Implications of dental disease in children

Question 1

Epidemiology: untreated caries

Answer 1

10th most prevalent disease worldwide

Affects 621 million children globally

Question 2

Epidemiology: in the UK

Answer 2

Nearly 1/3 children aged 5 have caries

Rising to almost of half of 8yos

Question 3

Implications of disease

Answer 3

Pain
Infection
General health
Psychosocial

Question 4

Pain

Answer 4

An unpleasant sensory and emotional response to actual or potential tissue damage
Purely subjective

Question 5

How common is dental pain?

Answer 5

Very few researchers have actually asked children about their experience of dental pain
We don’t know how children describe dental pain
-could think it was earache
-never experienced this kind of pain before

Question 6

Words used by children

Answer 6

McGill Pain Questionnaire useful in adults
Most children don’t use these words or don’t know them
Stabbing, burning, dull, pressing
“Like lots of bees stinging me”
Weird

Question 7

Words to describe pulp testing

Answer 7

Uncomfortable
Sore
Hitting
Dizzy

Question 8

Prevalence of pain

Answer 8

Appears to be approx 50% of children with caries 
Pain more likely if caries present
-at young age
-2 or more surfaces
-disease in lower molars

Question 9

Effects they describe (parents might describe)

Answer 9

Crying
Stopping them from playing
Missing school

Question 10

Impacts they describe in their own words

Answer 10

Hurt/ toothache/ earache
Eating/ sleeping/ school and related activities
Annoyed, sad, grumpy and worse than most people

Question 11

Signs in very young children

Answer 11

Pain on toothbrushing
During eating
Surprisingly, not crying at night

Question 12

Chronic infection

Answer 12

Buccal sinus

Hypoplasia of permanent successor (Turner’s tooth)

Question 13

Acute infection

Answer 13

Facial swelling
Pyrexia
May require hospitilisation

Question 14

USA deaths

Answer 14

2 children died as result of caries over last few years

Question 15

General health

Answer 15

Poor diet
-high sugar intake
Pain when eating
-makes diet even worse

Question 16

Weight

Answer 16

May be lower in weight than peers

Catch up in weight following dental treatment

Question 17

Height

Answer 17

Mean height between 10th and 25th percentiles in group with caries
Compared with mean height between 50th and 75th percentiles in caries-free group

Question 18

Iron deficiency

Answer 18

Children who required higher no. of extraction had lower Hb

80% suffered iron deficiency

Question 19

Psychosocial

Answer 19

Oral health related quality of life measures:
-oral symptoms
-functional limitations
-social well-being
emotional well-being

Question 20

Oral impact: 2014 Children’s Dental Health Survey

Answer 20

Pain was most common impact experienced
22% 12yos and 19% 15yos reported experiencing difficulty eating
12yos self-confidence was lower in those with disease

Question 21

Smiling

Answer 21

45% of children with caries said they felt sad about teeth
35% 12yos and 28% 15yos reported being embarrassed to smile/ laugh
31% ashamed to smile
Children with decay rated smiles less +vely
Parents also less +ve about thei smiles
Children with decay showed less teeth when smiling

Question 22

Implications of treatment of disease

Answer 22

Not little adults
Short attention span
Fear of unknown

Question 23

Child dental anxiety

Answer 23

1/5 of children have dental anxiety

Varies with age and unequal gender distribution (higher with females)

Question 24

Impact of dental anxiety on children

Answer 24

Oral health status
Oral health-related QoL
Waiting lists
Travel

Question 25

Impact of dental anxiety on dental professionals

Answer 25

Cause of occupational stress | Time-consuming

Question 26

Impact of dental anxiety on dental services

Answer 26

Financial implications Higher rates of missed/ cancelled apts Referrals to specialist services demand

Question 27

"Children-ese"

Answer 27

Problems with communication a recurring theme in interviews with children with dental anxiety Evidence that improving communication < dental anxiety

Question 28

Communication problems described by children

Answer 28

Less info provided than required Problems understanding language Lack of opportunities for children to participate

Question 29

Slow handpiece "Children-ese"

Answer 29

buzzy bee

Question 30

Airotor "Children-ese"

Answer 30

Whizzy brush | Mr Whistle

Question 31

Triplespray/ inhalation sedation "Children-ese"

Answer 31

Magic wind

Question 32

LA "Children-ese"

Answer 32

Jungle juice | Sleepy juice

Question 33

Giving LA "Children-ese"

Answer 33

Spray your teeth off to sleep

Question 34

Rubber dam "Children-ese"

Answer 34

Rubber raincoat

Question 35

Rubber dam clamp "Children-ese"

Answer 35

Clip or button

Question 36

Fissure sealant "Children-ese"

Answer 36

Tooth paint

Question 37

Suction "Children-ese"

Answer 37

Hoover

Question 38

Amalgam "Children-ese"

Answer 38

Silver star

Question 39

LA

Answer 39

Topical (numbs gingiva) Explain how it might feel to be numb Small amounts of treatment

Question 40

Conscious sedation

Answer 40

Anxious children may require pharmacological behaviour management Most commonly nitrous oxide/ oxygen

Question 41

Types of conscious sedation

Answer 41

Oral Transmucosal Intravenous (for older children)

Question 42

General anaesthetic epidemiology

Answer 42

Dental caries most common reason for hospital admissions in children In England alone, ~60,000 hospital admissions of children U19yo with diagnosis of dental caries in 2016/17 Majority 5-9yos Estimated cost of £40 million per year in England Numbers going up

Question 43

Minor risks of GA

Answer 43

Nausea Vomiting Headache

Question 44

Impact of a GA from children

Answer 44

Pre-op: hunger, being scared/ worried Post-op: discomfort from IV canula, nausea, bleeding, tiredness, disturbed eating Satisfaction with resolution of problem, rewards and attention from family

Question 45

Major risks of GA

Answer 45

Mortallity rate 1:250000 - 1:2million Highest in infants and >70 years 5 children died between 1996-1999 while having GA for dental treatment

Question 46

Guidance about GA

Answer 46

``` Only done in hospitals with critical care unit if anything goes wrong Explain risk of death "a conscious decision" GA services modernised Provision of GA in hospital settings ```

Question 47

Lifetime risk of death from GA

Answer 47

1:250000 | Lower than lightning strike, alcohol poising, pedestrian accident

Question 48

Benefits of treatment under GA

Answer 48

One visit Multiple procedures Cost-effective

Question 49

Success of treatment

Answer 49

< pain Eating more Sleeping better Improved OHQoL

Question 50

Minimising impact of dental caries

Answer 50

Prevention (according to Delivering Better Oral Health) - LEARN CHILD BITS Community OH promotion < child dental anxiety

Question 51

Community OH promotion

Answer 51

Targeted community-based fluoride varnish programmes in schools or care homes Targeted provision of toothbrushes and toothpaste (postal or through health visitors or school) Supervised tooth brushing in nurseries and schools Healthy food and drink policies in childhood settings Fluoridation of public water supplies Influencing local and national government policies

Question 52

Reducing child dental anxiety

Answer 52

Development of self-help CBT resources - resources developed based on principles of Cognitive Behavioural Therapy - used child-centred approach - resources for children with accompanying resource for parents and dental professionals

Question 53

Your teeth: you are in control

Answer 53

1) Challenge unhelpful thoughts - normalises dental anxiety - provides info 2) Enhance control - message to dentist - stop signal contract 3) Reflect and plan reward