operative consideration in cariology
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what are the traditional methods of caries detection and diagnosis?
Describe the "iceberg of dental caries".
- base: caries just started. consiered as "caries free" . Caries is in enamel.
- water line and emerged: detection in dentin now
- tip: lesion has moved into pulp
Early diagnosis is the key. What is the oral condition needed to examine?
- teeth needs to be clean and dry.
- good light
an explorer "catch" in a pit or fissure is an appropriate or not diagnostic criteria? and why?
- inappropriate because it report too many false positives
- an explorere can destroy remineralizable enamel matrix -> preventing remineralization possibilities
Describe the treatment of dental caries surgically vs. non-surgically.
- non-surgical model: treating the disease as an infection. goal - prevent the advance of reversing the lesions w/o cutting.
- surgical model: ;cutting the tooth to remove the disease, then restoring. goal - to stop the advance of the lesion at that site.
what are the steps in caries treatment decision making?
- prevention procedures
- remineralization/ reversal procedures
- operative intervention
- maintenance procedures
Smooth surface diagnosis...
- easy to diagnose
- easy to treat if supragingival
On occlusal surfaces, fissure sealant is used for:
- active enamel lesion
- sound fissure in a high caries risk patient
- recall and reassessment
cavitated occlusal surfaces requires...
to diagnose approximal surfaces, what is needed?
what is this?
What are the keys to prep design?
- preservation of tooth structure
- access for adequate caries removal
- supporting remaining enamel
- clean edges
- appropriate to the restorative material
what is stepwise excavation?
- 2 step caries removal technique for "deep carious lesions"
- clear out caries on dentin near pulp and leave caries. seal it well. allow for tooth to react and build tertiary dentin.
Why is it done in 2 steps for the stepwise excavation?
- changes the cariogenic environment
- promotes tubules sclerosis
- creates proper environment for reparative dentin formation
what is the rationale for leaving caries behind?
- inner lesion has no bacteria which has potential to remineralize after bacteria has been taken from the outer lesion
how to choose the tooth that is right for this stepwise excavation?
- young pulp
- evaluate restorability
- deep active lesions - more than 75% of dentin
- no sign of irreversible pulpitis or pulp necrosis
- no swelling or react negatively to percussion
- positive pulp vitality
- x ray with no peripapical pathosis
operative intervention is performed to do what?
- control plaque
- restore function
- avoid progression of the lesion
pulp exposure in teeth through stepwise are much less than conventional methods. T or F
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