caries management in children Flashcards
5 management strategies for caries
Complete caries removal, and restoration
Partial caries removal, and restoration
No caries removal, seal with restoration
No caries removal, provide prevention alone or after first making the lesion self-cleansing
Extraction, or review with extraction if pain or sepsis develops
management of caries in primary teeth
choose options that 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
avoid LA until child cope
do not use conventional GI for permanent rest
manage a primary tooth that is associated with sepsis (signs or symptoms of abscess, sinus, inter-radicular radiolucency, non-physiological mobility) 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
no amalgam rule
primary teeth
under 15 years
pregnant and breastfeeding women
compomer
e.g. detract, compoglass, hyrax
polyacid modified composites
occ and 2 surface
can’t set in the dark as only small GIC content = must be light cured and have good isolation
indication for preformed crowns
d primary molars
> 2 surfaces affected
Extensive 2 surface lesions
Pulpotomy / pulpectomy
Developmental defects
XS tooth surface loss
High caries
Impaired OH
Space maintainer
make sure NO BUCCAL OR LINGUAL REDUCTION
GIC cement- reduced microleakage
IP discing of primary ants
Indications
exfoliation time close, pre-cooperative, extensive superficial/ minimal interproximal
Advantages
simple, quick, opens contacts
Disadvantages
PULP!, food impaction, space loss, aesthetics poor
Technique
Sand paper discs, tapered stone or diamond in slow speed
Tapered crown - narrower incisally
Round off proximal surfaces
Polish & Fluoride varnish
strip crowns for primary ants
Indications:
Enamel hypoplasia
Dental anomalies - amelo, dentino
Labial and interproximal caries
Technique:
LA & isolation
Tapered prep - high speed diamond
Labial groove
2mm incisal reduction
Cellulose acetate crown form & composite- using all available enamel for bonding
IP caries 1st and 2nd PM
f-varnish
monitor progression
floss
if the distal of the E is carious, considering managing the E with either a restoration, a Hall crown or slice preparation (taking care to avoid iatrogenic damage to the 6), or even extraction of the E.
suspicious fissure
clean, dry, radiographs
if micro-aviation, shadowing under enamel or 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.
if the fissure is stained but none of the previous slide applies then place fissure sealant and review at every recall visit.
if unsure IP cavity
place separator to allow visualisation
where an enamel lesion is developing on a FPM next to a carious 2nd primary molar provide a preformed crown on the primary molar or make the area self cleansing- take care not to cause iatrogenic damage to the FPM.
adult 6s with poor prognosis
at around the age of 8-9 years, make an assessment of the likely prognosis of any 6s affected by caries. If prognosis is poor, consider planned loss.
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.
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.
