Notebooks Flashcards
Perform a caries risk assessment
You’re looking at:
their clinical evidence (teeth; xla, caries, nctsl, gingival inflammation, swelling, redness)
their diet (diary/what they say)
social history (GA in siblings?)
fluoride use (x/per day, time)
plaque control (plaque scores, ask to demonstrate how they brush, take a look intra orally and make a rough assessment)
saliva (rate, buffering capacity)
medical History (any xerostomia, immunocompromised, dexterity issue, behavioural issue (adhd), long-term cariogenic medicine)
Take them one at a time and ask questions, build a picture of their caries risk: low or high
Taking a plaque score
Teeth: 16,26,36,46 and 11,31
10/10 - perfectly clean
8/10 - line of plaque around cervical margin
6/10 - cervical third covered
4/10 - middle third covered
Taking a BPE on a child
For ages;
7-12: 0, 1 or 2 (mixed dentition)
12-17: 0,1,2,3,4,* (permenant)
Fluoride varnish:
1.When would you use it
2.When wouldn’t you use it
3.Explain how it works
4.Explain how it’s applied
5.Explain aftercare
- To prevent caries developing
To treat hypersensitivity
2.
Patient is allergic to sticking plasters (colophony)
Patient has ulcerative gingivitis or stomatitis (characterised by ulcerated and/or inflamed gums)
Patient has history of severe asthma (allergic reaction potential)
3.
Stops demineralisation
Promotes remineralisation
Stops bacterial metabolism
*basically it stops any damage that’s happening and makes the tooth stronger against any future damage
4.
The teeth will be cleaned first
(Remove gross plaque with gaws)
The teeth will then be dried (with the 3:1)
0.25-0.5ml of FV (duraphat) will be coated on all the teeth with a little brush, starting with the lower teeth first
5.
Avoid eating or drinking for next hour
No hard foods for rest of day
Don’t be worried about the yellowish appearance, it’ll disappear after eating/brushing that evening
So yes, brush as normal
22,600ppm fluoride (a.k.a 5%)
A child experiencing dental neglect
Don’t assume anything negative. Start off with the frame of mind the parent wants to help and work with you.
Identify the problems, address any concerns you have; previous attendance, child in pain, why haven’t they had the pain dealt with, why didn’t they show up to their appointment
Offer support to the parent. Let them know what treatment/appointments would be a good idea for the child’s welfare
Ask the parent if they’re willing to work together to meet these targets, these plan aims
Keep records of the conversation for future reference in the event the conversation/agreement needs to be referred back to
(All that is stage 1 - internal handling of the problem, assuming cooperation)
If future appointments are not made/parent doesn’t cooperate with recommendations then think about step 2.
- liase with other professionals to see if concerns are shared (school nurse, GP)
- make a decision if a CAF and a child protection plan needs to be carried out
- make an agreement on a plan of action with other professionals and review at agreed intervals
- if patient still fails to attend, think about sending a letter to the health visitor
Stage 3 (for complex/deteriorating situations)
- refer to social services
Our job in these cases is: ORCR
OBSERVE (situation)
RECORD (on R4)
COMMUNICATE (concerns to other health professionals)
REFER (for CAF) if appropriate
Treating the anxious child
First, recognise the signs and symptoms of anxiety on the patient.
Second, provide a warm demeanour, calm, friendly, trustworthy
Third; give them some control
-you can have a rest when you want
-just lift your hand and we can stop
-I’m just going to use this little mirror and air (use on hand)
Management during the appointment:
Positive reinforcement (you’re doing so well)
Distraction (ask math questions or solve a tricky problem then tell me after)
Role modelling (are you going to be brave for me and open wide like a big lion)
Tell/show/do
Acclimatisation (slowly talk them through everything)
Voice control (adjust your tone)
Use topical gel before LA
Treat upper arch before lower
Tools/aids
MCDAS
Venham picture scale
Facial image scale
Extra techniques:
Ask them what scares them, why and then reframe it to them in a non-scary way
Acknowledge their fears and talk about ways to make them feel less scary and more achievable
Treating the patient with special needs
1.Higher likelihood of
2.Commonly at risk of
3.Aims of tx
4.Types of Special Needs
5.Cautions with Special Needs
6.Referral with Special Needs
1.
Fewer teeth, untreated caries, perio. disease, dental anxiety
2.
Delayed diagnosis, delayed management (of teeth and gums), pain, infection, sepsis, reduced QoL, requires more interdisciplinary planning
3.
Normal speech development
Healthy self esteem
Healthy eating habits
Good oral hygiene
4.
Muscular dystrophy, spina bifida, cerebral palsy, adhd, autism, impaired learning, cardiac defect, type I diabetes, leukaemia, cancer, blind, deaf
- Cardiac: caution (not contraindicated) with GA and LA containing adrenaline
Autism: direct communication, reduce sensory inputs, may not be able to communicate verbally - ask parent for changes in behaviour (noise,light, smell, fewer people in the room, turn off radio ect)
Cancer/Leukemia/Musculo-skeletal disorders: CONTRAINDICATED for Inhalation sedation
6.
GA indications:
extensive treatment
uncooperative patient
*consent: 0-13 13-16 16+
How may a diabetic patient present
Reduced salivary flow (glossy tongue)
Xerostomia
Burning mouth
Candidiasis
Perio risk
Caries likely
Delayed wound healing
Greater risk of infection
3 types of infection and their treatment
Viral - acyclovir
Bacterial - antibiotics
Fungal - fluconizole, miconizole
Special need patients and their considerations
Cardiac, asthma, CF, cancer, renal disease
Cardiac - OH v.important to prevent IE
Asthma - avoid aspirin, nsaids (increased risk of bronchospasm)
Inhalers risk factor for fungal growth on tongue (dry surface)
CF - GA risk, sedation contraindicated
Renal disease - GA caution
Cancer - sodium bicarbonate, gelclair, biotene mouth rinse, difflam, tetracycline oral suspension
When not to do an IDB
Patient with a bleeding disorder
When not to use articaine
Sickle cell disease
When not to use citanest
Pregnant women
Safe dose calculation
2.2 x (44,66,88) = mg/ cartridge
mg/kg safe dose (5,8,7)
- Know the mg in the cartridge
- Know the safe mg number
- Know the kg of the kid
Engaging patient
30% plaque 35% bleeding
MPBS
Stable patients
20% plaque
10% bleeding
Full mouth scores
The No.1 aetiological factor in periodontitis
Plaque
S3 guidelines engaging patient
< or equal to:
20% plaque
30% bleeding
Normal pulp diagnosis
Transient response to pulp testing
Reversible pulpitis response
Discomfort to cold or sweet (sharp then subsides)
Common causes: caries, deep restorations, dentine sensitivity
Resolves once aetiology is removed
