1
Q
Define: Caries
A
Disease of mineralised tissues due to the action of microorganisms on fermentable carbohydrates
2
Q
Define: Early Childhood Caries
What is the DMFS?
A
Presence of one or more cavitated or non-cavitated carious lesions before the age of 6
- DMFS >1 before age 6
3
Q
Define: Severe Early Childhood Caries
What is the DMFS?
A
Presence of smooth surface caries in children less than three
- DMFS (age+1)
4
Q
What does DMFS stand for?
A
Decayed, missing, filled surfaces
5
Q
Methods of caries detection in children
A
- Clinical examination
- Radiographs
- Ortho separators
- Laser fluoresence
- Electric caries detector
- Transillumination
6
Q
Checklist before taking radiographs in children?
A
- Check previous radiographs first
- Clinically justify exposure
- Determine most appropriate radiograph for diagnosis
7
Q
Radiograph recall in paediatrics?
- Initial appt
- High risk
- Low risk (primary and permanent dentition)
A
- BW at initial appt
- 6 months for high risk (until risk status changes)
- 12-18 months for low risk in primary dentition
- 2 years for permanent dentition
8
Q
Indications for radiographs in children?
A
- Caries
- Ix for unerupted teeth
- Retained primary tooth
- Poor prognosis 6s as part of ortho assessment
9
Q
Rationale of electrical caries detector
A
Loss of mineral = increased porosity of tooth structure
Increased porosity = decreased electrical resistance
10
Q
Rationale of laser fluorescence for caries detection
A
Caries exhibits fluorescence proportional to the degree of caries
11
Q
Relationship between ICDAS and caries management in high risk
A
HIGH RISK - ICDAS 0-4 = seal, ICDAS 5,6 = RESTORE
12
Q
Consequences of ECC (9)
A
- Pain/discomfort
- Sepsis (Ludwig’s angina)
- Space loss
- Reduced QOL
- Disruption to growth and development
- Disruption to intellectual development
- Higher incidence of hospitalisation
- Increased risk of caries in permanent dentition
- Risk of dental anxiety
13
Q
Benefits of restoring primary teeth
A
- Stop progression of caries and spread of infection to pulp
- Restore function and integrity of teeth
- Reduced risk of consequences (pain, sepsis, space loss)
14
Q
Risks associated with restorative treatment
A
- Weakened tooth structure = more susceptible to fracture
- Recurrent lesions
- Restorative failure
- Iatrogenic pulp exposure
- Damage to adjacent teeth
15
Q
What is Ludwig’s Angina?
A
Rapidly progressive cellulitis of FOM which has a high mortality rate (8-10%)
16
Q
Evidence for risk of sepsis from caries
A
- Pine et al found 5% of children attending hospital for sepsis had dental sepsis, with highest predictor being caries
- Unkel found 47% of facial cellulitis were odontogenic in origin
17
Q
Consequences of premature tooth loss
A
Deviation of midline Canines moving distally Molars moving mesially Crowding Impaction Ectopic eruption Crossbite formation
18
Q
What is a space maintainer
A
Removable or fixed appliance intended to keep the space open for the permanent tooth to erupt into place
19
Q
UK clinical guidelines for paediatric dentistry - When to use space maintainers -
A
- Loss of Es in all arches (Except spaced arches)
- Following loss of D or E where crowding is >3.5mm per quadrant
20
Q
Disadvantages of space maintainers
A
- Plaque retention
- Can dislodge
- May impinge on soft tissue
- Issue with compliance if removable
- May affect eruption of adjacent tooth
- Regular checks by dentist required
21
Q
How can reduced dental QOL be observed in children?
A
Verbal complaints of pain
Pain manifesting in eating, sleeping and behavioural problems
22
Q
3 features indicating failure to thrive
A
- Weight of height below 3rd percentile for age
- Failure to maintain previously established growth pattern
- Growth failure of unknown origin
23
Q
Link between caries and failure to thrive
A
- Children with ECC weighed approx 1kg less than controls and <80% their ideal weight for age
24
Q
Evidence that caries tx improves growth in children
A
Post tx, children with ECC had a significant increase in growth velocity until they caught up with controls (catch up growth)
25
Define: catch up growth
Phenomenon seen in children after a period of growth retardation after the growth deficit is removed
26
Link between nutrition and ECC
ECC was a risk marker for under nutrition and iron deficiency
27
What is the importance of chronic iron deficiency in children?
Associated with impaired brain development and function
28
Evidence for increased risk of caries and ECC
- Skeie et al - clinical predictor at 5yo for being high risk at 10 was presence of primary Es with >2 carious surfaces
29
How does caries in the E influence caires in the 6 ?
- Mejare et al - if distal caries present in the E, the 6 is 15x more likely to be carious
30
How can direct conditioning cause dental anxiety?
Association between pain/stress with the dental setting
31
How can latent inhibition prevent dental anxiety?
Positive or neutral visits to the dentist serve as a defence against the development of dental phobias in children
32
Management strategies of caries in the primary dentition (5)
Complete caries removal and restore
- Partial caries removal and restore
- No removal, seal
- No removal, prevention only
- Extract
33
How can carious primary teeth be sealed? (2)
- Fissure sealant
| - Hall crown
34
Benefits of retaining caries
Avoids need for LA and preparation
| No risk of iatrogenic pulp exposure or damage to adjacent teeth
35
Indications for extraction of primary molar
Unrestorable tooth
Signs of sepsis
Pulp therapy unsuccessful
36
What is a self-cleansing preparation
Modification of a lesion resulting in a cavity form allowing easy cleaning
37
Materials used in primary teeth
RMGIC
Composite
Preformed metal crowns
38
Use of amalgam in children
Minimata treaty - amalgam no longer used in the treatment of deciduous teeth or children under 15 unless deemed necessary
39
Indications for RMGIC as a restorative material
Class I or II cavities in high risk children
| Temporary sealant
40
Adv of RMGIC
```
Biocompatible
F release
Reasonable wear resistance
Increased working time and rapid set
Less sensitive than composite
Better aesthetics than GIC
```
41
Disadvantages of RMGIC
Sensitising potential due to resin
Inferior mechanical properties than composite
Inferior aesthetics compared to composite
42
Indications for composite in primary teeth
Occlusal and proximal lesions where moisture control can be achieved
Fissure sealants
PRR
43
Advantages of composite
Superior mechanical properties
Excellent longevity and aesthetics
Adhesive (MI)
44
Disadvantages of composite
Demanding for pt and dentist (moisture control)
Time consuming
Technique sensitive
45
Indications for PMC
Primary teeth with extensive caries, decalcification or developmental defects
After pulp therapy
Intermediate restoration of fractured tooth
High caries risk
46
Advantages of PMC
Durable- Low failure rate
Cheap
Low susceptibility to secondary caries
Simple to fit
47
Disadvantages of PMC
Poor aesthetics
| Contraindicated for nickel allergy
48
Methods for isolation in paeds
Cotton wool
Rubber dam
Dry tips
Dry dam
49
Methods to manage caries in primary anterior teeth
- Prevention
- Inter-proximal disking
- Strip crowns
- Extraction
50
What is interproximal stripping / disking
Removal of superficial caries proximally, resulting in a crown with parallel mesial and distal surfaces that taper towards the incisal edges
51
How much caries is removed in disking?
Superficial caries only
| Any deeper caries can be left as the prep is self-cleansing
52
Indications for inter-proximal disking
Superficial caries proximally
Tooth fully erupted and exfoliation close
Good pt cooperation
53
Advantages of inter-proximal disking
Simple
Quick
Renders tooth self-cleansing due to open contacts
No effect on space loss
54
Disadvantages of inter-proximal disking
- Poor aesthetics
- Risk of iatrogenic pulp exposure
- Food impaction
- Sensitivity - fluoride varnish required
55
Indications for strip crowns
Caries affecting primary anterior teeth >1 surrface
Enamel hypoplasia
Fractured primary incisors
Discoloured incisors following trauma
56
What is a strip crown?
Acetate crown form is adjusted to fit the tooth and then filled with composite. The crown form is then removed from the final restoration
57
Advantages of strip crowns
Aesthetic
58
Disadvantages of strip crowns
Technique sensitive due to composite
Moisture control required
Reduction required - risk of pulp exposure, damage to adjacent teeth, weakened tooth structure
59
What is the Hall Technique?
Evidence-based restorative technique involving PMC placement on a primary molar tooth without the need for LA, caries removal or tooth preparation.
60
Rationale behind hall technique
Manipulates the plaque environment by denying the plaque biofilm bacteria from the source of nutrition, thus slowing down or arresting caries progression
61
List the clinical indications for hall crown technique
```
Class I and II lesions
Restorable tooth
Good patient cooperation
No pulpal involvement (clinically or radiographically)
Developmental defects
Fractured molar tooth
```
62
Why does the patient have to be cooperative?
Can be dangerous working with a small crown - risk of compromising airway
63
Contraindications for Hall technique
```
Irreversible pulpitis
Unrestorable tooth
Uncooperative
Unhappy with aesthetics
Risk of endocarditis
Nickel allergy
Root resorption >50%
```
64
Advantages of hall crown
Excellent success in primary teeth
Cheap and quick to place - cost-effective
Non-invasive - No LA or prep
Can acclimatise patient before need for invasive techniques
65
Disadvantages of hall crowns
Poor aesthetics
| Risk of compromising airway
66
Compare hall crowns vs conventional restorations
- Studies show less pain, secondary caries, pulpal symptoms, filling loss with hall crowns v conventional restorations in the long-term (Innes)
67
How should the hall crown fit the tooth?
- Smallest possible size that can fit should be used
- Must cover all cusps and approach contact points
- Should demonstrate slight spring back (but not over contact points)
68
Cement used with hall crowns
GIC
69
Ways to protect the child's airway when placing PMC?
- Sit child upright
- Cooperative child
- Use of gauze or tape
70
When should ortho separators be placed prior to PMC placement
- Tight contact points
| - Loss of mesio-distal width of a tooth due to tooth fracture
71
How long is ortho separator be placed for?
3-5 days before next appt
72
How should the ortho separator look in correct position
Half of the band is visible above the marginal ridge
Paediatric Dentistry
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Decks in class (11)
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