Restorative work in Primary teeth

Question 1

What are the four stages of pulpal disease?

Answer 1

Normal, Inflamed, Necrotic, Infected

Question 2

What are the four different terms for pulp status?

Answer 2

Healthy, Reversibly Inflamed, Irreversibly Inflamed, Pulp Necrosis

Question 3

Why is it important to know about pulpal pathology in primary teeth?

Answer 3

there is early pulpal involvement from decay etc due to the larger pulp horns relative to tooth size

Question 4

What are the ways primary pulp can respond to caries?

Answer 4

pulp regeneration, reparative dentine, pulpal inflammation

Question 5

Why is it important to diagnose pulp status?

Answer 5

to determine the most appropriate treatment option

Question 6

What are some ways it is difficult to diagnose pulp status in primary teeth?

Answer 6

lack of correlation between clinical symptoms and histological evidence, unreliable tests

Question 7

What is the only method to get a precise diagnosis of pulp status?

Answer 7

histological examination

Question 8

How do we diagnose pulp status?

Answer 8

symptoms, clinical findings, special investigations

Question 9

What are symptoms of reversible pulpitits?

Answer 9

pain on stimulus, pain stops when stimulus is removed, pain is sharp, painkillers work, pain doesn’t linger

Question 10

What are symptoms of irreversible pulpitits?

Answer 10

spontaneous pain, constant pain, pain lingers, painkillers don’t work, pain is a dull throbbing ache, pain disrupts sleep

Question 11

What are some clinical findings for irreversibly inflamed teeth?

Answer 11

discoloured, over 1/2 the tooth broken down, over 2/3 the marginal ridge broken down, pain when you touch the tooth, sinus, intra or extra oral swelling

Question 12

What are the special investigations you can complete to asses pulp status in primary molars?

Answer 12

radiographs, mobility, TTP

Question 13

What can you assess on radiographs regarding pulp status?

Answer 13

extent of caries, any inter-radicular radiolucency, external or internal resorption

Question 14

What can you assess with mobility?

Answer 14

whether the mobility is pathological or physiological

Question 15

What can you assess with the TTP?

Answer 15

differentiate between food impaction and peri-radicular pathology

Question 16

Does vitality testing have any benefit in primary teeth?

Answer 16

no

Question 17

When assessing teeth what are the two pathways for treatment?

Answer 17

restore or extract

Question 18

What medical factors can indicate you should try and restore the tooth?

Answer 18

bleeding disorders, if the patient would be at risk under GA

Question 19

What medical factors can indicate you should extract the tooth?

Answer 19

immunocompromised patients, patients with cardiac disorders and at risk of infective endocarditis

Question 20

What are some behavioural and social factors to consider when determining whether to restore or extract a tooth?

Answer 20

dental awareness, motivation, pattern of attendance, age of the child, how long the tooth will last

Question 21

What are some dental factors to consider when determining whether to restore or extract a tooth?

Answer 21

if the patient has gross dental neglect or any acute infection, time to natural exfoliation of the tooth, effect on developing dentition, if the patient has hypodontia

Question 22

If the tooth is due to exfoliate within a year, what are your recommended treatment options?

Answer 22

provisional restoration or extraction

Question 23

If the tooth is due to exfoliate later than a year, what are your recommended treatment options?

Answer 23

retain the tooth with a definitive restoration

Question 24

What are the options for pulp therapy for vital teeth?

Answer 24

pulp capping, pulpotomy

Question 25

What are the options for pulp therapy for non-vital teeth?

Answer 25

pulpectomy, extraction

Question 26

When do you perform vital pulp therapies?

Answer 26

if there is a restorable crown, if there is no radiographic pathology, reversible pulpitis, if there are no sinus or abscesses

Question 27

What is pulp capping?

Answer 27

a method of maintaining the vitality of the pulp by placing a dressing

Question 28

What is the aim of pulp capping?

Answer 28

to promote pulpal healing

Question 29

what are the two type of pulp capping?

Answer 29

direct or indirect

Question 30

What is direct pulp capping?

Answer 30

medicament placed directly onto pulp

Question 31

What is the aim of direct pulp capping?

Answer 31

to promote dentine bridge formation and preserve vitality

Question 32

What medicament is commonly used for direct pulp capping?

Answer 32

Calcium Hydroxide

Question 33

Is direct pulp capping recommended for carious primary molars?

Answer 33

no

Question 34

When is direct pulp capping recommended for primary molars?

Answer 34

if the exposure is iatrogenic

Question 35

What are the aims of indirect pulp capping?

Answer 35

arrest caries, allow for formation of reactionary dentine, promote pulp healing and preserve vitality

Question 36

What are indications of indirect pulp capping?

Answer 36

deep carious lesion, no signs of pulpal pathosis

Question 37

What is indirect pulp capping?

Answer 37

placing a dressing on to residual dentine left over a nearly exposed pulp

Question 38

What is the most important part of indirect pulp capping?

Answer 38

getting a good coronal seal

Question 39

Why can you get inter-radicular radiolucency?

Answer 39

there are accessory foramen between the roots and the toxins from pulp can leach into the area causing bone resorption

Question 40

What is pulpotomy?

Answer 40

removal of the coronal part of the pulp tissue

Question 41

What is the aim of a pulpotomy?

Answer 41

maintain the vitality of radicular pulp

Question 42

What is the haemostatic agent used in pulpotomy?

Answer 42

ferric sulphate

Question 43

How does ferric sulphate stop bleeding?

Answer 43

causes agglutination of blood proteins - improves clotting

Question 44

What is the aim of a desensitising pulpotomy?

Answer 44

to reduce pulpal inflammation or symptoms to facilitate subsequent pulp therapy

Question 45

What are some indications for densensitising pulpotomy?

Answer 45

hyperalgesic pulp and poor patient compliance

Question 46

What dressing do you use in a desensitising pulpotomy?

Answer 46

ledermix then GIC

Question 47

How long can you leave the temp GIC restoration after desensitising pulpotomy before placing a definitive restoration?

Answer 47

1-2 months

Question 48

What is a pulpectomy?

Answer 48

extirpation of soft tissue content from the coronal pulp chamber and root canals

Question 49

What are the indications for pulpectomy?

Answer 49

evidence of irreversible pulpitits or pulpal necrosis

Question 50

What indicated success of pulp therapy at follow up appointments?

Answer 50

absence of signs or symptoms of pathology

Question 51

What indicates failure of pulp therapy at follow up appointments?

Answer 51

worsening or increase in symptoms, radiolucencies

Question 52

What are the keys to success for pulp therapy?

Answer 52

accurate diagnosis, good technique, restoration with a good coronal seal

Question 53

What is the easiest way to get a good coronal seal with primary teeth?

Answer 53

pre-formed metal crown

Question 54

What question is important to ask the parent about the child's pain?

Answer 54

Is your child kept awake with tooth ache at night?

Question 55

Can you use GP in primary teeth?

Answer 55

no

Question 56

Why can you not use GP in primary teeth?

Answer 56

GP doesn't resorb but primary roots do

Question 57

Where is most decay found in primary teeth?

Answer 57

interproximally

Question 58

Why is it important to treat extensively decayed primary teeth?

Answer 58

the infection can affect adult teeth

Question 59

What is classed as obvious caries?

Answer 59

caries visible upon clinical examination

Question 60

What percentage of 5 year olds in england, wales and northern ireland have obvious caries experience?

Answer 60

40%

Question 61

Does the percentage of children with obvious caries increase or decrease as they age?

Answer 61

decrease

Question 62

Do the majority of children with obvious caries have many restoration or no restorations?

Answer 62

no restorations

Question 63

For the 5 year olds with tooth decay, what is the average number of teeth affected?

Answer 63

3-4

Question 64

What is the average cost of a tooth extraction in hospital for a child aged under 5?

Answer 64

£836

Question 65

How should you diagnose caries in children?

Answer 65

clinical examination using good lighting and 3 in 1, radiographs

Question 66

Can radiographs be used instead of a good clinical exam and history?

Answer 66

no, they are additional

Question 67

What are the best radiographs that can be used to assess caries?

Answer 67

bitewings

Question 68

Why can you not see most of the interproximal caries clinically in primary teeth?

Answer 68

there are broad contact areas

Question 69

How often should bitewing radiographs be taken in high caries risk children?

Answer 69

every 6 months

Question 70

When do you stop taking bitewings every 6 months for high caries risk children?

Answer 70

when no new or active lesions are apparent and the individual is no longer high caries risk

Question 71

How often should bitewing radiographs be taken in moderate caries risk children?

Answer 71

once a year

Question 72

How often should bitewing radiographs be taken in low caries risk children?

Answer 72

every 12-18 months for primary dentition, every 2 years for permanent dentition

Question 73

Why do we complete restorations in primary teeth?

Answer 73

eliminate disease, prevent pain, avoid infection, preserve space, maintain function

Question 74

What percentage of 5 year olds have dental pain due to caries?

Answer 74

12%

Question 75

What percentage of DMFT in UK 5 year olds go untreated?

Answer 75

86%

Question 76

What is the average DMFT score for UK 5 year olds?

Answer 76

1.1

Question 77

What are some problems that may occur when trying to restore primary teeth?

Answer 77

children can't concentrate or cooperate for long periods of time, may be scared of the dentist, may not understand all the reasons to complete the treatment, the childs mouth is smaller and access can be poor, moisture control can be more difficult, child may have mobile teeth

Question 78

What is the clinical significance regarding restorations due to the narrow occlusal table of primary teeth?

Answer 78

buccal-lingual width of the cavity needs to be reduced

Question 79

What is the clinical significance regarding restorations due to the broad, flat contact areas of primary teeth?

Answer 79

there are problems diagnosing caries as they are harder to see clinically

Question 80

What is the clinical significance regarding restorations due to the thinner enamel and dentine layers of primary teeth?

Answer 80

caries progresses to pulp faster

Question 81

Where are most caries located in primary teeth?

Answer 81

interproximally

Question 82

How are most interproximal lesions detected in primary teeth?

Answer 82

radiographically

Question 83

What are the potential materials that can be used for restoring caries in primary teeth?

Answer 83

composites, GIC, Resin modified GIC, Compomers, Preformed Metal Crowns

Question 84

What are advantages to using composites to restore primary teeth?

Answer 84

adhesive, aesthetic, good mechanical properties

Question 85

What are disadvantages to using composites to restore primary teeth?

Answer 85

good moisture control is needed, expensive, has no fluoride leaching therefore is not preventative

Question 86

What is the setting reaction for standard GIC?

Answer 86

the acid-base reaction between glass and poly acid

Question 87

What is the setting reaction for dual cure GIC?

Answer 87

the acid-base reaction between glass and poly acid as well as a light activated free radical polymerisation

Question 88

What are advantages to using GICs to restore primary teeth?

Answer 88

adhesive, good aesthetics, flouride leaching which means they are preventative

Question 89

What are advantages to using Light cure GIC over standard GIC to restore primary teeth?

Answer 89

they are command set

Question 90

What are characteristics of conservative restorative technique for GIC prep?

Answer 90

optimise tooth integrity, reduce load on restorative material, preserve pulp status, reduce risk of further caries

Question 91

When is GIC not recommended?

Answer 91

for long term restorations or for large cavities

Question 92

How do you place the GIC in a primary tooth?

Answer 92

remove caries with slow handpiece, place cavity conditioner, place a matrix band, place GIC, allow to set with minimal disturbance for 2-3 mins

Question 93

What are benefits to placing unfilled resin over GIC?

Answer 93

protects the GIC during final setting

Question 94

What are some disadvantages to using GIC to restore primary teeth?

Answer 94

mechanical properties are not as good as resins, poor resistance to wear, not as durable as resins

Question 95

What are compomers?

Answer 95

polyacid modified composites

Question 96

What are advantages to using compomers to restore primary teeth?

Answer 96

good handling properties, radio-opaque, better mechanical properties than GIC

Question 97

What are disadvantages to using compomers to restore primary teeth?

Answer 97

less fluoride leaching than GIC, there is resin polymerisation contraction, need a primer

Question 98

What are indications for the use of preformed metal crowns?

Answer 98

inter-proximal cavities, 2 or more carious surfaces on a tooth, primary teeth that have been root treated, young children

Question 99

What are contra-indications for the use of preformed metal crowns?

Answer 99

a non vital tooth, small occlusal cavities, older children, parental preference

Question 100

What is the restorative technique of choice for primary dentition?

Answer 100

preformed metal crowns