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BDS3 Caries Symposium > Caries pattern and diagnosis caring for children and yp > Flashcards

Caries pattern and diagnosis caring for children and yp Flashcards

1
Q

What is the definition of caries?

A
  • Disease of mineralised tissues; enamel, dentine and cementum, caused by action of micro-organisms on fermentable carbohydrates…
  • … in it’s very early stages the disease can be arrested since it is possible to remineralisation to take place
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2
Q

What is another term for decalcification?

A
  • White/brown spot lesions
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3
Q

What are the different classifications of caries?

A
  • Decalcification (white spot lesions)
  • Pit and fissure caries
  • Smooth surface caries
  • Interproximal caries
  • Early childhood or nursing bottle caries
  • Recurrent/secondary caries
  • Arrested caries
  • Rampant caries
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4
Q

Where are smooth surface caries usually found? (3)

A
  • Buccal/lingual/cervical areas
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5
Q

What do caries look like when they are very active?

A
  • Light brown

- Soft and mushy

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6
Q

Which teeth are most likely to be affected by nursing bottle caries? (3)

A
  • Max incisors
  • 1st molars
  • Mandibular canines
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7
Q

Which teeth are usually protected from nursing bottle caries?

A
  • Lower incisors protected by the tongue
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8
Q

What is the definition of rampant caries?

A
  • > or equal to 10 mew lesions per year
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9
Q

What teeth are likely to be affected by rampant caries?

A
  • Lower anterior’s = have some uncontrolled caries to deal with
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10
Q

What is the definition of young permanent dentition?

A
  • From the age of about 12 where the permanent teeth are there but they are still maturing - they do not have closed apexes
  • So still a developing dentition
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11
Q

In the primary dentition which type of teeth are most likely to be affected by caries? (3)

A
  • Lower molars
  • Upper molars
  • Upper anteriors
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12
Q

In the primary dentition which type of teeth are least likely to be affected by caries? (3)

A
  • Lower anteriors

- Buccal and lingual surfaces (except rampant caries)

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13
Q

In the primary dentition where are they most likely to get occlusal caries?

A
  • 1st primary molars (more than 2nd molars)
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14
Q

Does the primary dentition usually get affected by interproximal caries?

A
  • Not until contacts develop
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15
Q

Does enamel hypo mineralisation in the primary dentition make a child more susceptible to caries?

A
  • Yes
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16
Q

In the mixed dentition are upper or lower molars (6’s) more likely to get caries?

A
  • Lower 6’s
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17
Q

Where in the mixed dentition are pit and fissure caries likely to develop? (3)

A
  • Buccal lower 6’s
  • Palatal upper 6’s
  • Palatal upper laterals (cingulum pits)
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18
Q

When would you get caries in the mixed dentition in upper and lower incisors?

A
  • With uncontrolled caries
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19
Q

What might you want to do with erupting second molars in the early permanent dentition?

A
  • Might want to put fissure sealants on if child is high risk
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20
Q

What are 2 host factors that can increase caries risk in the early permanent dentition?

A
  • Reduced salivary flow rate

- High mutans counts

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21
Q

What are 3 caries management factors that are particular to children?

A
  • Parental Involvement
  • Patient development
  • Dealing with 2 dentitions
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22
Q

What would be included in an assessment of a child? (7)

A
  • Parent/patient management
  • Symptoms?
  • History of present complaint
  • Past dental history
  • Medical history
  • Social history
  • Caries risk assessment
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23
Q

What might be included in a past dental history of a child? (2)

A
  • Treatment experiance to date

- Oral hygiene habits, F history, Dietary habits

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24
Q

What would you assess in an extra-oral examination? (2)

A
  • Asymmetry

- Nodes

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25
Q

What would you check about the soft tissues in an intra-oral examination? (5)

A
  • Oral hygiene
  • Swellings
  • Sinuses
  • Ulceration
  • Gingival health
26
Q

What would you check about the hard tissues in an intra-oral examination? (6)

A
  • Teeth present, dental age
  • Occlusion
  • Loose, missing, extra teeth
  • Trauma
  • Dental anomalies
  • Caries activity - past and present
27
Q

What are different ways of detecting caries? (5)

A
  • Clinical examination
  • Radiographs
  • Sensibility testing - nerve (hot/cold/electric)
  • Vitality testing - blood supply (laser dopler)
  • (only gentle probing to appreciate surface texture)
28
Q

How can we detect caries through a clinical examination? (4)

A
  • Visual (dry teeth, good light, sharp eyes, FOTI)
  • Ortho separators
  • Caries detector dyes
  • Lasers
29
Q

When evaluating the dentition what do you need to consider? (6)

A
  • Tooth restorable?
  • Patient/parent compliance
  • Stage dental development
  • Space management
  • Anticipated difficulties
  • Overall prognosis
30
Q

What can temporary restorations be good for? (6)

A
  • Prevent pain
  • Preventive therapy
  • Arrest restorable lesions
  • Acclimatisation (e.g. hand excavation, use of carisolv, atraumatic restorative technique, Intermediate restorative material/GIC, diet advice, OHI)
  • Decrease bacterial load in mouth
  • Improve OH by making areas easier to clean
31
Q

What does the parent need to do to show motivation to comply with improving the caries risk of their child? (3)

A
  • Compliance with prevention regimes
  • Attendance
  • Support at home
32
Q

What might effect the co-operation of a parent in preventing their child’s risk of caries?

A
  • Their own anxieties
33
Q

What might effect the co-operation of the child in preventing their own risk of caries? (5)

A
  • Emotional maturity
  • Fears
  • Previous bad experience
  • Behavioural problems
  • Ability to co-operate
34
Q

With the primary dentition what do we need to consider in relation to stages of development that will determine whether we try to restore the tooth or not?

A
  • Are they close to exfoliation?
35
Q

With permanent molars what do we need to consider in relation to stages of development that will determine whether we try to restore the tooth or not? (3)

A
  • What is the long term prognosis?
  • Cold extractions be part of the ortho treatment plan?
  • What about space maintainers?
36
Q

What is caries prognosis dependent on?

A
  • Preventive issues and motivation
37
Q

What does the effect of premature loss of primary teeth depend on? (4)

A
  • Tooth size/jaw relation
  • Muscle behaviour
  • Age at loss
  • Which tooth it was
38
Q

Why can the loss of first permanent molars be a problem?

A

As this can have a big effect in regards to spacing and where things are going to end up

39
Q

What can premature loss of primary teeth cause?

A

Crowding

40
Q

What is a band and loop space maintainer and what is it used for?

A
  • Used where the second primary molar has been removed
  • Type of space maintainer if have a good compliance patient
  • First permanent molar with an orthodontic band around it
  • Instead of ortho band can also use a stainless steel crown
41
Q

When would a Distal shoe space maintainer be places instead of a band and loop SM?

A
  • Placed when FPM is still unerupted
42
Q

How does a distal shoe space maintainer work?

A
  • When removing a second primary molar when the first permanent molar isn’t there
  • Has a spike that goes down into the bone so that then the first molar can slide up the piece of metal and sit in the right space
43
Q

What are possible results of early primary tooth loss? (2)

A
  • Increased crowding = Increased tendency for space loss

- Earlier removal = increased degree of space loss

44
Q

How can we balance/compensate early primary tooth extractions? (4)

A
  • Balance primary canines to prevent centre-line shift
  • Consider balance of lower 1st primary molars if arch is crowded
  • In general no other b’s or a’s necessary in the primary dentition
  • Must always consider balance/compensation when removing FPM’s
45
Q

If the patient loses their upper first molars (6’s) before the complete eruption of the second molars (7’s) what will happen?

A
  • Will get rotation & mesial movement of 7 & distal drift of 5
46
Q

If the patient loses their lower first molars (6’s) after optimum age what will happen?

A
  • Tilting of 7’s
47
Q

If the patient loses their lower first molars (6’s) before optimum age what will happen?

A
  • 5 drifts distally and rotates
48
Q

What are our aims of treatment? (3)

A
  • Relief of symptoms
  • Prevention of disease initiation and progression
  • Restore function and aesthetics
49
Q

In order to relieve symptoms what does the treatment depend on? (5)

A
  • Nature of the pain
  • Status of the pulp
  • Stage of dental development
  • Level of patient compliance
  • Parental factors
50
Q

What could you ask the child when taking a pain history from them? (7)

A
  • 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 precipitated e.g. by eating
  • Is the pain relieved by analgesics or antibiotics? (antibiotics should only ever be prescribed when there is systemic illness, pyrexia and or facial swelling)
51
Q

What are possible emergency treatment options for treating children with caries? (5)

A
  • Caries excavation and sedative dressing
  • Pulp therapy - pulpotomy or pulpectomy
  • Drainage of pus
  • Extraction (LA, Inhalation sedation, GA)
  • (IV sedation only considered for 12 years and over)
52
Q

What are possible ways of giving pain free LA to children? (4)

A
  • Topical
  • Warm LA cartridge
  • Lower 6’s rule (if patient doesn’t have their lower 6’s in then can get away with an infiltration rather than an IDB but if 6 years old or 6’s erupting then use IDB)
  • Intra-papillary infiltration avoids palatal injection (not always avoids but makes it more co mfortable)
53
Q

Use of rubber dam increases safety by decreasing…? (3)

A
  • Damage to soft tissues
  • Risk of inhalation
  • Cross-infection
54
Q

Use of rubber dam has a benefit to the operator and patient by increasing…? (5)

A
  • Isolation and moisture control
  • Retraction of gingivae and cheeks
  • Patient confidence
  • Operator confidence
  • Effective inhalation sedation
55
Q

What is the sequence of restorations you would go through with a child? (6)

A
  • Fissure sealants
  • Preventive restorations
  • Simple fillings e.g. shallow cervical cavities
  • Fillings requiring LA but not into the pulp (do upper arch first as it is easier to do a pain free injection in the upper arch)
  • Pulpotomies/pulpectomies
  • Extractions
56
Q

What are possible methods of caries removal? (5)

A
  • Hand excavation
  • Rotary instruments
  • Chemo-mechanical removal (don’t use this in the dental school)
  • Air abrasion
  • Lasers
57
Q

What are 3 types of chemo-mechanical caries removal?

A
  • Caridex
  • Carisolv gel
  • Ozone
58
Q

Look at the anatomical features and clinical significance of primary teeth slide

A

https://s3.amazonaws.com/classconnection/248/flashcards/20134248/png/primary_teeth_anatomical_features_and_clinical_significance_slide-173E39996452179AC8E.png

59
Q

When the marginal ridge has a breakdown of more than 2/3 of its length what does this mean?

A
  • Means there is caries in the pulp so plan pulp treatment not a simple restoration
60
Q

If caries are > or equal to 2/3 into dentine what does this mean?

A
  • The pulp is involved
61
Q

What are general considerations that need to be made when deciding on a restorative material/technique for a child? (9)

A
  • Longevity of the tooth - how long must it last?
  • Co-operation - how easy?
  • Medical and dental history
  • Extent of the lesion - how much of restoration exposed to wear
  • Which tooth?
  • Oral hygiene
  • Diet history
  • Attitude
  • Parental preference
62
Q

What are dental considerations that need to be made when choosing which restorative material/ technique for a child? (3)

A
  • Extent of lesion - how much of restoration exposed to wear
  • Which tooth?
  • Oral hygiene

BDS3 Caries Symposium (7 decks)

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