Dental Caries Management
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Questions and Answers

What characterizes extremely deep caries?

  • Caries reaching the middle quarter of dentine
  • Caries penetrating half of the dentine thickness
  • Caries reaching the outer quarter of dentine
  • Caries penetrating the entire thickness of the dentine (correct)

    • What is the primary goal of vital pulp treatment?

  • To prevent pulp exposure
  • To remove all carious tissue
  • To promote dentine regeneration
  • To maintain the health of all or part of the pulp (correct)

    • What is the characteristic of soft dentine?

  • Resistant to excavation using hand instruments
  • Excavatable with minimum resistance using hand instruments (correct)
  • Hard and resistant to scratching
  • Resistant to probe penetration

    • What is indirect pulp capping?

    <p>Application of a biomaterial onto a thin dentine barrier</p> Signup and view all the answers

    What is the difference between selective carious-tissue removal to soft dentine and firm dentine?

    <p>The type of carious tissue removed</p> Signup and view all the answers

    What is the main advantage of selective carious-tissue removal?

    <p>Preservation of more tooth structure</p> Signup and view all the answers

    What is the primary concern in aseptic treatment techniques?

    <p>Preventing contamination and infection</p> Signup and view all the answers

    What is the primary goal of preventing pulp exposure?

    <p>To maintain pulp vitality</p> Signup and view all the answers

    What is the recommended approach for carious tissue removal in teeth with reversible pulpitis?

    <p>Selective carious-tissue removal in one or two stages</p> Signup and view all the answers

    What is the primary goal of aseptic treatment techniques in vital pulp therapy?

    <p>To prevent ingress of new bacteria into the lesion</p> Signup and view all the answers

    What type of materials are recommended for use in vital pulp therapy?

    <p>Glass-ionomer cement</p> Signup and view all the answers

    What is the treatment goal in cases of carious pulp exposure?

    <p>To preserve the pulp in teeth with reversible pulpitis</p> Signup and view all the answers

    What is the benefit of using hydraulic calcium silicate materials in vital pulp therapy?

    <p>They have superior histological and clinical outcomes</p> Signup and view all the answers

    What is the purpose of placing a hydraulic calcium silicate material during procedures aimed at avoiding pulp exposure?

    <p>To cover all remaining carious dentine</p> Signup and view all the answers

    Why is operator skill and experience important in vital pulp therapy?

    <p>Because it affects the outcome of the treatment</p> Signup and view all the answers

    What is the recommended approach for restoring teeth with deep (and extremely deep) carious dentine?

    <p>Using a rubber dam and sterile instruments</p> Signup and view all the answers

    What is the main difference between pulpotomy and pulpectomy?

    <p>Pulpotomy involves removal of the coronal pulp, while pulpectomy involves removal of the pulp from the root canal system.</p> Signup and view all the answers

    What is the primary indicator of irreversible pulpitis?

    <p>Spontaneous, radiating pain that lingers after removal of the stimulus</p> Signup and view all the answers

    What is the recommended method for assessing the status of the pulp?

    <p>Meticulous clinical examination and pulp sensibility testing using low temperature cold testing</p> Signup and view all the answers

    What is the primary factor that determines the outcome of vital pulp therapy?

    <p>The inflammatory state of the pulp and the presence of microorganisms</p> Signup and view all the answers

    What is the recommended approach for carious tissue removal to avoid pulp exposure?

    <p>Step-wise removal of carious tissue, with careful assessment after each step</p> Signup and view all the answers

    What is the classification of pulpitis according to the American Association of Endodontists?

    <p>Reversible and irreversible</p> Signup and view all the answers

    What is the purpose of a biomaterial in pulpotomy?

    <p>To apply directly onto the pulp tissue at the level of the root canal orifice(s)</p> Signup and view all the answers

    What percentage of cases may have symptomless irreversible pulpitis?

    <p>14-60%</p> Signup and view all the answers

    What is a possible cause of erosive tooth wear on the palatal surfaces of maxillary teeth?

    <p>Regurgitation of stomach acid</p> Signup and view all the answers

    What is a common lifestyle factor that can accelerate tooth structure loss?

    <p>Engaging in frequent toothbrushing</p> Signup and view all the answers

    What is a characteristic of erosive tooth wear caused by exogenous acidic agents?

    <p>Crescent-shaped defects on the surfaces of teeth</p> Signup and view all the answers

    What is an important factor in diagnosing and managing dental erosion?

    <p>Saliva flow and buffering capacity</p> Signup and view all the answers

    What is a possible cause of generalized erosion on the lingual, incisal, and occlusal surfaces of teeth?

    <p>Gastric fluids</p> Signup and view all the answers

    What is the term for the mechanical wear of the incisal or occlusal surface of teeth?

    <p>Attrition</p> Signup and view all the answers

    What is a possible source of erosion associated with chemotherapy?

    <p>Vomiting</p> Signup and view all the answers

    Why is consultation with a physician important in diagnosing dental erosion?

    <p>To diagnose and manage GERD</p> Signup and view all the answers

    What is the primary cause of intrinsic erosion due to endogenous acids of gastric origin?

    <p>Eating disorders</p> Signup and view all the answers

    What is a common symptom of GERD (Gastro Esophageal Reflux Disease) that contributes to dental erosion?

    <p>Regurgitation without nausea or abdominal contractions</p> Signup and view all the answers

    What is rumination, and in which population is it commonly found?

    <p>A syndrome of repetitive, effortless regurgitation of undigested food in young infants</p> Signup and view all the answers

    What is a common occupational factor that contributes to extrinsic erosion?

    <p>Professional wine tasters</p> Signup and view all the answers

    What is the definition of erosion?

    <p>The wear or loss of tooth surface by chemical action in the continued presence of demineralizing agents with low pH</p> Signup and view all the answers

    What is the primary concern in the diagnosis and management of dental erosion?

    <p>Identifying the underlying etiological factors</p> Signup and view all the answers

    What is the characteristic of erosion lesions on the labial surfaces of the maxillary and mandibular anterior teeth?

    <p>They are typically found on the labial surfaces of the maxillary and mandibular anterior teeth</p> Signup and view all the answers

    What is a common medical condition that contributes to intrinsic erosion?

    <p>All of the above</p> Signup and view all the answers

    What is the primary cause of enamel wear on the cusp tips or incisal edges?

    <p>Stress and bruxism</p> Signup and view all the answers

    What is the term for the abnormal tooth surface loss resulting from direct forces of friction between teeth and external objects?

    <p>Abrasion</p> Signup and view all the answers

    What is a common clinical feature of abrasion?

    <p>Rounded notches in the gingival portion of the facial aspects of teeth</p> Signup and view all the answers

    What is a factor that influences the role of tooth brushing in abrasion?

    <p>All of the above</p> Signup and view all the answers

    What is a habit that may contribute to abrasion?

    <p>Chewing on hard objects, such as pens or pencils</p> Signup and view all the answers

    What is the term for the wear of tooth structure in the cervical areas?

    <p>Abrasion</p> Signup and view all the answers

    What may be a consequence of heavy occlusal loading from clenching?

    <p>Craze lines on the enamel surface</p> Signup and view all the answers

    Why is it important to round the sharp edges of worn teeth?

    <p>To improve comfort</p> Signup and view all the answers

    Study Notes

    Managing Deep Caries

    • Selective carious-tissue removal is advocated in teeth with reversible pulpitis, provided radiographic assessment indicates caries has a zone of dentine separating the carious lesion from the pulp chamber.

    One-Stage and Two-Stage Procedures

    • Asepsis should be preserved throughout the procedure, including the use of rubber dam.
    • A hydraulic calcium silicate or a glass–ionomer cement should be placed over the deep dentine in both one- and two-stage procedures.

    Managing Carious Pulp Exposure

    • Treatment options after carious pulp exposure include direct pulp capping and pulpotomy (partial and full).
    • Pulp preservation in cases of carious pulp exposure is only advocated in teeth with reversible pulpitis.

    Vital Pulp Treatment (VPT)

    • Strategies aimed at maintaining the health of all or part of the pulp.
    • Indirect pulp capping involves applying a biomaterial onto a thin dentine barrier in a one-stage carious-tissue removal technique.

    Full Pulpotomy and Pulpectomy

    • Full pulpotomy involves complete removal of the coronal pulp and application of a biomaterial directly onto the pulp tissue at the level of the root canal orifice(s).
    • Pulpectomy involves total removal of the pulp from the root canal system followed by root canal treatment.

    Classifications of Disease Severity

    • The American Association of Endodontists (AAE) describes pulpitis as either reversible or irreversible, depending on clinical signs and symptoms.
    • Reversible pulpitis symptoms range from no complaint to a sharp pain sensation with hot/cold stimuli, with no tenderness to percussion.

    Clinical Decision-Making

    • Caries depth radiographically, as well as clinical indicators of activity (e.g. symptoms, progression rate, colour, sensibility tests), should be used to assist clinical decision-making.
    • A detailed pain history and meticulous clinical examination, supplemented with a high-quality periapical radiograph and pulp sensibility testing using low-temperature cold testing, are necessary to assess the status of the pulp.

    Non-Carious Lesions and Their Management

    Erosion

    • Definition: Wear or loss of tooth surface by chemical action in the presence of demineralizing agents with low pH
    • Classification based on etiology:
      • Intrinsic erosion: Caused by endogenous acids of gastric origin (e.g. recurrent vomiting, eating disorders, medical conditions, GERD, rumination)
      • Extrinsic erosion: Caused by extrinsic factors (e.g. citrus fruit juices, acidic beverages, carbonated beverages, aspirin, ascorbic acid, diet, lifestyle)

    Clinical Features of Erosion

    • Palatal surfaces of maxillary teeth (particularly anterior teeth) can be affected by regurgitation of stomach acid
    • Extrinsic erosion commonly leads to dissolution of facial aspects of anterior and buccal aspects of posterior teeth
    • Erosion processes may cause loss of tooth structure with a clinical presentation of ‘cupped-out’ areas on occlusal surfaces
    • Endogenous acidic agents can cause generalized erosion on lingual, incisal, and occlusal surfaces
    • Crescent-shaped or dished defects can be caused by exogenous acidic agents (e.g. lemon juice)

    Attrition

    • Definition: Mechanical wear of incisal or occlusal surface as a result of functional or parafunctional movements of the mandible (tooth-to-tooth contacts)
    • Includes proximal surface wear at the contact area due to physiologic tooth movement

    Clinical Features of Attrition

    • Worn-off enamel of cusp tips or incisal edges can result in cupped-out areas
    • Areas may be an annoyance due to food retention or presence of peripheral, sharp enamel edges
    • Heavy occlusal loading from clenching may result in presence of ‘craze lines’ limited to enamel
    • Craze lines are not sensitive and do not require treatment but may be evidence of excessive masticatory muscle activity

    Abrasion

    • Definition: Abnormal tooth surface loss resulting from direct forces of friction between teeth and external objects or from frictional forces between contacting teeth components in the presence of an abrasive medium
    • Etiology:
      • Improper brushing habit (e.g. brushing technique, force, bristle stiffness, time, frequency)
      • Habitual chewing on hard objects (e.g. paper clips, pens, pencils)
      • Chronic use of agents with high abrasivity (e.g. smokeless tobacco)

    Clinical Features of Abrasion

    • Loss of tooth structure in cervical areas (abrasion) appears as a rounded notch in the gingival portion of the facial aspects of teeth
    • Surface of the defect is usually smooth
    • Presence of defects does not automatically warrant intervention

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    Related Documents

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    Non-Carious Lesions and Their Management.pptx

    Description

    This quiz covers the selective removal of carious tissue in teeth with reversible pulpitis and the procedures for managing deep caries, including asepsis and cement placement.

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