Management of Caries in Permanent Teeth Flashcards
If there is initial caries posteriorly, what would you do?
Teeth with non-cavitated enamel carious lesions, white spot lesion, discoloured or stained fissures.
Place a resin fissure sealant.
Review clinically at each recall visit.
Review radiographically 6-12 months- according to caries risk assessment.
Top up when required.
If lesion is progressing or caries present- selective caries removal and restore or stepwise caries removal and restore.
If a permanent tooth has moderate dentinal caries occlusally, what does this mean?
Caries is visible within dentine and may extend into the middle third.
Enamel cavitation clinically and dentine shadow or cavity visible in dentine.
What is the ideal treatment for moderate occlusal caries?
Selective caries removal and restore.
If a permanent tooth has extensive occlusal dentinal caries, what does this mean?
The caries extends into the inner third of dentine radiographically but should still be a clear band of dentine between the caries and the pulp.
Extensive cavitation with visible dentine or widespread dentinal shadow.
What is the ideal treatment for extensive occlusal caries?
Carry out stepwise caries removal
- Give LA, apply dam, remove carious tissue with high speed. Then use slow speed to remove caries until the cavity walls are cleared to hard dentine.
- Pulpally, selectively remove carious dentine until soft dentine is reached- leave this over the pulp.
- Ensure no caries left at the ADJ.
Restore temporarily- recommends using Fuji Triage to ensure you can see the margins of the restoration.
Wait 6-12 months- remove the temp, remove carious tissue until hard dentine is reached.
Place permanent restoration.
If you’re unsure whether a proximal lesion is cavitated, what could you do?
Apply orthodontic separators and get the child to come back 5 days later to visualise.
Radiographs.
If there is initial proximal caries, what does this mean?
Teeth with white spot lesions, enamel is intact.
Caries in the outer third of dentine radiographically.
What treatment would you carry out for an initial proximal lesion?
Site specific prevention.
or
Seal the lesion.
What does it mean if a tooth has moderate dentinal caries proximally?
Enamel may be cavitated
Dentine shadow seen
Radiographically- dentinal caries in the outer to middle third of dentine
What does it mean if a tooth has extensive dentinal caries proximally?
Cavitation with visible dentine
Extensive dentine shadow
Caries extends into inner third of dentine radiographically but should still be a clear band of dentine seen between that and the pulp.
How would moderate and extensive dentinal caries be treated proximally?
Moderate- partial caries removal and restoration
Extensive- step wise caries removal and restoration
What factors would class a FPM as having poor prognosis?
Moderate to severe MIH
Advanced or unrestorable caries
Pulpitis with reversible or irreversible symptoms
Dental infection
Pulpal involvement radiographically or periradicular pathology
What radiographs would you request if considering extracting a FPM with poor prognosis?
OPT
What factors would you take into consideration before extracting a FPM?
Calcification of the bifurcation of lower second permanent molars- 8.5-10 years old.
Position of the 8’s
5’s present and in a good position
Mild buccal segment crowding
Class I incisor relationship
Under what circumstances might you want to refer to a paediatric specialist if a FPM is of poor prognosis?
Other teeth missing
Poorly placed
Generalised developmental defects
Significant skeletal discrepancy
