amalgam in…? (3)

A
  • Primary teeth
  • Persons under 15 years of age
  • Pregnant and breastfeeding women
  • Exception - specific medical needs of the patient (if you need to place an amalgam instead of something else)
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15
Q

What are the possible restorative options for primary molars? (5)

A
  • Composite
  • Compomer
  • Stainless steel crown
  • GIC (temporary restoration only)
  • RMGIC
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16
Q

What is a compomer?

A
  • Polyacid modified composites
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17
Q

Give 3 examples of compomers?

A
  • Dyract, Compoglass, Hytac
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18
Q

What kind of cavities can compomers be used for? (2)

A
  • Occlusal and 2 surface cavities
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19
Q

Why must compomer be light cured?

A
  • As it can’t set in the dark as only small GIC content
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20
Q

Do you need good isolation and moisture control for placing a compomer?

A
  • Yes
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21
Q

What are possible indications for traditional preformed metal crowns? (9)

A
  • > 2 surfaces affected
  • Extensive 2 surface lesions
  • Pulpotomy/pulpectomy
  • Developmental defects (weakness in enamel or dentine)
  • Fractured primary molars
  • Excessive tooth surface loss
  • High caries
  • Impaired OH
  • Space maintainer
22
Q

Explain the steps of traditional prep for a preformed metal crown? (5)

A
  • Give LA
  • Remove caries (if at risk of pulpal exposure, place an indirect pulp cap)
  • Cut a mesial slice and a distal slice. The bur should pass through the crown cervically in order to avoid the creation of a cervical ledge, as this will impede the seating of the crown
  • Reduce the occlusal surface of the tooth enough to allow a straight probe to be passed across the tooth surface when the teeth are in occlusion
  • Select the correct size of preformed metal crown, cement the PMC in place with GIC, remove excess cement and clear contacts using floss
23
Q

What does OAP mean in relation to preformed metal crowns?

A
  • Occlusal, approximal, peripheral reduction
24
Q

Do you want to do buccal and lingual reduction for preformed metal crowns?

A
  • No
25
Q

What kind of ‘fit’ do you want a preformed metal crown to be?

A
  • Snap fit

- Measure the contra-lateral tooth, flatten proximally if necessary

26
Q

Why do we use GIC cement to place a preformed metal crown?

A
  • It reduced microleakage
27
Q

We want to clear excess cement from the margins of a preformed metal crown and have no overhangs distally. How can we do this?

A
  • Pull knotted floss through interproximal areas to clear the cement
28
Q

What is the 5 year survival rate of preformed metal crowns?

A
  • 92%
29
Q

What is involved in the process of partial caries removal and restoration? (6)

A
  • If necessary, gain access to caries using high speed handpiece (since this approach rarely requires the cutting of sound dentine, LA is usually unnecessary)
  • Remove superficial caries with a slow speed handpiece or excavators, until there is no obvious caries visible at the ADJ and the cavity allows an adequate thickness of restorative material to be placed (be careful not to cause iatrogenic damage and be aware of the pulp chamber anatomy to reduce the risk of pulpal exposure)
  • Place the restoration, using adhesive material and bonding system. Do not use GI materials for restoration of a Class II cavity
  • Fissure seal the tooth surface and as many of the restoration margins as possible
  • Monitor for any caries progression using radiographs where appropriate
  • Inform the child and parent/carer of the approach taken and record details in the patient’s notes
30
Q

What are the advantage of partial caries removal and restoration? (3)

A
  • Evidence largely from secondary care and private practice, this approach can be effective
  • Reduce risk of pulp exposure
  • Reduce time for cavity prep, less need for LA
31
Q

What are the disadvantages of partial caries removal and restoration? (2)

A
  • As caries is left in the cavity, the marginal seal must be effective to prevent caries progression
  • No evidence, as yet, that this approach is effective in primary care
32
Q

One technique of no caries removal and sealing with a restoration is by placing fissure sealants. What is the process of this? (2)

A
  • Place a fissure sealant over non-cavitated pit or fissure caries, to completely seal the fissure system
  • If using this approach on a pre-cooperative child, consider using the press finger technique with a glass ionomer material as a temporary measure
33
Q

What is the hall technique?

A
  • This technique involves sealing caries into primary molars with a preformed metal crown. No LA, tooth preparation or caries removal is used
  • Crown must cover all caries, otherwise bacteria/substrate will continue to feed the caries process under the crown
34
Q

What is the technique for making a lesion self cleansing?

A
  • As only enamel and carious dentine are removed, the use of LA should not be necessary unless subgingival tooth prep is required
  • Using a high-speed handpiece, or hand instruments, remove undermined enamel adjacent to the carious lesion making the surface of the lesion accessible to toothbrushing
  • Apply fluoride varnish straight away
  • Inform the child and parent/carer of the approach taken and record details in the patient’s notes
35
Q

What is the technique for partial caries removal and restoration of primary anterior’s? (4)

A
  • Thoroughly clean the teeth with prophylaxis paste (caries removal will be minimal so LA is not required)
  • Acid etch the entire crown; wash, dry and apply a bonding system
  • Place the composite restoration, either by hand building or using strip crowns
  • Inform the child and parent/carer of the approach taken and record details in the patient’s notes
36
Q

What are then indications for interproximal discing of primary anterior’s? (4)

A
  • Exfoliation time close
  • Pre-cooperative
  • Extensive superficial/ minimal interproximal
37
Q

What are the advantages of interproximal discing of primary anterior’s? (3)

A
  • Simple
  • Quick
  • Opens contacts
38
Q

What are the disadvantages of interproximal discing of primary anterior’s? (4)

A
  • PULP
  • Food impaction
  • Space loss
  • Aesthetics poor
39
Q

What is the technique for interproximal discing of primary anterior’s? (4)

A
  • Sand paper discs, tapered stone or diamond in slow speed
  • Tapered crown - narrower incisally
  • Round off proximal surfaces
  • Polish and fluoride varnish
40
Q

What does interproximal discing of teeth allow the tooth to be?

A
  • Self cleansing
41
Q

What are indications for strip crowns for primary anterior’s? (3)

A
  • Enamel hypoplasia
  • Dental abnormalities - amelo, dentino
  • Labial and interproximal caries
42
Q

What is the technique for strip crowns for primary anterior’s? (5)

A
  • LA & isolation
  • Tapered prep - high speed diamond
  • Labial groove
  • 2mm incisal reduction
  • Cellulose acetate crown form & composite - using all available enamel for bonding
43
Q

Make it a priority to identify and arrest early enamel-only lesions on the mesial surface of 6’s. We do this by…? (3)

A
  • Applying fluoride varnish, and monitoring for progression with bitewing radiographs
  • Ensuring parent’s and carers are aware of the potential impact on the child’s oral health, and encouraging them to floss or use floss wands on the 6/E contact 2-3 times a week
  • If the distal of the E is carious, consider managing the E with either a restoration, a hall crown or a slice preparation (taking care to avoid iatrogenic damage to the 6), or even extraction of the E
44
Q

How would you manage a suspicious fissure in the FPM?

A
  • Thoroughly clean the fissures of all debris, dry the tooth and view it with bright, direct light
  • Take good quality radiographs
  • IF there is micro-cavitation, shadowing under enamel, dentinal caries
  • Remove caries and then place a conventional composite restoration limited to the site of the caries and fissure seal the remaining fissure system
45
Q

If the fissure of a FPM is stained but not micro-cavitated, have shadowing under enamel or dentinal caries, What would the treatment be?

A
  • Place fissure sealant and review at every recall visit
46
Q

What technique can we use to detect cares via direct vision and repair microcavities without having to resort to cutting a conventional interproximal cavity?

A
  • Using a separator in between the teeth and removing 5 days later
47
Q

What should we do when an enamel lesion is developing on a FPM next to a second primary molar?

A
  • Provide a preformed crown on the primary molar or make the area self cleansing - take care not to cause iatrogenic damage to the FPM
48
Q

At around the age of 8-9 years, we make an assessment of the likely prognosis of any 6’s affected by caries. If the prognosis is poor what should we do?

A
  • Consider planned loss of the tooth
49
Q

When would be the ideal time to remove FPM’s if it was necessary?

A
  • Radiographically ideal when there is the start of calcification of the bifurcation of the unerupted lower second molars.
  • Ideally all premolars and 3rd molars should be present
50
Q

If lower FPM have to be extracted due to extensive caries why would we also have to remove the upper FPM’s despite them having no caries?

A
  • As the upers will over-erupt if we only remove the lowers
51
Q

Why is there some advantage of planned removal of poor prognosis FPM’s and what is this advantage?

A
  • In some situations, extraction of 6’s with poor long-term prognosis at the correct time can allow the development of a caries free dentition in the adolescent, without spacing
  • What tends to happen is the 4’s, 5’s and 7’s grow in and have spaces so are self cleansing but by the time the child is older the spacing will go
52
Q

What is the disadvantage of planned removal of poor prognosis FPM’s?

A
  • Requires extraction of permanent molar teeth from young children, which is demanding for the child, and which may necessitate general anaesthesia, with associated risks

BDS3 Caries Symposium (7 decks)

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