case 9: deep caries

Question 1

Case Summary

Answer 1

C/O - 30 y/o with severe pain lasting few seconds and fading slowly. Can’t localise, sensitive to all stimuli.
IO - reversible pulpitis, deep carious lesion U5.

Question 2

Investigations to carry out on this tooth:

Answer 2

• vitality testing (appears hypersensitive)
• PA (reaches inner 1/3 of dentine, no PAP)

Question 3

Is this tooth restorable? If so, what are the options?

Answer 3

yes - no endo or XLA indicated as still vital.
- guarded prognosis due to proximity to pulp.
- XLA still an option if the pt wishes but not the best option.

Question 4

Would dam be required in this restoration?

Answer 4

Yes -
- risk of exposure due to depth of caries.
- moisture control for marginal seal
- selective caries removal - leave at the base but clear ADJ for coronal seal.

Question 5

Any medico-legal considerations for managing a deeply carious tooth / doing selective caries removal?

Answer 5

• document everything in the notes
• conversations about prognosis of the tooth, risks and benefits of all option and the option chosen.
• include consent.