Paeds: Radiographic Caries Diagnosis And Staging

Question 1

Primary tooth: occlusal caries (outer 1/3 dentine)

Answer 1

Initial occlusal caries

Question 2

Primary tooth: occlusal caries (inner 1/3 dentine)

Answer 2

Advanced occlusal caries

Question 3

What is selective CR?

Answer 3

Drill till achieved sound cavity margin to allow seal.

May leave soft carious dentine.

Question 4

Non-restorable cavity control approach?

Answer 4

Reducing cariogenic potential of the lesion by altering the environment of the plaque biofilm overlying the carious lesion through brushing and dietary advice.

Question 5

Primary tooth: proximal caries (invading only the enamel)

Answer 5

Initial proximal caries

Question 6

Primary tooth: proximal caries (invading into the dentine)

Answer 6

Question 7

Permanent tooth: occlusal caries (confined to enamel)

Answer 7

initial occlusal caries

Question 8

Stepwise caries removal?

Answer 8

Two-steps

1. Soft dentine —> coloured temp rest (GI)

6-12 months

2. Hard dentine —> restore

Question 9

Permanent tooth: occlusal caries (middle 1/3 dentine)

Answer 9

Moderate occlusal caries

Question 10

Permanent tooth: occlusal caries (inner 1/3 dentine)

Answer 10

Extensive occlusal caries

Question 11

Permanent tooth: proximal caries (outer 1/3 dentine)

Answer 11

Initial proximal caries

Question 12

Permanent tooth: proximal caries (middle 1/3 dentine)

Answer 12

Moderate proximal caries

Question 13

Permanent tooth: proximal caries (inner 1/3 dentine)

Answer 13

extensive proximal caries

Question 14

Radiographic interpretation: Permanent tooth with caries proximally extending into the inner third of dentine?

Answer 14

PERMANENT TOOTH advanced proximal carious lesion

Management: Stepwise caries removal, temporise with an obviously temporary material and restore with a permanent restoration after 6-12 months.

Question 15

With or without clear band of normal dentine present?

Answer 15

With

Question 16

Right or left?

Answer 16

Tooth angled towards the right —> right

Question 17

Right or left?

Answer 17

Tooth angled towards the left = left

Question 18

Pain that occurs spontaneously but if provoked by a stimulus is typically not relieved when the stimulus is removed —> worse with heat, relieved by cold.

Answer 18

Irreversible pulpitis:
1. Gently remove gross debris from cavity
2. Place Corticosteroid antibiotic past under a temporary dressing (ideally open up pulp chamber and apply directly onto pulp).
3. Carry out Pulpotomy or extract

Question 19

No clear band of dentine seen radiographically on primary tooth?

Answer 19

Consider sealing using the Hall technique

Pulpotomy

Question 20

Fluoride varnish amount for 2-5 years old patient?

Answer 20

0.25ml

Question 21

Fluoride varnish amount for 5-7 and above years old patient?

Answer 21

0.4ml

Question 22

ART: atraumatic restorative technique

Answer 22

No drilling/LA - just sharp hand pieces (excavator/chisel etc) remove caries & achieve clear cavity margins - restore high viscosity GI.

Question 23

Reversible pulpitis from a proximal carious lesion

Answer 23

Temporary dressing for 3-7 days

Symptoms resolved = hall technique
Unresolved = treat as irreversible pulpitis

Question 24

Reversible pulpitis from occlusal carious lesion

Answer 24

Temporary dressing 3-7 days

Symptoms resolved = Selective CR & restore
Symptoms unresolved = treat as irreversible pulpitis

Question 25

Irreversible pulpitis from a carious lesion treatment

Answer 25

If child can tolerate
—> straight to extract/pulpotomy

If child can’t initially tolerate
—> dress with sub lining of corticosteroid antibiotic paste & pain relief
—> then extract/pulpotomy

Question 26

What kind of clinical findings would suggest low risk caries but still requires bitewings to be taken?

Answer 26

good dentition, however crowding, high surface area contacts (i.e. multiple areas for hidden interproximal caries)

Question 27

Triangle radiolucencies on the mesial cusp of molars are likely to be?

Answer 27

Cusp of carabelli