Restorative management of caries in the primary dentition Flashcards
(58 cards)
Why bother restoring caries?
Maintain function, eliminate disease, restore health, prevent pain, avoid infection, preserve space, growth and development & have a positive attitude to oral health
Why is it important to restore health?
52 million school hrs/year are missed due to toothache
What % of 5 y/o are in pain?
12%
What is the purpose of preserving space?
Resorption of primary tooth sets place for permanent tooth to move into (without this may get delayed eruption etc)
Why is important to maintain a positive attitude to oral health?
To protect permanent teeth in the future
What % of 5y/o are caries free?
70%
What % of 5y/o have caries with an average dmft of 1.1?
30%
Why is so much untreated?
General problems: Co-operation, understanding, concentration, motivation, fear, parent
Oral problems: access, moisture control, dental anatomy, transient dentition, keeping mouth open
What are the different issues with crown morphology of primary teeth and their clinical significance?
- narrow occlusal table = B-L width of cavity needs to be reduced
- broad, flat, interproximal contact areas = problems with diagnosing caries
- thinner enamel and dentine layers = caries progresses more quickly to the pulp
What % of all caries by the age of 10 in the primary dentition are interproximal?
60%
What is made especially difficult by children’s difficulty in keeping their mouth open?
toleration of bitewings is poor = lateral obliques and DPTs used instead = are not so good
- for early diagnosis bitewings are essential (18-71% detected clinically, 40-470% detected radiographically
What order do we do treatment planning in?
- following a full history and examination
- operative management based various factors
- choice of restorative material
What is the purpose of doing a full history and exam?
So we can deal with pain, plan prevention and manage caries
What is operative management based on?
Childs ability to cope, no. and size of lesions, time until exfoliation, presence of infection, family support for prevention
What is the preferred treatment if a tooth is not near to exfoliation?
pulp treatment and restore tooth with preformed metal crown
What different factors play a role in choice of restorative material?
Patient factos, Tooth factors and operator factors
What are the different options for restorative material?
Composite, amalgam, compomer, stainless steel crown, temporise (GIC)
What are the different patient factors?
caries status, general health, parafunction (grinding/occlusion), age, diet and co-operation
What are the different operator factors?
Material properties, quality of finished, moisture control, expertise and anaesthesia
Which materials are best for temporary restorations?
Conventional GIC (triage = fugi VII)
Which materials are best for permanent restorations?
If can rubber dam = composites, if not RMGIC (Fugi II) or compomer
What are the different tooth factors?
Tooth location (accessibility and aesthetics), cavity design, pulp involvement (metal crown = no root fill), dentition, occlusal load and tooth quality
What are the different stages of cavity prep?
- Gain access
- Remove caries
- Look, think and design (based on extent of caries, material)
BE CONSERVATIVE
How do we manage interproximal caries that are confined to enamel?
Encourage to arrest = monitor, preventative advice, topical fluoride, avoid using bur
