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Caries symposium 2 > Caries pattern and diagnosis - caring for children and young people > Flashcards

Caries pattern and diagnosis - caring for children and young people Flashcards

1
Q

What does decalcification look like

A

white/brown spot lesions

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2
Q

how do you improve prognosis of decalcification lesions

A
  • angle toothbrush towards these lesions

- great if can get into a self cleansing situation

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3
Q

good treatment for pit and fissure caries?

A

fissure sealants

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4
Q

what does active caries look like

A
  • light brown colour

- soft

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5
Q

what’s importnat to consider checking with interproximal caries

A

adjacent tooth likely affected

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6
Q

what teeth are affected primarily by early childhood caries (nursing bottle caries)

A
  • maxillary incisors
  • 1st molars
  • mandibular canines
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7
Q

what is the usual cause of early childhood caries

A

child put to bed with something other than water (milk is also a problem at night cause of lactose)

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8
Q

how do you spot recurrent/ secondary caries

A

look at margins of restorations

- ditches?

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9
Q

what does arrested caries look like

A
  • dark brown

- hard

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10
Q

how do you define rampant caries

A

> 10 new lesions per yr

- lower anteriors affected

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11
Q

where is caries most common in primary dentition

A
  • lower molars
  • upper molars
  • upper anteriors
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12
Q

where is it rare to see caries

A
  • lower anteriors

- buccal/ lingual surfaces

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13
Q

under GA, what are the most common primary teeth to remove

A
  • all primary molars

- upper incisors

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14
Q

what is the general pattern of caries

A
  • caries rate lower 6s> upper 6s
  • pits and grooves
  • cingulum pits of lateral incisors
  • upper and lower incisors = uncontrolled caries
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15
Q

what pits and grooves are most common to find caries in

A
  • palatal upper 6s
  • palatal upper laterals
  • buccal lower 6s
  • cingulum pits of lateral incisors
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16
Q

what caries management factors particular to children are there

A
  • parental involvement
  • patient development
  • dealing with 2 dentitions
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17
Q

what is included in an assessment for children

A
  • parent/patient management
  • symptoms (if in pain, they may have been for a while)
  • history of present complaint
  • past dental history (treatment experience to date, OH habits, F history, diet)
  • medical history
  • social history
  • caries risk assessment
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18
Q

What do you examine extra orally and intra orally

A

Extra oral

  • asymmetry
  • nodes
Intra oral
Soft tissues
- OH
- swellings
- sinuses
- ulceration
- gingival health
Hard tissues
- teeth present
- dental age
- occlusion
- loose, missing, extra teeth
- trauma
- dental anomalies
- caries activity past and present
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19
Q

what do you need to detect caries visually

A

dry teeth, good light, sharp eyes

20
Q

what are different ways of detecting caries

A
  • clinical examination
  • radiographs
  • sensibility testing (nerve)
  • vitalitiy testing (blood supply)
21
Q

what do you consider when evaluating the dentition

A
  • is the tooth restorable (if not needs to come out)
  • patient/parent compliance
  • stage dental development
  • space management
  • anticipated difficulties
  • overall prognosis
22
Q

what do you consider if the tooth is restorable

A
  • choice of mateiral
  • choice of technique
  • cavity shape/form and restoration before starting
  • permanent vs temp restorations
23
Q

what are the aims for stablising carious dentition

A
  • prevent pain
  • preventative therapy
  • arrest restorable lesions
  • acclimatisation e.g. hand excavation, diet advice, OHI etc
  • decrease bacterial load in the mouth
  • improve OH by making areas easier to clean
24
Q

what things do we need to consider with patient/ parent compliance

A
  1. motivation
    - parent - compliance with prevention regimes, attendance, support at home
    - child - compliance, OH
  2. Co-operation
    - parent - own anxieties
    - child - emotional maturity, fears, previous bad experience, behavioural problems, ability to co-operate
25
what things to consider when looking at stage of development
Primary teeth - are they close to exfoliation Permanent molars - long term prognosis? - could extractions be part of the ortho treatment plan - what about space maintanance
26
why is having an overall prognosis important
- pattern indicates level of caries activity | - prognosis dependant on preventative issues and motivation
27
why might you consider space maintanance?
- effect of premature loss of primary teeth - loss of 1st perm molars - crowding
28
what are ways you can maintain space
- band and loop space maintainer | - distal shoe
29
when might you pick a band and loop space maintainer
- 2nd primary molar had to be removed and need to create space for the 2nd premolar to come through - stops the 1st perm molar drifting mesially
30
when might you pick a distal shoe
when FPM still unerpupted so 6 can erupt in the right place
31
what are the results of early primary tooth extractions
- increased crowding - increased tendency for space loss - earlier removed, increased degree space loss - balancing/compensating extractions
32
what are common balancing/ compensating extractions
- balance primary canines to prevent center-line shift - consider balance of lower 1st primary molars if arch crowded - in general no other b's or a's necessary in the primary dentition - must consider balance compensation when removing FPMs
33
consequences of early loss of maxilla 16 and 26?
loss before complete eruption of 7 = rotation and mesial movement of 7, distal drift of 5
34
consequences of early loss of mandible 36 and 46?
- loss after optimum age = tilting 7s | - loss before optimum age = 5 drifts distally and rotates
35
what are the aims of treatment
- relief of symptoms - prevention of disease initiation and progression - restore function and aesthetics
36
What does relief of symptoms depend on for treatment
- nature of the pain - status of pulp - stage of dental development - level of patient compliance
37
What do you ask when taking a history of pain from a child
- where is the pain - what does the tooth feel like - how long has the tooth been painful - does anything make the pain better or worse - does the pain keep the patient awake or wake them from sleeping - is the pain spontaneous or precipitate e.g. by eating - is the pain relieved with analgesics or antibiotics (n.b. antibiotics should only ever be prescribed when there is systemic illness, pyrexia and/or facial swelling)
38
what are emergency treatment options
- caries excavation and sedative dressing - pulp therapy - pulpotomy or pulpectomy - drainage of pus - extraction (LA +/- IHS)/GA - IV sedation only considered for 12 years and over
39
how old does someone have to be before getting IV sedation
12 years and over
40
what are ways to achieve pain-free LA
- use topical - warm LA cartridge - 6 years old/6s erupt use IDB - intra-papillary infiltration avoids palatal injection
41
ways to optimise treatment?
- pain free LA | - rubber dam
42
if they don't have lower 6s what LA technique do you do
infiltration rather than IDB
43
why is rubber dam beneficial
- decreases damage to soft tissues and risk of inhalation cross-infection - benefit to operator and patient by increasing isolation and moisture control, retraction of gingivae and cheeks, effective inhalation sedation, patient confidence, operator confidence
44
what is the sequence of restoration choices
1. fissure sealants 2. preventative restorations 3. simple fillings e.g. shallow cervical cavities 4. fillings requiring LA but not into pulp (upper arch first) 5. pulpotomies/pulpectomies 6. extractions
45
different methods of caries removal
- hand excavation - rotary instruments - chemo-mechanical removal - air abrasion - lasers

Caries symposium 2 (7 decks)

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