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Flashcards in Caries Risk Assessment and Prevention Deck (20):

What are some risk factors to caries development?

-Previous caries experience
-Plaque/bacteria type
-Diet: Food Substrate, feeding habits (Time/Frequency of substrate intake, bottle feeding over night, sugary drinks)
-SE factors
-Oral hygiene
-Medical conditions (sugar based meds, dry mouth, special needs (lower access to care), defective glands)
-Enamel defect
-Level of parents' education
-Geographic location (lack of F- and access to care)


What are some protective factors to caries development?

-Remin agents
-Antimicrobial agents


What are some preventative measures to prevent childhood caries spread?

-Treating mother's oral health to prevent vertical transmission
-Treat sibling's oral health to prevent horizontal transmission


What are some available caries assessment tools?

-Caries management system (CMS)-Sydney
-CAMBRA (Caries Management by Risk assessment)
-AAPD: American Academy of Paediatric Dentistry


What are some preventative measures available in ADH?

-Antibacterials (chlorhex)
-Saliva test
-xylitol gum
-Tooth mousse


What are some benefits and limitations of CAMBRA assessment tool?

-Some factors based on scienetific evidence

-No evidence of extent of success in individuals
-May not encompass all preventive/risk factors
-Lack of evidence to support population based preventative programs
-Success may be 'temporary', small overall reduction in population
-Should be modified to suit individual needs
-Only a tool, not a guaranteed solution


What preventative advice should be given to parents?

-Perinatal counselling
-Feeding practices
-Between meals snacking
-Brushing habits
-Interdisciplinary advice
-Growth and Development


What are the Australian guidelines for use of fluoridated toothpaste?

-Start brushing after first tooth erupts
0-17 months: brush without toothpaste
18months - 6 years: child toothpaste 400-550ppm
6 years +: 1000ppm standard adult toothpaste

However if high risk can bump up their dosage, e.g.
-5 year old high risk goes straight to adult
-3-4 year old high risk can just smear adult toothpaste over teeth-->preventative effect is greater than risk of getting fluorosis
*Note this only applies to motivated patients (if not brushing jsut get them to start)


When should fluoride mouthwashes be used in children? What is the fluoride concentration?

-Only above age of 6
-In high risk children at a time of day different from brushing-->no point straight after brushing as fluoride is already everywhere
-Use daily (Neutral NaF: 220-227ppm; acidulated NaF 200ppm)
-If lack motivation then use weekly neutral NaF 900-910ppm


What is the most effective method of professional fluoride application according to the literature?

-Fluoride varnish


How much fluoride is contained in fluoride varnish? How often should it be used?

(22 300 ppm)

Used once every 6 months


What should you warn your patient about when applying fluoride varnish?

-It will feel sticky


What is the concentration of fluoride gel/foam? What are some restrictions of gel/foam usage? How is it applied?

Neutral NaF:
900-12 300ppm

Acidulated NaF:
(12 300 ppm)

-Do not apply in kids less than 10 years of age due to risk of swallowing/fluorosis (fluoride varnish does not have this restriction)

-Put in trays and left in for 4 mintues, use suction with trays to reduce swallowing, re-apply every 6months


What are the usual toothpastes use and what are teh fluoride concentrations?

Colgate (1-6): 400ppm
Macleans: 500ppm
Oral B: 500ppm

Colgate: 1000ppm
Colgate Total: 1450ppm
Neutrafluor: 5000ppm


What post-op instructions should be given after fluoride application?

No eating, rinsing or drink 30 minutes post application (but tell patient 1 hour)


What are the percentage reduction in caries of:
-Fluoride varnish
-Fluoride gel/foam
-Fissure sealants?

Varnish: 33% (about 1/3)
Gel/foam: 26% (about 1/4)
Fissure sealsnt: (50-87%) (over half)


What should you warn parents about when doing fissure sealants?

They won't last forever


What is the toxic dose of fluoride?

3-5mg/kg in young children and frail adults-->GI problems
(thus in 2 year old weighing 10kg, 45g tube of toothpaste is the equivalent)

Lethal dose: 10mg/kg
(in 2 year old weighing 10kg, 90g tube of toothpaste is lethal)

*Warn parents to be careful of where they keep toothpaste


How should tooth mousse be used? What is the concentration of fluoride in toothmousse?

-As a last line, if patient is already doing the maximum, can add tooth mousse on top (this applies due to availability + pt motivation)
-Put over finger and wipe over teeth and leave overnight
-Good for enamel lesions, not dentine lesions
-Evidence limited vs fluoride applications
-Used with hyposalivation and white spot lesions

-Fluoride free


When should chlorhexidine be used in kids?

-High risk teenagers
-Otherwise not used often (it is hard enough to brush with kids, asking them to rinse with chlorhex will be harder)
-Use for 1 week at the start of each month, continue this routine for 3 months