Treatment of Large Carious lesions

Question 1

What are the benefits of varnish?

Answer 1

Seal tubules and cavomargins

Question 2

What are the benefits of bonding agent/adhesives?

Answer 2

Seals tubules and cavomargins

Question 3

What are the benefits of dycal?

Answer 3

Reparative dentin formation

Question 4

What are the benefits of RMGI?

Answer 4

Fluoride release, bonding capability, some moisture tolerance

Question 5

What are the benefits of IRM?

Answer 5

Eugenol is sedative

Question 6

All preperations require long-term sealing of the dentinal tubules and cavomargins for

Answer 6

reduced sensitivity and pulpal inflammation

Question 7

Base and liner placement depends on the need for medication or pulp protection and depends on

Answer 7

remaining dentin thickness

Question 8

Characteristics of eugenol

Answer 8

palliative, antimicrobial, good cavomargin sealing

Question 9

Characteristics of GI

Answer 9

bonding capability, fluoride release, antimicrobial, remineralization, cavomargin sealing

Question 10

Characteristics of dycal

Answer 10

starts reparative dentin

Question 11

Compatibility issues for amalgam

Answer 11

none-compatible with all materials

Question 12

What is composite not compatible with?

Answer 12

Varnish or materials containing eugenol (ZOE/IRM)

Question 13

The long chain acids in GI are though to have limited diffusion down the tubules therefore sensitivity in moderately deep preps due to

Answer 13

acid irritation from GI may not be a problem

Question 14

Bases weaken restorations, so you should

Answer 14

minimize thickness

Question 15

Base placement

Answer 15

Avoid covering entire floor and gingival wall. Keep no closer than 1mm from cavosurface margin

Question 16

Caries process requires

Answer 16

1. Cariogenic bacteria
2. Susceptible tooth surface
3. Nutrients for bacterial growth

Question 17

Describe cariogenic bacteria

Answer 17

• Initial is S. mutans
• Adheres to enamel
• Produce and tolerate acid
• Thrive in sucrose rich environment
• Produce bacteriocins
• Lactobacillus (post enamel cavitation)

Question 18

Outer carious dentin (infected dentin)

Answer 18

Bacteria is present. Dentin is demineralized and cannot remineralize- must be removed

Question 19

Inner carious dentin (transparent zone) (affected dentin)

Answer 19

No bacteria present. Dentin is demineralized. Region is capable of self repair provided the pulp remains vital (affected layer)

Question 20

Pulp reaction to carious dentin

Answer 20

Increase in inflammatory cells. Pulp-dentin complex attempts to remineralize and block off open tubules

Question 21

Reparative dentin serves as a

Answer 21

barrier to diffusion products

Question 22

Reaction to a long-term, low-level acid demineralization associated with a slowly advancing lesion is the deposition of crystalline material forming

Answer 22

sclerotic dentin

Question 23

Reaction to a moderate intensity attach with bacterial invasion. Odontoblasts can die leaving dead tracts. Replacement odontoblasts form and deposit

Answer 23

reparative dentin on the affected pulp chamber wall

Question 24

Reaction to severe, rapidly advancing caries characterized by very high acid levels results in infection, abscess and

Answer 24

pulp death- necrosis

Question 25

Clinically, dentin softening precedes discoloration which in turn precedes

Answer 25

bacterial invasion

Question 26

In acute/rapid caries, the bacterial front is

Answer 26

well behind the discoloration front therefore some discolored dentin can be left

Question 27

In slow/chronic caries, bacterial front is close to the

Answer 27

discolored front. Therefore, best to remove discolored dentin unless it is within 0.5mm of pulp

Question 28

What are strategies for caries prevention?

Answer 28

- Limit substrate - Modify microflora - Plaque disruption - Modify tooth structure - Stimulate salivary flow/ artificial saliva - Restore defective tooth surfaces

Question 29

Reversible pulpitis

Answer 29

limited inflammation of the pulp from which the tooth can recover if the caries producing the irritation is eliminated by operative treatment

Question 30

Reversible pulpitiis is clinically evident by

Answer 30

short lingering sharp pain in response to a cold thermal stimulus

Question 31

Irreversible pulpitis is clinically evident by

Answer 31

lingering pain (>10 seconds) following thermal (cold) stimulus

Question 32

Irriversible pulpitis

Answer 32

Severe inflammation of the pulp from which the tooth is unlikely to recover after removing the caries

Question 33

Recommended treatment for irreversible pulpitis

Answer 33

EXT or endodontics

Question 34

What do you do if removal of decay causes a pulp exposure

Answer 34

Direct pulp cap

Question 35

What is a direct pulp cap?

Answer 35

Treatment of pulp with a material such as dycal that seals over the exposure site and promotes reparative dentin formation

Question 36

Reversible pulpitis, what can be done to avoid a pulp exposure?

Answer 36

Indirect pulp cap or stepwise excavation

Question 37

What is indirect pulp cap?

Answer 37

Deliberate retention of softened dentin near the pulp (0.5mm) and treatment with dycal covered by IRM and placement of final restoration

Question 38

Favorable prognosis for a direct pulp cap if

Answer 38

1. Blood supply to the pulp is maintained 2. Elimination of bacteria and bacterial toxins 3. Tooth is asymptomatic and normal response to pulp testing before operative treatment 4. Exposure is small (<0.5mm diameter) 5. Hemorrhage is easily controlled 6. In a traumatic exposure, there is little desiccation and no evidence of aspiration of blood into the dentin (blushing)

Question 39

Clinical decisions: Pin-point exposure having sound dentin on periphery of exposure. Indication of either no pulpal inflammation or mild pulpal inflam restricted to the exposure site

Answer 39

Exposure can be successfully repaired if properly treated

Question 40

CLinical decision: Pin-point exposure, sound dentin at periphery. Mild bleeding that coagulated immediately. Mild degree of pulpal inflammation

Answer 40

Repairable condition

Question 41

Clinical decision: Exposure with decayed or infected carious dentin at the periphery. Considerable inflammation in the pulpal or root canal tissues far beyond the exposure sit. Considerable bleeding with clot formation

Answer 41

Repair is doubtful

Question 42

Clinical decision: An exposure with profuse hemorrhage. Great involvement (usually mechanical) of pulpal and root tissues.

Answer 42

Exposure usually beyond repair

Question 43

Clinical decisions: An exposure accompanied by inflammatory fluids and pus. Extensive inflammation and destructive of pulpal and root canal tissues.

Answer 43

Not repairable

Question 44

Successful pulp capping requires

Answer 44

long term exclusion of bacteria and bacterial products. Some irritation to the pulp

Question 45

Characteristics of Mineral Trioxide Aggregate (MTA)

Answer 45

pH 12.5, high compressive strength

Question 46

Treatment sequence for large carious lesions

Answer 46

1. Collect objective and subjective information. Determine status of pulp health 2. Prepare outline form to sound structure removing undermines enamel unless needed for retention for a temporary rest. 3. Remove all decay from periphery 4. Clinical decision regarding extend of pulpal decay and type of restoration (Direct pulp cap, indirect pulp cap, or stepwise excavation)