management of caries

Question 1

caries assessment workflow

Answer 1

assessment
diagnosis and risk assessment
care planning
preventative care
operative care

Question 2

what happens in the caries assessment

Answer 2

history taking
examination
special investigatons

Question 3

dental caries

Answer 3

instigated by bacteria on fermentable carbohydrates in the plaque biofilm on tooth surfaces
leads to acid demineralisation and proteolytic destruction ( in dentine of organic component of dental tissues

Question 4

Keyes triad

Answer 4

tooth
bacteria
diet
time

Question 5

restoration of pits and fissures of posterior teeth

Answer 5

class I

Question 6

proximal caries restoration type

Answer 6

posterior class II 
anterior class III prep

Question 7

non carious lesiosn

Answer 7

balance of protective and pathologic factors remain stable overtime

Question 8

what bacteria is found in higher quantities with caries

Answer 8

streptococcus mutans

Question 9

how do coronal caries ddevelop

Answer 9

starts in enamel, bacteria retained in plaque
breakdown sugars in diet and release acid
demineralisation
loss of calcium and phosphate from the surface
demineralsiaoton leads to carious lesion
- white spot lesiojs

Question 10

which ph leads to demineralsiaon

Answer 10

below 5.5

Question 11

common areas for white spot lesions

Answer 11

around dental brackets

plaque retention around the brakets

Question 12

white spot lesion progression

Answer 12

if OH does not improbe
demineralsiaon of enamel progresses
weakens enamel and will reach ADJ
caries reaches the dentine and spreads along ADJ laterallu
enamel breaks under occlslusal force

Question 13

dental caries layers

Answer 13

carious enamle
infected dentine
affected dentiene
sound dentine

Question 14

infected dentien

Answer 14

dentine that we want to remove clinically(outermost layer)
cannot be repaired
- necrotic zone of destruction
-dark coloir
- soft mushy wet
- denatured collagen matrix
- extensive mineral loss
- tubular structure destroyed

Question 15

affected dentine

Answer 15

inner layer of carious dentine

• paler brown, harder
• demineralised
• collagen still damaged but lesser exent
• tubular structure foundations remain

Question 16

non operative caries control

Answer 16

- OH instructiosn
Plaque control
diet advice
fluoride
casein phospopeptide
antimicrobial agents

Question 17

Plaque control

Answer 17

removal of plaque retentive factors
calculus
restorations with poor borders
denture

Question 18

when should you use operative caries manaagment

Answer 18

only when lesion is cavitated

lesion that renders plaque removal difficult or impossible

Question 19

aims of operative manamgent

Answer 19

aid plaque control and thereby manage caries activity at location
protect pulp dentine complex and arrest lesion by sealing it
restore functional and aesthetic form

Question 20

caries removal technique

Answer 20

complete caries removal
partial
stepwise

Question 21

complete caires removal

Answer 21

removal of all caries material including enamel infected and affected dentine
- results in sound enamel and sound dentine (i.e. no darkened dentine
completely clean cavity

Question 22

stepwise caries removal

Answer 22

1st appointment
- open cavity
remove infected dentine, place temporary dentine 2-6months
2nd
- removal of temporary restoration
removal of remaining caries at base and place restoration

Question 23

how does stepwise caries removal work

Answer 23

after removing bacteria layer of affected dentine would Harden and calcify
increased distance between base of caries and pulp
allows tertiary dentine to be laid down

Question 24

partial caries removal

Answer 24

selective removal of carious dentine
removing all carious enamel and infected dentine
leaves affected dentine
preserves pulp vitality

Question 25

final cavity must have

Answer 25

sound enamel around cavity | no staining at ADJ to form seal

Question 26

caries removal steps

Answer 26

``` enamel access clearing the ADJ management of unsupported enamel management of unsupported enamel management of body of the carious lesion working from out to in ```

Question 27

enamel access

Answer 27

gain access to the carious dentine via high speef | not always needed if we have large carious lesio

Question 28

clearing the ADJ

Answer 28

work around the periperhu of the lesion | informs the extent of the lesion and once cleared to sound enamel and dentine ensures a seal

Question 29

managment of unsupported enamle

Answer 29

work around the periphery of lesion | removal of enamel not supported by dentine

Question 30

why remove enamel not suppoted by dentine

Answer 30

will fracture under occlusal load

Question 31

management of body of carious lesion

Answer 31

removing all infected dentine | retain caires affected dentine

Question 32

working out to in

Answer 32

allows sound marins | allows removal of bacterial and prevents reaching the pulp

Question 33

hand instruments

Answer 33

chisels | excavators

Question 34

chiseals

Answer 34

gingival margin trimmers hatchets straight chiseal manage caries and remove unsupported enamel

Question 35

excavator

Answer 35

remove carious dentine to clear the ADJ

Question 36

advantages of hand instruments

Answer 36

controlled removal of tooth structure tactile feedback during instrumentation cheap no noise or vibration

Question 37

disadvantages of hand instruments

Answer 37

time consuming exclusivese of hand instruments limited to open cavities operator fatigue

Question 38

rotary instruments

Answer 38

high speed | low speed

Question 39

high speed instruments

Answer 39

``` air powered 450000 rpm water cooling system used to remove enamel can modify cavity preparations to aid retention and support of restorative material ```

Question 40

low speed instruments

Answer 40

motor powered 4000 rpm use latch grip burs

Question 41

advantages of rotary instruments

Answer 41

more efficient can be used for anytime of carious lesion tactile feedback during instrumentation versatile different speeds burs and anguluations

Question 42

disadvantages of rotary insttuments

Answer 42

noise vibrations can be uncomfortable for patient and operator produce sig heat that requires cooling less conrol produce an aerosol

Question 43

chemo mechanical caries removal

Answer 43

proteolytic chemical that breaks down the organic tissue in the caries facilitates removal of it with an excavator type instruments

Question 44

advantages of chemo mechanical removal

Answer 44

controlled removal of tooth structure tactile feedback during instrumentation may reduce need for local anaethetic no noise or vibration

Question 45

disadvantages of chemo mechanical caries removal

Answer 45

time consuming limited use to open cavities selective caries removal(claims not proven) more fatiguing than other techniwues

Question 46

air abrasion, lasers and ultrasonics

Answer 46

mainly to prepare cavities reduce need for anethetic slower require purchese

Question 47

advantages of air abrasion, lasers and ultrasonics

Answer 47

reduce need for local anaetheic no noise or vibration no drilling air abrasion likely to improve bonding for composite

Question 48

disadvantages of air abrasion, lasers and ultrasonics

Answer 48

most cannot remove soft caires lack tackle feedback more time consuming expensive