Management of Carious Lesions
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Questions and Answers

What concept is emphasized as the first step in managing any carious lesion?

  • Restorative treatment
  • Preventative advice (correct)
  • Fluoride exposure
  • Tooth structure removal
  • Which of the following is NOT considered a minimally invasive dentistry technique?

  • Performing restorations
  • Using materials that are long-lasting
  • Removing a significant amount of tooth structure (correct)
  • Utilizing fissure sealants
  • What is the primary goal of minimally invasive dentistry?

  • To completely eliminate the risk of future decay
  • To ensure the longest possible lifespan of restorations
  • To preserve as much tooth structure as possible (correct)
  • To achieve the most aesthetically pleasing result
  • In the context of the "Restorative Spiral" diagram, what is a possible follow-up procedure after a restoration?

    <p>Crown (B)</p> Signup and view all the answers

    Which of the following is NOT mentioned as an essential aspect of preventative advice for managing dental caries?

    <p>Using specific types of toothpaste (A)</p> Signup and view all the answers

    What does the term "arrested caries" refer to in the context of the text?

    <p>The halting of the progression of a carious lesion (D)</p> Signup and view all the answers

    Based on the provided text, what is a possible next step if a patient has "Caries with limited tooth tissue remaining"?

    <p>Extraction (A)</p> Signup and view all the answers

    What is indicated as the primary motivation behind the "Restorative Spiral" concept?

    <p>To promote a logical progression of restorative treatments based on severity (A)</p> Signup and view all the answers

    What type of restorative option is used when extensive tooth tissue is lost due to caries?

    <p>Crown (C)</p> Signup and view all the answers

    In the context of restorative options, what is the primary purpose of preparing a tooth for a crown?

    <p>To reshape the tooth to accommodate the crown's size and shape (C)</p> Signup and view all the answers

    What occurs after the dentist takes an impression of a tooth for an inlay or onlay?

    <p>The impression is sent directly to the dental lab for inlay/onlay construction. (D)</p> Signup and view all the answers

    Which of the following is NOT a benefit of using an indirect restoration?

    <p>Requires fewer appointments for completion (A)</p> Signup and view all the answers

    What is the main advantage of using a crown over an inlay or onlay?

    <p>Crowns provide greater protection for the underlying tooth structure. (B)</p> Signup and view all the answers

    What is the difference between an inlay and an onlay restoration?

    <p>An inlay covers the chewing surface, while an onlay covers both chewing and cusp surfaces. (D)</p> Signup and view all the answers

    What is the primary reason for taking an impression of a tooth before placing an inlay or onlay?

    <p>To ensure the inlay/onlay is made to fit the tooth perfectly. (B)</p> Signup and view all the answers

    Which of these is NOT a valid reason for a dentist to recommend a crown over an inlay or onlay?

    <p>The tooth needs to be strengthened due to recurrent decay. (B)</p> Signup and view all the answers

    What is the primary role of a dental therapist in caries management?

    <p>To provide preventive care and simple restorations (B)</p> Signup and view all the answers

    What is indicated by an ICDAS score of 3?

    <p>Localized enamel breakdown (D)</p> Signup and view all the answers

    Which of the following represents a direct management option for dental caries?

    <p>Filling a carious lesion (C)</p> Signup and view all the answers

    Which factor is essential in the management of carious lesions?

    <p>Presence of plaque bacteria (D)</p> Signup and view all the answers

    Which of the following options reflects indirect management of extensive tooth tissue loss?

    <p>Crown placement (D)</p> Signup and view all the answers

    What is the primary approach to managing arrested caries?

    <p>Prevention and monitoring for reactivation (C)</p> Signup and view all the answers

    Why should drilling be avoided in cases of enamel caries?

    <p>It can lead to a restorative spiral (B)</p> Signup and view all the answers

    What is one of the active prevention strategies to manage enamel caries?

    <p>Applying fluoride varnish (D)</p> Signup and view all the answers

    What role do fissure sealants play in managing enamel caries?

    <p>They help prevent bacterial access to carious enamel (B)</p> Signup and view all the answers

    What is essential for preventing the progression of sealed enamel caries?

    <p>Regular review of the sealant condition (A)</p> Signup and view all the answers

    What is a significant reason why caries progresses rapidly in deciduous dentition?

    <p>The size of the teeth and porous enamel (B)</p> Signup and view all the answers

    What is a key aspect of managing caries in paediatric patients?

    <p>Parents must be involved in the prevention process (A)</p> Signup and view all the answers

    What is the primary role of fissure sealants in paediatric caries management?

    <p>To seal early-stage caries (B)</p> Signup and view all the answers

    Which of the following describes a challenge when using conventional restorative techniques in paediatric patients?

    <p>Moisture control for composite restorations is often inadequate (B)</p> Signup and view all the answers

    What is a limitation of using Glass Ionomer Cement (GIC) in caries management?

    <p>It is poorly retained in moist conditions (C)</p> Signup and view all the answers

    What is the recommended treatment for outer 1/3 of dentine caries?

    <p>Preventative resin restoration (A)</p> Signup and view all the answers

    Which restorative material is typically phased out due to environmental concerns?

    <p>Amalgam (B)</p> Signup and view all the answers

    What is the main objective of active prevention strategies for outer to middle 1/3 dentine caries?

    <p>Increased fluoride exposure (C)</p> Signup and view all the answers

    What is a potential consequence of untreated inner 1/3 dentine caries?

    <p>Signs of pulpitis symptoms (C)</p> Signup and view all the answers

    In cases requiring stepwise excavation, what is the initial step?

    <p>Removal of superficial necrotic caries (B)</p> Signup and view all the answers

    Which of the following treatments may be required for teeth where caries has invaded the pulp?

    <p>Root canal treatment (A)</p> Signup and view all the answers

    Which restoration type is considered more modern compared to stepwise excavation?

    <p>Atraumatic restorative technique (ART) (D)</p> Signup and view all the answers

    What does ART primarily aim to do?

    <p>Seal remaining tooth to cut off bacterial nutrients (C)</p> Signup and view all the answers

    What is a key consideration for using amalgam restorations in pregnant women?

    <p>Requires specific indications for use (D)</p> Signup and view all the answers

    Which treatment option may be needed if pulp exposure occurs during caries management?

    <p>Pulp capping treatment (B)</p> Signup and view all the answers

    What is used to manage root caries when moisture control cannot be achieved?

    <p>Glass ionomer cement (A)</p> Signup and view all the answers

    What is the advantage of using glass ionomer cement in caries management?

    <p>Chemically bonds to tooth structure (B)</p> Signup and view all the answers

    When may tooth extraction be the only option during caries treatment?

    <p>If there is inadequate tooth structure remaining (D)</p> Signup and view all the answers

    Flashcards

    Dental Caries Management

    Approaches to treat and prevent dental caries effectively.

    Direct Management Options

    Immediate treatments such as fillings or restorations for carious lesions.

    Indirect Management Options

    Strategies used when there is extensive loss of tooth tissue, like crowns.

    ICDAS Scoring

    A system for assessing the severity of dental caries based on visual changes.

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    Role of Prevention

    The importance of preventing caries through proper oral hygiene and lifestyle choices.

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    Paediatric Caries

    Caries that progress rapidly in children's teeth due to thin enamel and size.

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    Fissure Sealants

    Materials used to seal early-stage caries, especially in high-risk molars.

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    Conventional Management Techniques

    Restorative techniques employed when caries are not extensive, similar to adult methods.

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    Fluoride Adjustment

    Modifying fluoride doses for children compared to adults to prevent caries.

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    Regular Review of Sealants

    Frequent checks needed to ensure fissure sealants remain effective without failure.

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    Extent of caries

    Classification reflecting the severity and depth of dental caries in tooth structure.

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    Enamel caries

    Caries affecting the outermost layer of a tooth, such as white spot lesions.

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    Early enamel breakdown

    Initial damage to enamel manifesting as white spots before further decay occurs.

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    Caries into dentine

    When caries progress from enamel into the dentine, further compromising tooth structure.

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    Preventative advice

    Guidance aimed at preventing dental caries, including diet and oral hygiene tips.

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    Minimally Invasive Dentistry

    Dental practice approach that aims to preserve as much tooth structure as possible during treatment.

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    Fluoride exposure

    Increasing fluoride application to strengthen teeth and prevent decay.

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    The Restorative Spiral

    The sequence of procedures in restoring a tooth, including different interventions like crowns or fillings.

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    Outer 1/3 Dentine Caries

    Irreversible caries requiring restorative treatment.

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    Restorative Treatment for Caries

    Involves caries removal and restoration to prevent progression.

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    Preventative Resin Restoration (PRR)

    Used for occlusal surfaces; involves drilling and sealing.

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    Active Prevention Strategies

    Methods include increased fluoride exposure to reduce caries.

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    Temporary Restorations

    Includes materials like glass ionomer and amalgam for short-term use.

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    Amalgam Restorations

    Metallic restoration, phased out due to environmental concerns.

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    Composite Restorations

    Tooth-colored filling material used in cavities.

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    Root Caries Management

    Requires prevention and restoration; often uses composite or GIC.

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    Stepwise Excavation

    Two-step caries treatment, involves provisional restoration.

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    Atraumatic Restorative Technique (ART)

    Minimally invasive method using glass ionomer to seal caries.

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    Arrested Caries

    Inactive dental caries that do not require treatment unless for aesthetic reasons.

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    Pulp Capping Treatment

    Restoration placed over exposed pulp to promote healing.

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    Restorative Spiral

    Cycle of continued dental treatment that can arise from drilling into caries.

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    Root Canal Treatment

    Process to remove infected pulp and fill tooth chamber.

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    Extraction Necessity

    Surgical removal when too much tooth structure is lost.

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    Dentine Caries Progression

    Caries can progress through outer to inner dentine layers.

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    Fluoride Varnish Use

    A preventive treatment to enhance tooth enamel protection against caries.

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    Direct restorative approaches

    Clinician builds filling directly into the tooth to treat caries.

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    Indirect restorative approaches

    Restoration is made by a dental technician and cemented by the clinician.

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    Inlay

    A type of indirect restoration fitted into the tooth's cavity.

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    Onlay

    An indirect restoration that covers a larger portion of the tooth than inlays.

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    Crown

    A restoration that encases the entire tooth for strength.

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    Tooth preparation for crowns

    Reshaping the tooth to create space for a crown.

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    Loss of tooth tissue

    Occurs when extensive caries weaken the tooth.

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    Role of dental technician

    Creates molds and restorations such as inlays and crowns.

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    Study Notes

    Management of Carious Lesions

    • Carious lesions are managed using a preventative approach as the first step
    • This includes dietary advice to reduce sugar intake, oral hygiene advice on effective cleaning, and increasing fluoride exposure.
    • These steps are consistent throughout the management progression.

    Pre-reading

    • The aetiology and sequelae of dental caries were covered in a lecture.
    • The histopathology of enamel and dentine caries was covered in a lecture.

    GDC Learning Outcomes

    • Describe oral diseases and their relevance to prevention, diagnosis, and treatment.
    • Assess and manage caries, occlusion, and tooth wear; and, where appropriate, restore the dentition using minimal intervention maintaining function and aesthetics.
    • Explain the role of a dental therapist in teeth restoration.
    • Recognise the importance of and record a comprehensive and contemporaneous patient history.

    Intended Learning Outcomes

    • List direct management options for various presentations of dental caries.
    • List indirect management options for cases with extensive tooth tissue loss.
    • Describe the role of prevention in caries management.
    • Describe the differences between the use of each management option.

    Caries Recap

    • Caries development involves susceptible tooth surfaces, plaque bacteria, and fermentable carbohydrates.
    • These factors interact over time to cause caries.

    ICDAS Recap

    • ICDAS scores are used to assess the severity of caries.
    • Different scores, from 1 to 6, depict varying stages of visual change in enamel and the progression to dentine decay.

    How do we approach caries management?

    • This is a question used to prompt discussion on the approaches used to manage various degrees or severity of caries.

    Extent of caries

    • Caries extent is categorised into reversible and irreversible stages, along with initial, moderate, and extensive categorisation.
    • Different stages of caries involve enamel and dentine.
    • ICDAS scores from 0–6 are used to further define caries extent.

    Extent of Caries - Visual

    • Caries progression from sound tooth tissue to initial, moderate, and extensive lesions is visually depicted.
    • Images illustrate different stages of progressive enamel and dentin damage.
    • The image references the ICDAS scoring system to match each stage.

    Extent of Caries – Increasing Severity

    • This section illustrates caries progression from arrested caries to pulp involvement.
    • Stages show caries into varying portions of dentin, including middle and inner thirds, culminating in caries into the pulp.
    • Caries can also be arrested to prevent further progression.

    Philosophies in the management of dental caries

    • This section is designed for discussion among learners on the theories or philosophies involved in managing dental caries.

    The first stage of treating any patient with any carious lesion

    • Prevention is paramount in the primary treatment of carious lesions.
    • This section highlights the need for dietary advice, oral hygiene advice, and increasing fluoride exposure.

    Minimally Invasive Dentistry

    • Minimal intervention is preferred.
    • Employ techniques that minimise tooth structure removal.
    • Use long-lasting materials for restorations.

    The Restorative Spiral

    • The restorative spiral diagram depicts various stages of tooth repair.
    • The images include visual examples showcasing tooth decay in various levels of severity.

    How would each of these presentations be managed?

    • This is a question for reflection and discussion on the different ways to approach tooth decay.

    Arrested Caries

    • Arrested caries is inactive and typically doesn't require active treatment unless aesthetics are a concern.
    • Prevention and review are key to monitoring potential re-activation.

    Enamel Caries (white spots)

    • Enamel caries (white spots) are reversible and require prevention strategies, including oral hygiene improvement, better diet, and increasing fluoride.

    Enamel Caries - Fissure Sealant

    • Fissure sealants are a simple preventive measure.
    • Used to seal off the tooth's grooves, thus preventing bacteria from entering and causing damage.
    • Requires regular review to ensure the sealant is working effectively.

    Now into dentine...

    • This is a transition point in the discussion to the more invasive aspects of caries management as they advance to involvement of dentine.

    Extent of caries in dentine

    • Different stages of dentine involvement are categorised.
    • These include outer third, outer to middle third, inner third, and root caries, each requiring different management strategies.

    Enamel Caries/Outer 1/3 Dentine Caries

    • Caries progression to the outer third of dentine is irreversible.
    • A preventative resin restoration is necessary.
    • Prevention remains a crucial aspect of treatment.

    Dentine Caries - Outer to Middle 1/3

    • Restorative treatment is commonly undertaken in this stage to address dentine decay.
    • Prevention and active strategies for fluoride exposure remain essential to reduce further deterioration.

    Dentine Caries - Outer to Middle 1/3 (restorative treatments)

    • Specific restorative treatments, such as temporary restorations, and various types of permanent restorations, are used in dentine caries management.
    • Ionomer cements, amalgam, and composite are common restorative materials.
    • Certain restorative materials should not be used with pregnant or breastfeeding patients.

    Dentine Caries - Outer to Middle 1/3 (composite and amalgam)

    • Composition and amalgam restorations are the common methods of restoring outer-to-middle dentin cavities.
    • Amalgam use is declining due to environmental concerns.

    Dentine Caries - Outer to Middle 1/3 (Radiographic Visualization)

    • Radiographic images are used as visual aids to outline the progression and severity of dentine decay.

    Dentine Caries - Outer to Middle 1/3 (Treatment Visualization)

    • Images showing the various stages of treatment progression within deeper caries are used to further explain the management techniques.

    Root Caries

    • Root caries management differs from coronal caries management.
    • Prevention remains crucial. Restoration with composite or glass ionomer cement is often used, ideally under a rubber dam.

    Dentine Caries - Inner 1/3

    • Deep dentin caries are typically irreversible.
    • Pulp treatment, such as direct or indirect pulp caps, may be necessary.
    • Root canal treatment or extractions might be required for extensive cases affecting the pulp.
    • Therapists should use caution in cases potentially outside their scope to avoid unnecessary intervention or risk of potentially damaging treatments.

    Stepwise Excavation and the Atraumatic Restorative Technique (ART)

    • ART is a minimally invasive approach for deep caries.
    • Stepwise removal of affected dentin, using calcium hydroxide base, and provisional restorations are elements of the process.
    • The technique involves re-entry following the formation of tertiary dentin for permanent restorations later.

    Stepwise Excavation and the Atraumatic Restorative Technique (ART) (additional details)

    • ART involves the removal of necrotic caries and the placement of a suitable restorative material.
    • This method aims to minimise the removal of healthy tooth structures.
    • A specific type of glass ionomer cement is used for the restoration to seal and stop bacteria supply.

    Dentine Caries - Inner 1/3 (Pulp exposure)

    • Pulp may become exposed during treatment, even with ART.
    • Pulp capping materials, such as calcium hydroxide or biodentine, may help preserve the pulp.
    • This approach aims to avoid root canal treatment.

    Dentine Caries - Inner 1/3 (advanced caries)

    • If the caries extends into the pulp, the damage is considered irreversible.
    • Treatment options are limited to root canal therapy or tooth extraction.
    • Root canal treatment removes the pulp, and a filling is placed.
    • The coronal portion of the tooth is then restored to complete the treatment process.

    Caries with limited tooth tissue remaining

    • Extraction may be the only option for severe, extensive caries involving significant tooth tissue loss.
    • This might necessitate discussion with the dentist on tooth replacement options.

    What additional restorative treatments are there?

    • Additional restorative treatments include procedures like inlays, onlays, and crowns.
    • These treatments are beyond the scope of dental hygienists or therapists.

    Additional restorative options

    • Restorative treatments for caries can be direct or indirect.
    • Direct restorations are completed by the clinician.
    • Indirect restorations use materials crafted by technicians and cemented by the clinician.
    • Inlays, onlays, and crowns are examples of indirect restorations.

    Additional restorative options – inlay or onlay

    • Inlays and onlays are indirect restorative treatments for caries.
    • The process involves removing decayed parts, taking impressions, creating restorations in a dental lab, then cementing them into place.
    • This approach avoids some of the challenges of direct restorations.

    Additional restorative options – Crowns

    • Crowns are used to restore severely damaged teeth, encasing the remaining tooth structure to strengthen it.
    • Prepared grooves allow space for the crown to fit over the tooth.
    • This method strengthens the tooth against further damage.

    How does this vary for paediatric patients?

    • Childrens' teeth are smaller and thin-enameled, leading to faster caries progression.
    • Prevention and fluoride doses adapted to the patient.
    • Paediatric patients also require involvement of their parents in the treatment process.

    Paediatric Caries Management

    • Prevention is crucial for children.
    • Adjustments in fluoride doses might be needed for children compared to adults.
    • The involvement of parents in the treatment process is necessary.

    Fissure Sealants

    • Fissure sealants protect early cavities, especially on primary and permanent molar teeth.
    • Regular reviews are required to ensure the sealants are effective.

    Conventional Management Techniques

    • For less extensive caries, conventional restorative methods can be used.
    • Moisture control complications could arise when utilizing composite material restorations.

    Newer Techniques

    • Stainless steel crowns and specifically tailored techniques, such as the Hall Technique, are new approaches to preserving teeth.
    • These methods aid in reserving space for future orthodontic treatments.

    PMCs

    • Preformed metal crowns (PMCs) are easier to apply than other techniques.
    • No tooth grinding or drilling is required.
    • PMCs are often preferred in children's dental care.

    Newer Techniques (retained teeth)

    • PMCs retain teeth and reduce the risk of space loss and orthodontic complications in children.

    Why is this relevant to me as a hygienist?

    • Patients will often ask hygienists about restorative procedures.
    • Understanding restorative techniques allows hygienists and clinicians to adequately address patient concerns about procedures.
    • Collaboration with dentists is essential.

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    Description

    This quiz focuses on the management of carious lesions, emphasizing a preventative approach. Key elements include dietary advice, effective oral hygiene, and fluoride exposure. It also covers the role of dental professionals in diagnosing and treating oral diseases.

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