MDL modules quizzes Flashcards
1
Q
What factor is most likely to improve the oral health of all pre-school children?
a. Fluoridation of fizzy drinks
b. Use of 1000ppm toothpaste
c. Water fluoridation
d. Use of 1450ppm toothpaste
A
c. water fluoridation
Some see this as mass medication but it is the most efficent way to get fluoride to those who most need it. It involves no effort on behalf of the recipient.
2
Q
Which treatment is of the highest priority in the following plan?
a. Restoration of pain free primary teeth
b. relief of pain
c. Restoration of pain free permanent teeth
d. Oral hygiene instruction
A
b. relief of pain
3
Q
When planning treatment which of the following should be carried out first?
a. Simple restorations requireing LA in the upper jaw
b. Simple restorations requireing LA in the lower jaw
c. Anterior tooth restoration requireing LA
d. Pulpotomy in the upper jaw
A
a. Simple restorations requireing LA in the upper jaw
4
Q
What is not wanted from the parents/carers of a small child when treatment planning?
a. Consent
b. Showing the child that they are nervous
c. Motivation toward appropriate dietary improvements
d. Willingness to help aid good oral hygiene
A
b. Showing the child that they are nervous
5
Q
Which factors do we not need to take into consideration when formulating a treatment plan for a
a. Social background
b. Plan made for child’s best friend
c. Medical history
d. Caries risk
A
b. Plan made for child’s best friend
6
Q
Which of the following would not alter your treatment plan?
a. Child has congenital cardiac disease
b. Need for prevention
c. Need for General Anaesthetic
d. Allergy to latex
A
b. Need for prevention
7
Q
Which of the following is not important in the social history of a child for dentistry?
a. If they have a best friend
b. Siblings
c. Age
d. Year at school
A
a. If they have a best friend
8
Q
What factors do not need to be considered in the mixed dentition phase?
a. Development of all permanent teeth
b. Growth of the child
c. Developing malocclusion
d. Size of the maxillary sinuses
A
d. Size of the maxillary sinuses
9
Q
What should form the first component of any treatment plan?
a. Restorative Treatment
b. Diet advice and oral hygiene instruction
c. Prevention
d. Relief of pain
A
d. Relief of pain
10
Q
Which of the following is not a major factor in a preventive treatment plan for a child?
a. Fluoride therapy
b. Water fluoridation
c. Fissure sealing
d. Oral hygiene instruction
A
b. Water fluoridation
11
Q
Which of the following would be a suspicious indicator of child abuse or neglect?
Select one:
- There is a loving relationship between the parent and child
- Delayed presentation of dental trauma
- All dental appointments kept
- Parent shows interest in the treatment of their child
A
Delayed presentation of dental trauma
Highly suspicious- normal parenting would predict that a child would be taken for medical assistance immediately. If there is a delay in presentation there should be a very good reason for this.
12
Q
Your adult patient attend their appointment heavily under the influence of drugs or alcohol. You realise that they they have also brought a child along with them who is sitting in the waiting room. Which of the following would NOT be an appropraite course of action?
Select one:
- Find out if another family member or friend can pick up the child and care for them until the parent is able to do so.
- Contact the localpolice station to help deal with the situation.
- Call the duty social worker at the local social services department to see if they can look after the child as the parent is unfit to do so.
- Let the child leave with the intoxicated parent, after all they are not your patient.
A
Let the child leave with the intoxicated parent, after all they are not your patient.
- This is clearly the wrong thing to do. It is our responsibility to look after all children whether they actually be our patient or not.
13
Q
Which of the following in isolation would NOT be a suspicious indicator of child abuse/neglect?
Select one:
- A child who is clearly dirty and smells of unwashed clothes first thing on a monday morning.
- A torn upper labial fraenum
- Multiple injuries in different locations
- Late presentation of an injury
A
A torn upper labial fraenum
14
Q
The Criminal Justice (Scotland) Act has NOT made it illegal to:
Select one:
- Hit a child anywhere on the head
- Hit a child with any kind of object
- Shake a child
- Smack a child
A
Smack a child
Smacking is not illegal in Scotland but the other three answers are. This is a contentious issues as peoples definition of a “smack” can vary widely. now is 2020
15
Q
Who are the main agency concerned with coordinating child protection procedures?
Select one:
- General Medical Practitioners
- Police
- Social Services
- Health Visitors
A
Social Services
16
Q
All dental professionals who are registered with the general dental Council have a responsibility to….?
Select one or more:
- Know how to refer concerns about abuse or neglect.
- Diagnose abuse or neglect in children
- Know who to contact for further advice about abuse or neglect of children.
- Raise concerns about the possible abuse or neglect of children
A
- Know how to refer concerns about abuse or neglect.
17
Q
Which of the following is the accepted definition of child protection?
Select one:
- Ensuring children grow up in a safe and caring environment.
- Measures taken to minimise the risk of harm to children
- Activity undertaken to protect specific children who are suffering or are at risk of suffering significant harm
- Preventing the impairment of children’s health
A
Activity undertaken to protect specific children who are suffering or are at risk of suffering significant harm
18
Q
What are contributing factors in child abuse/neglect cases?
Select one:
- Domestic violence, drug/ alcohol misuse, poverty
- Poverty, mental health problems, unemployment
- Step parents, drug/ alcohol misuse, mental health problems
- Domestic violence, drug/ alcohol misuse, mental health problems
A
Domestic violence, drug/ alcohol misuse, mental health problems
19
Q
How many children in Scotland are killed by a parent/ parent substitute?
Select one:
- 52 per year
- 10 per year
- 80 per month
- 1 - 2 per week
A
10 per year
20
Q
Why is it possible that ‘neglect of neglect’ might occur?
Select one:
- Becasue children don’t die from neglect
- Becasue neglect is rare
- Becasue neglect does not damage children
- Becasue neglect is less incident focussed
A
Becasue neglect is less incident focussed
21
Q
Which of the following is NOT a long term effect for adults who were neglected as children?
Select one:
- Greater incidence of diabetes
- Greater incidence of heart disease
- Greater incidence of epilepsy
- Greater incidence of arrest
A
Greater incidence of epilepsy
22
Q
What 3 stages in managining dental neglect are suggested by “Child Protection and the Dental Team” website?
Select one:
- Preventive dental team management, preventive multi-agency management, child protection referral
- Preventive dental team management, referral to local dental hospital, preventive multi-agency management
- Examination, diagnosis, review
- Referral to local dental hospital, speak to child protection advisor, child protection referral
A
Preventive dental team management, preventive multi-agency management, child protection referral
23
Q
What proportion of serious head injuries in the first year of life are non-accidental?
Select one:
- 95%
- 5%
- 10%
- 60%
A
95%
24
Q
What proportion of injuries in abuse cases are found on the head and neck areas?
Select one:
- 10%
- 60%
- 5%
- 95%
A
60%
25
Which of the following is NOT an indicator of dental neglect?
Select one:
* Occult dental caries
* Obvious dental caries
* Dental disease which has an impact on the child
* Children with dental disease where practical care has been offered and yet the child has not returned for treatment
Occult dental caries
26
When reading clinical guidelines what does the strength of a strong key recommendation convey?
Select one:
1. Based on available information, weighing up balance of benefit versus risk, almost all individuals would choose this option.
2. Based on available information, weighing up balance of benefit versus risk, the majority of individuals would choose this option.
3. Based on available information, weighing up a finer balance of benefit versus risk, not all individuals would choose this option.
4. Based on available information, weighing up a finer balance of benefit versus risk, some individuals would choose this option.
1. Based on available information, weighing up balance of benefit versus risk, almost all individuals would choose this option.
27
Which of the following is an aim when providing dental care for children:
Select one:
1. To keep the permanent dentition mainly free from disease
2. To reduce the risk of the child experiencing pain, infection or treatment induced anxiety
3. For the child to grow up feeling positive about their oral health but for medical health to be a priority
4. To safeguard dental neglect only and not to consider wellbeing
2. To reduce the risk of the child experiencing pain, infection or treatment induced anxiety
28
A comprehensive assessment of the child does not include the following element for an effective plan to improve oral health:
Select one:
a. Carer Motivation and Responsibility only
b. Patient history
c. Clinical examination
d. Caries Risk Assessment
a. Carer Motivation and Responsibility only
29
An assessment of lesion activity is essential for providing the appropriate level of caries prevention this includes:
Select one:
1. On one occasion using clinical assessment
2. One one occasion using radiographic assessment
3. Progression over time using clinical photographs
4. Using lesion colour as an indicator
3. Progression over time using clinical photographs
30
The broad contact points of the primary dentition make diagnosis of proximal caries difficult using clinical examination alone.At what age should bitewing radiographs start to be taken as an adjunct to visual diagnosis?
Select one:
1. Age three and above
2. Age four and above
3. Age five and above
4. Age six and abov
2. Age four and above
31
When assessing toothbrushing and recording visible plaque levels at each examination, a score of eight out of ten indicates:
Select one:
1. Perfectly clean tooth
2. Plaque line around the cervical margin
3. Cervical third of the crown covered
4. Middle third cover
2. Plaque line around the cervical margin
32
Motivational Interviewing is used to translate knowledge into behaviour change, this process involves:
Select one:
1. Seek permission, Open Questions, Affirmations, Reflective learning, Summarising
2. Self permission, Open Questions, Affirmations, Reflective listening, Summarising
3. Seek permission, Open Questions, Affirmations, Reflective listening, Summarising
4. Self permission, Open Questions, Affirmations, Reflective listening, Summarising
3. Seek permission, Open Questions, Affirmations, Reflective listening, Summarising
33
Standard prevention for all children includes the following at least once a year:
Select one:
1. Toothbrushing demonstration on the child and age appropriate toothpaste advice
2. spit, don't rinse and information on supervision of their brushing habits until age nine years old
3. Brush thoroughly twice daily, including first thing in the morning and appropriate amount of toothpaste
4. information on supervision of their brushing habits until age nine years old and spit, don't rinse
1. Toothbrushing demonstration on the child and age appropriate toothpaste advice
34
Enhanced prevention for children at increased risk of caries should include the following at each recall visit:
Select one:
1. Standard prevention and hands on toothbrushing to child only at each recall visit
2. Standard prevention and 1350-1500 ppmF advice for children up to 9 years old
3. Standard prevention and 2800 ppmF advice for children aged 9-16 years old
4. Standard prevention and hands on toothbrushing to child and parent/carer at each recall visit
4. Standard prevention and hands on toothbrushing to child and parent/carer at each recall visit
35
Standard prevention for all children should include the following at least once per year:
Select one:
1. Restricting sugar containing food and drinks x4 per day and drink only flavoured water or milk between meals
2. Restricting sugar containing food and drinks x3 per day and drink only water or milk between meals
3. Snack on sugar free foods such as digestive biscuits and be aware of hidden sugars in foods
4. Snack on sugar free foods such as oatcakes and be aware if acid content of drinks
4. Snack on sugar free foods such as oatcakes and be aware if acid content of drinks
36
Enhanced prevention for children at increased risk of caries should include the following dietary actions:
Select one:
1. Patients only may require more-in-depth support to change dietary habits, such as motivational interviewing
2. Carer only may require more-in-depth support to change dietary habits, such as motivational interviewing
3. Utilise community/home support for dietary change that is available locally
4. Patients and parent/carer only may require more-in-depth support to change dietary habits, such as motivational interviewing
4. Patients and parent/carer only may require more-in-depth support to change dietary habits, such as motivational interviewing
37
Enhanced prevention includes fissure sealant of the following tooth and surface if assessed as likely to be beneficial:
Select one:
a. Cs cusp tip
b. 2's palatal pits
c. Third permanent molar
d. As & Bs palatal pits
b. 2's palatal pits
38
Standard prevention for All children includes the following:
Select one:
1. Sodium fluoride varnish (3%) twice a year to ALL children over 2 years of age
2. Sodium fluoride varnish (5%) twice a year to ALL children over 4 years of age
3. Sodium fluoride varnish (5%) twice a year to ALL children over 3 years of age
4. Sodium fluoride varnish (5%) twice a year to ALL children over 2 years of age
4. Sodium fluoride varnish (5%) twice a year to ALL children over 2 years of age
39
Which method of fluoride delivery does the patient not administer?
Select one:
A. Fluoride supplements
B. Fluoride mouthrinse
C. Fluoride varnish
D. Fluoride toothpaste
C. Fluoride varnish
40
Which of the following is not suitable for use in any 10-year-old child?
Select one:
A. 5,000 ppm fluoride toothpaste
B. 1,450 ppm fluoride toothpaste
C. Fluoride Mouthwash after dinner
D. 22,600 fluoride varnish
A. 5,000 ppm fluoride toothpaste
41
Which of the following is not one of the take home messages from the Marimho 2008 review of the evidence for topical fluorides?
Select one:
A. The higher the caries rate, the greater the preventive effect of topical fluorides
B. Additional topical fluorides (e.g. mouthwash, varnish, tablets) used as well as toothpaste further reduce the occurence of caries
C. Fluoride varnish is the most important method of delivering topical fluoride
D. Fluride toothpaste prevents dental caries
C. Fluoride varnish is the most important method of delivering topical fluoride
42
The least amount of fluoride in toothpaste that should be recommended for a 2-year-old child is?
Select one:
A. 2800ppmF
B. 1450ppmF
C. 1000ppmF
D. 500ppm
C. 1000ppmF
43
What is the strength of fluoride in duraphat varnish?
Select one:
A. 22,800 ppm
B. 22,600 ppm
C. 12,600 ppm
D. 27,600 ppm
B. 22,600 ppm
44
When should topical fluorides (other than toothpaste) be taken?
Select one:
A. At a different time from toothbrushing
B. Instead of toothbrushing
C. Along with meals
D. With a drink of milk
A. At a different time from toothbrushing
45
Which is the correct drug information that should be written on a prescription to allow a tube of Duraphat 2,800ppm toothpaste to be dispensed?
Select one:
A. Duraphat toothpaste 5mg/Kg
B. 1.1% Sodium Fluoride toothpaste
C. Sodium Fluoride 0.619% toothpaste
D. Duraphat toothpaste 2,800ppm
C. Sodium Fluoride 0.619% toothpaste
46
From when should a parent be using a toothbrush for their child?
Select one:
A. When their first tooth erupts
B. When they start consuming sugars
C. When they are born
D. When they start eating solids
A. When their first tooth erupts
47
For a 6-month-old child at low risk of caries, which of the following brushing regimes would you recommend?
Select one:
A. Small pea size amount of 500ppm for twice daily brushing
B. Small pea size amount of 1000ppm for twice daily brushing
C. Smear of 500ppm toothpaste for twice daily brushing
D. Smear of 1000 ppm toothpaste for twice daily brushing
D. Smear of 1000 ppm toothpaste for twice daily brushing
48
A parent calls your surgery to advise that their child has ingested some toothpaste. Which of the following is not an essential question for you to ask?
Select one:
a. Amount of toothpaste
b. Age/weight of child
c. Colour of toothpaste
d. Strength of toothpaste
c. Colour of toothpaste
49
How is the minimum fluoride concentration that would provide a probable toxic dose?
Select one:
A. 5mg/Kg body weight
B. 1mg/Kg body weight
C. 6.5mg/Kg body weight
D. 2mg/Kg body weight
A. 5mg/Kg body weight
50
Which of the following is not associated with physiological and somatic sensations associated with dental anxiety?
Select one:
1. Breathlessness
2. Nasal Blockage
3. Feelings of unease
4. Perspiration
2. Nasal Blockage
51
Which statement below is not associated with behaviour shaping or positive reinforcement
Select one:
1. Shifting the chid's attention to another situation/action
2. A child centred empathetic specific response
3. stickers or badges at the end of a successful appointment
1. Shifting the chid's attention to another situation/action
52
Identify the correct order for needle desensitisation
Select one:
1. Practice L.A, Teach Relaxation, Explain L.A., Deliver L.A.
2. Teach Relaxation, Practice L.A, Explain L.A., Deliver L.A
3. Teach Relaxation, Explain L.A., Practice L.A. Deliver L.A.
4. Explain L.A, Practice L.A., Teach Relaxation, Deliver L.A.
3. Teach Relaxation, Explain L.A., Practice L.A. Deliver L.A.
53
Which of the following is the most effective technique to help a child cope when they have a blunting coping style?
Select one:
1. Show the child in great detail the equipment you will use.
2. Explain what will happen and then use distraction techniques.
3. Explain the treatment to the child in great detail
4. Complete the treatment giving lots of explanations
2. Explain what will happen and then use distraction techniques.
54
Which following statement is true?
Select one:
1. A 4-year-old is unwilling to accept change
2. A 5-year-old does not respond the flattery
3. A 2-year-old's favourite word is "yes"
4. A 3-year-ols's favourite word is "why"
3. A 2-year-old's favourite word is "yes"
55
Which of the following is not associated with causing child dental anxiety?
Select one:
1. A difficult dental experience whilst receving dental treatment or whilst attending the dentist
2. A difficult medical experience whilst receiving medical treatment or attending a medical appointment
3. Parental dental anxiety
4. School Achievements
4. School Achievements
56
Which of the following non verbal communications techniques have been shown to be ineffective?
Select one:
1. Child friendly environment
2. Reassurance non specific
3. Smiling
4. Reinforcement
2. Reassurance non specific
57
Which of the following techniques requires further training prior to its use?
Select one:
1. Enhanced control
2. Magic tricks
3. Systematic desensitisation
4. Hypnosis
4. Hypnosis
58
Which of the following helps to improve communication with a child?
Select one:
1. Wearing goggles and a mask
2. Getting down to the child's level
3. Standing with your arms crossed
4. Talking only with the parent
2. Getting down to the child's level
59
Which following term should not be used while talking to children about their dental treatment?
Select one:
1. "princess crown/robot tooth"
2. superhero toothpaste
3. "tooth pillow"
4. " a wee jag"
4. " a wee jag"
60
Identify the term which is now inaccurate and not used to describe child co-operation
Select one:
1. unco-operative
2. Pre co-operative
3. Potentially co-operative
4. co-operative
1. unco-operative
61
For a conventional light-cured resin fissure sealant which substance is used to etch the surface of the enamel prior to placement?
Select one:
A. Hydrogen Peroxide
B. 10% Nitric Acid
C. 18% Hydrochloric Acid
D. 35% Ortho-phosphoric Acid
D. 35% Ortho-phosphoric Acid
62
How is isolation for moisture control best achieved whilst placing a fissure sealant?
Select one:
A. By use of rubber dam
B. By use of a parotid shield
C. By use of a saliva ejector
D. By use of cotton wool rolls
A. By use of rubber dam
63
when is the ideal time to fissure seal a first permanent molar?
Select one:
A. As soon as the tooth erupts
B. Between the ages of 8 and 10-years-old
C. When the tooth has erupted sufficiently to allow for adequate isolation/moisture control
D. When caries develops in other primary or permanent teeth
C. When the tooth has erupted sufficiently to allow for adequate isolation/moisture control
64
Which of the following is not part of a preventive programme along with fissure sealing?
Select one:
A. Oral hygiene measures
B. Dietary advice/monitoring
C. Fluoride application
D. Preventive resin restorations
D. Preventive resin restorations
65
Which is the most common material used for fissure sealant placement?
Select one:
A. BIS-GMA resins
B. Glass ionomer cement
C. Resin modified glass ionomer
D. Amalgam
A. BIS-GMA resins
66
Which factor does not need to be taken into account when deciding to place a fissure sealant on a first permanent molar in a 6-year-old?
Select one:
A. Clinical findings
B. Parental Dental Anxiety
C. Patient’s caries risk
D. Radiographic finding
B. Parental Dental Anxiety
67
Which of the following patient groups require regular fissure sealant placement?
Select one:
A. Children with caries in their primary dentition
B. Children with compromised medical histories
C. Children at risk of caries development
D. All of the above
D. All of the above
68
After placement, fissure sealants should be checked for:
Select one:
A. Air bubbles
B. Flash
C. Non-adherence
D. All of the above
D. All of the above
69
How often should fissure sealants placed in a child of high caries risk be radiographically reviewed?
Select one:
A. Every 6 months
B. Every 12 months
C. Every 18 months
D. Every 24 months
A. Every 6 months
70
What is the major advantage of using a glass ionomer fissure sealant?
Select one:
A. It is more aesthetic
B. It sets quicker
C. It does not releases fluoride
D. It is easier to handle when moisture control is not ideal
D. It is easier to handle when moisture control is not ideal
71
Which of the following should be used to clean the tooth prior to fissure sealant placement?
Select one:
A. Air and water
B. Pumice and water
C. Diamond polishing paste
D. Toothpaste
B. Pumice and water
72
How should the occlusal surface of the tooth appear after adequate acid-etching and drying?
Select one:
A. Smooth and shiny
B. Mottled
C. Blue
D. Chalky-white/frosted
D. Chalky-white/frosted
73
Which instrument should be used to check the seal after placement?
Select one:
A. Flat plastic
B. Micro-brush
C. A sharp probe
D. 3-in-1 tip
C. A sharp probe
74
The IADT definition of 'Concussion' is:
Select one:
A. An injury to the tooth-supporting structures without increased mobility or displacement of the tooth and without pain to precussion
B. An injury to the tooth-supporting structures without mobility or displacement of the tooth, but with pain to percussion
C. An injury to the tooth-supporting structures with displacement of the tooth and with pain to percussion
D. An injury to the tooth-supporting structures with increased mobility but no displacement of the tooth and with pain to precussion
B. An injury to the tooth-supporting structures without mobility or displacement of the tooth, but with pain to percussion
75
When examining a patient with dental trauma, which of the following is not a sign of brain injury requiring medical assessment?
Select one:
A. Amnesia
B. Nausea
C. No Loss of consciousness
D. Vomitting
C. No Loss of consciousness
76
When considering treatment of an avulsed primary tooth which of the following are true?
Select one:
A. The patient requires to be followed up until eruption of the permanent successor
B. Healing after avulsion is not dependent upon good oral hygiene
C. It should be reimplanted
D. The permanent successor is always damaged by the injury to a primary tooth
A. The patient requires to be followed up until eruption of the permanent successor
77
A permanent tooth that has been subluxated if mobile should be?
Select one:
A. Splinted for 2 weeks
B. Moved to another position
C. Left to heal without treatment
D. Extracted
A. Splinted for 2 weeks
78
Treatment guidelines for an avulsed permanent tooth advise that:
Select one:
A. It should only be handled by the root whilst preparing to reimplant the tooth
B. If a tooth cannot be reimplanted immediately, it should be stored in water
C. Tap water should not be used to clean the tooth before it is reimplaned
D. If a tooth cannot be reimplanted immediately, it should be stored in milk
D. If a tooth cannot be reimplanted immediately, it should be stored in milk
79
Treatment of the avulsed permanent tooth depends upon:
Select one:
A. Whether the root apex is open or closed
B. All of the these options
C. How long the tooth was dry before being reimplanted
D. What the tooth was stored in
B. All of the these options
80
Treatment of a greater than 1 mm enamel-dentine-pulp fracture is best managed with a pulpotomy. Which of these is NOT part of this pulpotomy procedure?
Select one:
A. Apply calcium hydroxide or MTA
B. Access the pulp via the fracture site
C. Use of local anaesthesia
D. Remove all coronal pulp
D. Remove all coronal pulp
81
Regarding the prognosis for a permanent tooth with an enamel-dentine-pulp fracture with a newly formed root, when looking at the statistical review, which of these is true 10 years after injury?
Select one:
A. The risk of tooth loss is 12%
B. The risk of tooth loss is 0%
C. The risk of tooth loss is 34%
D. The risk of tooth loss is 100%
B. The risk of tooth loss is 0%
82
Regarding the prognosis for a permanent tooth with a lateral luxation injury with stage 2 root formation and no associated crown fracture, when looking at the statistical review, which of these is true at 10 years after injury?
Select one:
A. The risk of bone loss is 11.2%
B. The risk of surface resorption is 0%
C. The risk of pulp necrosis is 4.7%
D. The risk of tooth loss is 3.4%
C. The risk of pulp necrosis is 4.7%
83
Which following primary tooth injury has a clinical review time of 6 months?
Select one:
a. Avulsion
b. Concusion
c. Intrusive luxation
d. Subluxatio
c. Intrusive luxation
84
Which of the following permanent tooth injuries has a splinting time of 4 weeks?
Select one:
a. Avulsion
b. Lateral luxation
c. Root fracture (cervical 1/3)
d. Extrusion
b. Lateral luxation
85
Which of the following is true of teeth with pulp canal obliteration?
Select one:
a. Avulsion injuries have a high rate of pulp canal obliteration
b. It occurs more frequently in teeth with open apices
c. It occurs more freqenly in tooth which have suffered a mild luxation injury
d. It usually indicates the presence of necrotic tissue
b. It occurs more frequently in teeth with open apices
86
What are the three components of SDF?
Silver, Fluoride and Ammonium Ions
87
What are the diagnose for the licensed use of Riva Star in the UK.
* tooth sensitivity
* cavity cleansing
88
What are 10 indications for the use of SDF?
* Asymptomatic cavitated carious lesions in primary teeth
* Lesions that are, or can be made, cleansable
* Non-restorable dentinal lesions
* Several carious lesions that may not all be treated in one visit
* Root surface carious lesions (primary and permanent teeth)
* MIH cases to reduce sensitivity
* Pre-cooperative children, children and adults whose behaviour/medical conditions limit invasive restorative treatment
* Where there is a need to “buy time” to avoid or delay treatment with sedation or GA
* Patients with high caries risk with medical or psychological conditions that limit other treatment approaches eg patient with dental phobia, medical conditions or disabilities
* Patients who already have a high standard of brushing or are likely to be responsive to measures to change behaviour to carry out frequent, high quality toothbrushing or other methods to clean carious lesions
89
What are 4 contraindications for the use of SDF?
* Not able or willing to brush and unlikely to. Patients (or parents) unable or unwilling to take responsibility
* Potassium iodide is contra-indicated in pregnant or breastfeeding women, patients undergoing thyroid gland therapy or on thyroid medication or patients with known allergy to potassium or iodine.
* Patients with ulceration, mucositis, stomatitis.
* Patients with allergy to silver, fluoride or ammonia
90
Can you list 3 key elements of prevention that are required along with the placement of SDF?
* diet advice
* Oral hygiene instruction
* fluoride
91
After placement of SDF on a carious lesion what 5 things can occur as a result of the chemical reactions?
* Promotion of tooth desensitisation by blockage of the dentinal tubules
* Arrest of the carious lesion by blockage of the dentinal tubules
* Bacterial death
* Remineralisation of demineralised tooth tissue
* Inhibition of dentinal collagen degradation
92
Describe why SDF is thought to be useful as a caries detection agent.
It only stains carious tooth tissue therefore it can be used to show the margins of carious enamel more clearly so that less sound tooth tissue is removed during preparation of a cavity.
93
What is the recommended time that should be taken for applying SDF?
up to 3 minutes
1 min minimum
94
after the placement of SDF, what is the follow up period, what needs to be examined and what is the next course of action based on the results of this examination?
* 2-4 weeks after the first application
* If the lesion is still active = reapply
* If the lesion is able to be restored, then use appropriate restorative material
* If unrestorable then biannual SDF reapplication for better arrest rate
95
in what way can SDF benefit asymptomatic pre-cooperative children with multiple carious lesions?
SDF is a simple technique to arrest carious lesions and prevent them progressing further and helping to aid sensitivity
Buying time to acclimatise children so that they are more able to undertake different dental procedure/ preventing it all together
*It can arrest the active caries. SDF used with a preventive regime can stop carious lesions from progressing further and the need for active interventive dentistry.*
96
A 4-year-old patient attends your clinic for the first time. When you ask the mother about the child she says that she has recently noticed that she has sensitive teeth when drinking cold water and milk. The child is happy enough to communicate with you and points to the last lower molar tooth on the left- hand side. She lets you look inside her mouth and this is what you see:
teeth present
75, 74, 73, 72, 71, 81, 82, 83, 84, 85
97
When you ask the mother about the child she says that she has recently noticed that she has sensitive teeth when drinking cold water and milk.
3 investigations
3 in1
ethyl chloride
bitewings
98
adive for parent and child on prevention
* Tooth Brushing Instruction – until age 7 the parent should do the brushing
* Specific diet advice, using food diary over 3-4 days
* High caries risk toothpaste strength advice 1450 ppm F
99
4 yo
* diagnose reversible pulpitis on the symptomatic tooth with no pulpal involvement and you treat this tooth.
* elect to use SDF as part of your treatment plan in order to stop the progression of caries in the other teeth.
On which teeth would you choose to place the SDF and how would you manage the symptomatic tooth?
74 (Lower left first primary molar), 84 (Lower right first primary molar and 85 (Lower right second primary molar)
75 -stabilised with GI dressing, once acclimatised and improved co-operation work towards a preformed metal crown using The Hall Crown Technique.
100
Why is it important to assess DFA with a self-report style questionnaire?
What examples of self-report questionnaires are you aware of?
allow dental professionals to understand this child/adolescents’ specific needs and create a treatment plan that is more likely to be successful
* self report more reliable as other measures are based on perceptions of the child’s anxiety from dentist or parent
* Parent may place some of their anxieties on child’s score
Child may not necessarily be negatively behaved in dental setting even if highly anxious
Need to be accessible to the child so they understand the Q and how to answer it appropriately
* MCDASf
* Child Experience of Dental Anxiety Measure (CEDAM)
101
What factors may be important to consider when having to explain DFA to a child specifically? Think about how a child would react to/ understand what you are saying
Communicate directly to the child – not to parent/adult present first – helps give feeling of control
Involve in treatment planning and explain all types and stages of different possible procedures
Explain physical symptoms and thoughts in DFA (fight,flight,freeze and negative thoughts) and assure they are normal
Explain when response can be helpful (e.g. when riding bike and about to fall off) but how the body can activate it when it is not helpful and this is when we need to learn to spot the triggers and take control over it again – we want to teach relaxation so they can have control of which mode they are in
102
In what circumstances do you think MTD should be used?
Pt able to take away to think about ways in which they’re dental experience can be improved – helpful for anxious patients who may find it overwhelming to do in the dental setting
Helps build communication and rapport – both pt and dentist sign to show that they will both honour the agreement and control strategies above
103
How would you introduce the concept of what CBT is?
In what scenario do you think CBT should be used as opposed to sedation?
In what case might CBT and sedation both be used for treatment?
break it down to how it focusses on how thoughts can affect how you feel, what you do (behaviours), and the consequences of this and how we can work to gain control of them when we identify triggers – such as needles. So by working and practicing at this hopefully be able to use them when we feel levels of anxiety/negative thoughts building
can be used opposed to sedation when pt has worked on it sufficiently and says they would be comfortable to undergo treatment using strategies – can take time to get to this stage
if pt not comfortable for CBT alone sedation can be used as a way to help get them through the appointment
