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SDCEP > caries in children > Flashcards

caries in children Flashcards

1
Q

what are 3 aims while providing dental care for children?

A

prevent disease in primary and permanent dentition
reduce risk of child experiencing pain or infection
child grows up with skills and motivation to maintain OH

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2
Q

in what ordered you plan care for a child?

A

manage pain
provide caries prevention
manage caries/asymptomatic infection

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3
Q

what are the symptoms of reversible pulpitis?

A

pain to cold/sweet
tooth not TTP
resolves on removal of stimulus
tooth difficult to localise

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4
Q

how do you treat reversible pulpits?

A

restore

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5
Q

what are the symptoms of irreversible pulpitis?

A

spontaneous pain wakens child at night
does not resolve on removal of stimulus
pain to hot/cold
pain lasts hours
does not resolve with placement of dressing
no TTP

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6
Q

how do you treat irreversible pulpits in a primary tooth?

A

extraction or appropriate pulp therapy if cooperative

pre-cooperative - refer for extraction/treatment with sedation or GA

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7
Q

how do you treat irreversible pulpits in a permanent tooth?

A

RCT or extraction if cooperative
refer to specialist if uncooperative

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8
Q

what are the symptoms of dental abscess or periradicular periodontitis ?

A

spontaneous pain wakens child
tooth mobile
TTP
swelling, sinus or abscess
malaise

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9
Q

how do you treat an abscess or periradicular periodontitis?

A

antibiotics if spreading infection or systemic involvement
RCT or extraction
if pre-cooperative, refer for GA or sedation extraction, or refer to specialist care

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10
Q

what should you recommend when giving tooth brushing advice to child and parent

A

fluoride concentration and amount of toothpaste appropriate for age

spit don’t rinse

supervised brushing until child is effective

at least twice a day inc last thing at night

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11
Q

when do you used pea sized toothpaste

A

3+

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12
Q

when do you use a smear of toothpaste

A

<3

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13
Q

when can you give 2800ppmF toothpaste

A

10+

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14
Q

what is the standard caries risk fluoride content recommended

A

1000-15000ppmF

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15
Q

what is the increased caries risk F toothpaste content recommendation for under 10

A

1350-1500ppmF

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16
Q

what material do you use to fissuree seal sensitive MIH teeth?

A

GI cement

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17
Q

what is the minimum age for amalgam

A

15

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18
Q

give 5 examples of standard prevention for children

A

toothbrushing advice twice a year

3 min demonstration brushing annually

place sealant in pits and fissures of all permanent molars asap after eruption

sodium fluoride varnish 5% twice a year for 2+

diet advice once a year

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19
Q

4 diet advice points

A

limit sugar consumption

only water or milk between meals

snack on low sugar food such as fruit, carrot, oatcakes

don’t eat or drink except water after brushing at night

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20
Q

give 5 examples of enhanced prevention for children

A

at each recall give hands on brushing instruction to child and parent/carer

recommend 1350-1500ppm and 2800 in 10+

at each recall provide diet advice

sodium fluoride varnish four times a year or children 2+

fissure seal palatal pits in 2s and occlusal and palatal of Ds and Es 6s and 7s

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21
Q

define dental neglect

A

persistent failure to meet Childs basic oral health needs likely to result in serious impairment of Childs oral or general health or development

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22
Q

give 3 caries prevention methods in children

A

personalised oral hygiene advice

apply sodium fluoride varnish for children over 2 at least 2 times a year

for all children place fissure sealant on 6s as early as possible after eruption

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23
Q

when coming up with a treatment plan for a carious primary tooth, what should you take into consideration - give 3

A

time to exfoliation

absence or presence of infection

avoidance of treatment induced anxiety

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24
Q

treatment options for child with vital tooth with irreversible pulpitis symptoms

A

pulpotomy to preserve tooth

avoid need for extraction

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25
Q

what percentage of school children world wide have caries experience?

A

60-90%

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26
Q

give an example of a population based caries prevention measure

A

water fluoridation

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27
Q

what takes priority in mixed dentition:
prevention of caries in permanent
management of caries in primary

A

prevention in permanent

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28
Q

what 4 elements are included in a comprehensive assessment of child

A

parent/carer motivation and responsibility

patient history

clinical assessment

caries risk assessment

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29
Q

give 3 factors that can lead to difficult in establishing healthy behaviours in a child

A

deprivation

lack of education or motivation in prevention of dental disease

complex childcare arrangements

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30
Q

4 questions to ask about a childs dietry habits

A

do the take a bottle to bed, if so what in it

what snacks do the have between meals

how many portions of fruit and veg a day

do they have sugary drinks

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31
Q

how can you help a younger uncooperative child get a dental examination?

A

sit them on parent/carer lap facing parent and then get them to lower their head into your lap while holding parent hands

tell parent to keep encouraging and smiling and cuddle afterwards

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32
Q

best method for caries detection?

A

visual assessment on clean dry teeth with good light, radiographs can supplement

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33
Q

how does carious enamel differ to healthy enamel in colour

A

carious is white colour-due damaged enamel prisms in teeth refracting light instead of letting it pass through

healthy is 98% mineralised and almost transparent

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34
Q

what layer of tooth is affected if there is white, matt, opaque chalky lesion on tooth

A

enamel caries

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35
Q

what layer of tooth is affected if there is intact, transparent enamel with opalescent lesion

A

dentine caries

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36
Q

why must teeth be dry to assess caries

A

saliva fills pores in enamel and has similar optical properties to enamel
restores translucency in teeth and therefore hides caries

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37
Q

opalescent enamel next to a stained fissure indicates what?

A

dentine lesion

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38
Q

what does white opalescent enamel at marginal ridge indicate?

A

proximal dentine lesion

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39
Q

how can you assess if an enamel lesion is active or arrested

A

imaging and radiographic monitoring over time

run probe over surface - should feel smooth like sound enamel and not drag if arrested

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40
Q

how can you assess if a dentine lesion is active or arrested

A

imaging and radiographic monitoring over time

drag excavator over surface - dentine should be shiny and hard if arrested - if soft and matt likely to be active

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41
Q

frequency of bitewings in children is based on what

A

individual caries risk

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42
Q

what do you say to a parent concerned about exposing their child to x-rays

A

reassure that the risk from dental x-rays are very low and greatly outweighed by the diagnostic benefit
BW is equivalent to a few days of background radiation

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43
Q

how often can children at increased risk of developing caries get bitewings?

A

every 6-12 months

44
Q

how often can children at standard risk of developing caries get bitewings

A

every 2 years

45
Q

what can you do to aid visualisation of enamel proximal caries and assess cavitation

A

use orthodontic seperators

46
Q

what is the triangular radiolucency on the mesial surface of maxillary Es and maxillary 6s that is often mistaken for proximal caries

A

cusp of carabelli

47
Q

valid reasons to not take radiographs in primary dentition

A

spacing allows examination of contact points

pre-cooperative

48
Q

define MIH

A

molar incisor hypomineralisation is hypomineralisation of systemic origin affecting 1-4 first permanent molars frequently associated with affected incisors

49
Q

how does MIH compromise restorative outcome

A

abnormal etching and bonding pattern

50
Q

3 important things to ask about when taking child pain history

A

changes in sleep
use of analgesia
problems eating or drinking

51
Q

3 indicators of dental infection

A

TTP in non-exfoliating tooth
alveolar tenderness, sinus or swelling
radio graphic signs

52
Q

3 things to consider when assessing risk of caries causing pain or infection before exfoliation

A

time to exfoliation
activity of lesion
extent of lesion

53
Q

are clinical exposures of vital pulp likely to cause infection before exfoliation

A

no

54
Q

is a dark coloured hard lesion likely to cause infection/pain before exfoliation?

A

no

55
Q

are clinical exposures of necrotic pulp several years before exfoliation likely to cause pain/infection

A

yes

56
Q

10/10 plaque score meaning

A

perfectly clean tooth

57
Q

8/10 plaque score meaning

A

plaque gingival margin

58
Q

6/10 plaque score meaning

A

plaque covering cervical third of tooth

59
Q

4/10 plaque score meaning

A

plaque covering middle third of crown

60
Q

which tooth do you record the plaque score for in each sextant

A

worst tooth

61
Q

9 factors of caries risk assessment

A

evidence of previous disease
social history
medical history
dietary habits
use of fluoride
saliva
plaque control

62
Q

3 ways to reduce child anxiety

A

welcoming letter telling them what will happen and how to prepare child

anxiety questionnaire e.g. MCDAS

behaviour management

63
Q

4 behaviour management strategies

A

tell show do
enhancing control
distraction
relaxation

64
Q

3 components of communication

A

non-verbal
words
tone

65
Q

how can you enhance control

A

stop and go signals

66
Q

describe a behavior management technique useful for school age or older

A

relaxation
3 deep tummy breaths and breathe out slow

67
Q

what does SOARS stand for in motivational interviewing

A

seek permission
open questions
affirmations
reflective listening
summarising

68
Q

how often do you give dietary advice to standard prevention and enhanced prevention

A

at least once a year for standard
every recall visit for increased risk

69
Q

how would you give toothbrush instruction to child and carer

A

smear or pea
all cheek surfaces
all biting surfaces
all palate surfaces/tongue side
use short scrubbing motion
shh shh shh sound is good
2 minutes

70
Q

diet advice for general health

A

low saturates
low salt
low sugar
low fat
5 a day

71
Q

when should you place fissure sealant on 6s

A

as early as possible after eruption

72
Q

where should you apply fissure sealant - standard and high risk?

A

occlusal pits and fissures of 6s
buccal pits of lower 6s
palatal fissures of upper 6s

in high risk - also palatal pits of upper 2s and occlusal and palatal surfaces of Ds Es and 7s

73
Q

first choice material for fissure sealant

A

resin based e.g. bis-GMA resin

74
Q

when do you use GI for fissure sealant

A

uncooperative pt
where moisture control is an issue
PE tooth

75
Q

fissure sealant procedure

A

clean and dry tooth
isolate tooth using cotton wool rolls, dry guards and mirror
etch the tooth
apply resin to etched enamel
light cure
check integrity with probe

76
Q

what etch should you use for fissure sealant

A

phosphoric acid

77
Q

how far up the cusp should fissure sealant be

A

covers a third of the incline of the cusp

78
Q

how do you place a GI fissure sealant

A

dry tooth if possible
place GI on one finger and petroleum jelly on other
apply GI finger firmly for two minutes
rapidly switch to apply petroleum over GI to avoid moisture contamination

79
Q

what percentage is fluoride varnish

A

5%

80
Q

many fluoride varnishes contain colophony - who is at risk of allergic reaction to colophony

A

a child who has been hospitalised due to severe asthma or allergy in last 12 months

allergy to sticking plaster

81
Q

what alternatives are there for children at risk of colophony allergic reaction

A

colophony free varnish

82
Q

what is the fluoride content in duraphat varnish

A

22600ppm

83
Q

what volume of duraphat is used in 2-5 year olds

A

0.25ml

84
Q

what volume of duraphat varnish is used in 5-7 year olds

A

0.4ml

85
Q

post fluoride varnish advice

A

soft foods and liquids can be consumed from 30 mins after application

wait at least 4 hrs before brushing teeth or chewing hard food

86
Q

what are the signs and symptoms of infection/abscess?

A

swelling, redness, lymphadenopathy
sinus or abscess
TTP
Mobility

87
Q

if child is not cooperative enough to accept any type of fissure sealant to seal occlusal caries, what should you consider?

A

hall technique

88
Q

advantage if hall technique

A

avoids iatrogenic damage to teeth from rotary instruments

89
Q

what factors influence the optimal outcome e.g. no spacing, of extraction of the 6 in an 8-10 year old

A

bifurcation of 7s seen on OPT
2nd premolars and third molars present on OPT
mild buccal segment crowding
class 1 incisor relationship

90
Q

how do you manage early enamel caries and promote remineralisation

A

effective brushing demonstration
diet advice
fluoride varnish 4x a year

91
Q

what is the aim of a hall crown

A

to seal a carious lesion to alter plaque biofilm environment to slow or arrest caries progression

92
Q

when is a hall crown suitable

A

advanced lesion in occlusal or proximal surface

93
Q

how do you fit a PMC

A

sit child upright
assess if separators needed
select correct size - do not seat past contacts prior to cementation
fill with GI luting cement
seat over tooth
check crown seated evenly - get child to bite down
remove excess cement and clear contacts

94
Q

when would you use separators for a hall crown

A

broad tight contact between adjacent teeth
mesial drift of decayed teeth

95
Q

how many canals does a maxillary primary molar have

A

3 - 2 buccal one palatal

96
Q

how many canals does a mandibular

A

2 - mesial and distal

97
Q

what is a balancing extraction

A

an extraction of a contralateral tooth to avoid centre line shift and maintain symmetry for developing occlusion

98
Q

when should you consider balancing extraction

A

when one c is to be extracted
one c has exfoliated prematurely
centre line shift is developing after d extraction

99
Q

how can you reduce discomfort of LA in child

A

topical
distraction
very slow injection technique

100
Q

associated risk of GA

A

risk of death 1 in 100,000 - very rare

101
Q

when is GA considered

A

all less invasive options have been considered if not tried
young children who need extensive treatment or are unable to comprehend how to behave for treatment
can’t manage with prevention until able to accept treatment

102
Q

three stages of intervention for child protection

A

preventative dental team (single agency) response
preventative multi-agency response
child protection referral

103
Q

initial signs for child protection referral

A

history of injury changes over time or doesn’t not explain injury/illness
unexplained injuries
Childs behaviour with parent/carer

104
Q

what may indicate dental neglect

A

delay in seeking dental advice when child has pain or infection
severe untreated dental disease
dental disease with significant impact on child
failure to complete/attend for treatment

105
Q

what is GIRFEC

A

getting it right for every child
involves practitioners working together to promote, support and safeguard the well being of children and young people

106
Q

what are the GIRFEC 5 questions

A

what is getting in way of child’s wellbeing
do I have everything I need to help child
what can I do now to help child
what can my profession do to help this child
what additional help may be needed

SDCEP (8 decks)

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