Caries Managment Flashcards
What are the 5 Rs of caries managment?
- Recognition (of contributory factors + disease).
- Reorientation (of contributory lifestyle factors).
- Remineralization (of visible/ not visible + cavitated/ not cavitated)
- Repair (when no other solution is possible)
- Review (of child, oral health and situation)
What is the best predictor of future disease
Current disease
A patient has two white spot lesions. What risk level are they? How often would you take bitewings?
HIGH risk, 6 month bitewing interval.
What does caries risk status determine? (5)
- components of the preventive programme for the individual
standard or enhanced) - the intensity of the preventive programme
- the likelihood of success of interventions to repair
- recall interval
- radiograph use
A child is caries free but have a sibling with caries. What caries risk is the child?
HIGH risk. Same food, OH from family, same environment.
What are the 4 pillars of a preventive program?
Fluoride (varnish, toothpaste etc), OHI, Dietary Investigation, Sealants.
What is the difference between standard or enhanced preventative program.
- Strength of fluoride toothpaste, number of times fluoride varnish is applied.
What do all children have done?
All children have their 6s sealed.
What is the maximum number of times fluoride varnish can be applied?
4 times a year.
How often do you take radiographs in children at high caries risk?
6-12 months.
How often do you take radiographs in children at low caries risk?
2 years.
What is important for non restorative cavity control?
CASE SELECTION - must have a very motivated patient.
List 5 advantages of non restorative cavity control.
- allows child to develop intellectually and cope with more invasive procedure (MAKE THEM FROM PRE-COOPERATIVE TO COOPERATIVE).
- very little technical skill needed.
- don’t need injections (unless sound dentine must be cut)
- very low patient tolerance required.
- may slow caries enough to allow tooth to exfoliate without causing pain/ abscess
List 9 disadvantages of non restorative cavity control.
- Only works in about 50% of cases…
- pulp may be too damaged already.
- needs particular conditions
- at the mercy of the carers!!!!
- might be interpreted as watchful neglect
- other dentists might not recognise what you’ve done
- difficulty monitoring – photographs
- doesn’t look nice
- does it feel satisfying?
How often does non restorative cavity control work (%)?
50% of cases (even in engaged patients/ carers).
When is a stainless steel crown/ Hall crown best indicated?
- Proximal lesion OR multisurface.
There is a deep OCCLUSAL cavity in a primary tooth. What is the first line treatment? If child is pre-cooperative?
- COMPOSITE restoration (high chance of success with composite of an occlusal restoration).
- if pre-cooperative use Hall technique.
What medication may cause severe effects in the oral cavity?
antiepileptic drugs cause severe gingival overgrowth.
How might medical issues affect a child’s caries risk and your treatment planning decisions?
- physical/ mental disabilities.
- bleeding disorders.
- medications (ex. anticoagulants, anticonvulsants).
What makes a tooth unrestorable?
- amount of coronal tooth tissue (can it retain a restoration).
- pulpal involvment.
What is a disadvantage of Ds?
Very thin enamel - once a lesion is into enamel it has essentially reached dentine.
What is a common place for upper D and E and 6s to get caries? How can this be prevented?
distopallatine fissure.
- prevent by covering this with the fissure sealant.
What teeth would you not hall crown in the same appointment?
- teeth adjacent to each other or teeth that meet on opposing arches.
When is the ideal time to extract a 6?
8.5 to 10 years.
