SDCEP caries management

Question 1

what should be taken into account when deciding caries management of a deciduous tooth (3)

Answer 1

time to exfoliation
risk of pain or infection
number of teeth affected
co-operation of child

Question 2

treatment of choice for child with pulpitis pain in a vital tooth with irreversible symptoms and no evidence of dental abscess

Answer 2

pulpotomy

Question 3

benefits of the hall technique

Answer 3

no LA
no tooth preparation
to risk of iatrogenic damage

Question 4

what tooth is suitable for no caries removal and hall technique

Answer 4

primary tooth with advanced lesion on proximal surface

can also be done for advanced occlusal lesion

Question 5

aim of hall technique

Answer 5

completely seal a carious lesion so that the environment of the plaque biofilm is altered sufficiently to slow or even arrest caries progression

Question 6

process of hall technique

Answer 6

• have child sitting upright
• assess if separators requires, if so, place then 2nd appointment 3-5 days later
• select size of PMC
• fill crown with glass ionomer luting cement
• seat crown - can be assisted by child biting on cotton wool roll over the tooth
• remove excess cement and clear contacts using floss

Question 7

what teeth are suitable for no caries removal and seal with a fissure sealant

Answer 7

primary or permanent teeth with an initial occlusal (or proximal lesion)

Question 8

name an example of an atraumatic restorative technique

Answer 8

hand excavation

Question 9

how much caries is removed in selective caries removal

Answer 9

no obvious caries at ECJ
clear cavity walls till hard dentine
pupally, clear caries until adequate depth for durable restoration (in deep lesions this may been soft dentine is left)

Question 10

tooth suitable for a pulpotomy

Answer 10

• pulpitis with irreversible symptoms (vital tooth)
• primary molar with advanced carious lesion with no clear band of dentine separating caries and pulp (vital tooth)

Question 11

pulpotomy technique (primary teeth)

Answer 11

• give LA and ideally place dam
• access cavity and caries removal
• remove coronal pulp with slow speed or excavator
• irrigate with saline
• arrest haemhorrage with pledget soaked in ferric sulphate
• ZOE cement over stumps and to fill cavity
• restore with PMC

Question 12

contraindications for endodontics in primary molars

Answer 12

poor co-operation
space closure desired by orthodontics
advanced root resorption
severe-recurrent pain
pus in pulp chamber

Question 13

when would pulpectomy of a primary molar be done

Answer 13

• excellent co-operation
• long time till exfoliation
• no successor

Question 14

primary pulpectomy technique

Answer 14

• access
• coronal pulp extirpation
• root canal preparation
• obturation using calcium hydroxide iodoform paste (vitapex)
• create a GIC core
• crown

Question 15

what medical history precludes an extraction in children

Answer 15

bleeding disorders
coagulopathies

(endodontic treatment preferred)

Question 16

what medical history precludes pulp treatment in children and why

Answer 16

cardiac problems
immunocompromised

chance pulp treatment wont work, extraction preferred as less chance of developing infection

Question 17

how often should bitewings be taken in children

Answer 17

standard risk - every 2 years
increased risk - every 6 -12 months
(SDCEP guidelines)

Question 18

what age should bitewings start being taken

Answer 18

4-5 years old

Question 19

partial (cvek) vs complete pulpotomy

Answer 19

partial - removal of 2-3mm coronal pulp (permanent teeth only)
full - removal of entire coronal pulp to level of canal orifices

Question 20

pulpotomy technique in permanent teeth

Answer 20

1.LA, dam and access
2. remove 2-3mm coronal pulp (Cvek) with slow speed
3. arrest haemhorrage with saline soaked pledget
- if no bleeding or prolonged bleeding progress to full pulpotomy -
4. setting calcium hydroxide over exposed pulps
5. GIC (vitrebond) lining
6. seal with definitive restoration

Question 21

direct pulp cap indications and process

Answer 21

exposure <2mm
exposure <24 hours
control bleeding with saline soaked pledget
place layer of setting calcium hydroxide
restore

Question 22

pulpectomy in permanent immature tooth

Answer 22

1. LA, dam and access
2. irrigation with sodium hypochlorite (little to no prep required)
3. apexification using MTA
4. seal MTA with sealer
5. obturate with GP
6. seal with RMGIC
7. restore

Question 23

discuss stepwise caries removal

Answer 23

visit one:
LA and access with highspeed, clear till no obvious caries at ECJ
use slow speed or excavator to clear cavity walls to hard dentine
pulpally clear caries until adequate thickness for durable restoration
place temporary restoration e.g fuji triage

wait 6-12 months (tertiary dentine formation)

remove temporary restoration
remove carious dentine until hard dentine reached (be mindful of pulp)
may require indirect pulp cap
restore with definitive restoration

Question 24

what lesions would stepwise caries removal be appropriate for

Answer 24

extensive occlusal and proximal lesions in permanent teeth

Question 25

what lesions are suitable for selective caries removal and restoration

Answer 25

primary - advanced anterior and occlusal
permanent - moderate occlusal and proximal

Question 26

what lesions are suitable for complete caries removal and restoration

Answer 26

permanent teeth - moderate lesions at all sites

Question 27

discuss site specific prevention as a means of caries management

Answer 27

can be used for initial lesions on all sites of primary teeth and for occlusal and proximal lesions of permanent teeth
also primary teeth close to exfoliation and arrested caries

• brushing demonstration
• FV 4x year
• dietary advice