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SCR BDS4 > Paediatric Caries Guidelines and Management > Flashcards

Paediatric Caries Guidelines and Management Flashcards

1
Q

What do we do when we first see a child?

A

Pt info
RFA
C/O
HPC
MH (medical conditions, allergies, medications)
SH - school, siblings, any difficulty in bringing child to appt
DH - prev dental tx, attitude to tx (phobia/anxiety), caries experience of siblings, parents, toothbrushing habits, supervised? fluoride? spit? bottle at night? diet - snacks? dinner? lunch? breakfast? sugar medications?

E/O exam - as normal
I/O exam - as normal

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2
Q

What makes up a caries risk assessment?

A
  1. Clinical Evidence
  2. Plaque Control
  3. Fluoride Use
  4. Saliva
  5. Medical History
  6. Social History
  7. Diet
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3
Q

What makes up caries risk assessment prevention plan?

A
  1. OHI (toothbrushing instruction)
  2. Fluoride toothpaste
  3. Fluoride varnish
  4. Fluoride supplements
  5. F/S
  6. Diet advice
  7. Sugar Free medicine
  8. Radiographs
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4
Q

What guidance do we refer to with regards to caries in children?

A

SDCEP Caries in Paediatric pt guidelines

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5
Q

How do we obtain clinical evidence?

A

Thorough clinical intra and extra oral exam - dry teeth, good light source, direct vision where appropriate

consider radiographic investigation if appropriate

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6
Q

What is a sign of enamel caries?

A

If enamel is affected the lesion will be matt, opaque, chalky white, appear dark under light (enamel translucent and normally reflects light but caries blocks light)

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7
Q

How do we ensure we do proper assessment of teeth?

A

Dry teeth as wet teeth enamel pores are filled with saliva and allow light to be transmitted preventing dx

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8
Q

How do we know if a lesion more likely to be inactive/arrested?

A

Shiny
Dark
smooth to probe (with ball ended or will cause cavitation)

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9
Q

How do we know if a lesion more likely to be active?

A

Soft, mushy, mixed colour

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10
Q

How do we assess toothbrushing?

A

Plaque index:

10/10 = perfectly clean
8/10 = cervical margin
6/10 = cervicle third
4/10 = middle third

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11
Q

What affects pts SH?

A

If in SIMD 1-3 then high risk as considered relatively disadvantaged

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12
Q

How often are radiographs in high risk children?

A

6-12 months (6 monthly until no new active lesions and then new risk category group)

BWs - size 0 usually in kids

FGDP GUIDELINES

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13
Q

How often are radiographs in low risk children?

A

mixed dentition, primary dentition = 12-18 months

permeant dentition = 2 yearly

FDGP GUIDELINES!!!

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14
Q

How can we determine pts anxiety?

A

MCDAS questionnaire - pt rates diff elements of dentist/dental tx out of 5 or via faces and gives us indication on level of DFA (8 Qs - injection, needle in hand)

AIM IS TO REDUCE ANXIETY OVER TIME

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15
Q

What are behaviour management techniques?

A

COMMUNICATION
ENHANCING CONTROL
TELL SHOW DO
POSITIVE REINFORCEMENT
DISTRACTION
RELAXATION
STRUCTURED TIME
SYSTEMATIC DESENSITISATION

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16
Q

What is communication?

A

this is where we communicate with pts on how to support the child without disrupting appt

via:
verbal
non verbal
tone

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17
Q

What is enhancing control?

A

This is where we ensure child knows they are in control with a stop signal - can stop tx (may ease anxiety)

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18
Q

What is tell show do?

A

This is where we introduce child to new situation by telling them about it in age appropriate language, then we show the child what we will do, and then carry out action

aim is to acclimatise child (ie to use of handpiece) as we gain rapport and let them get more comfortable with use

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19
Q

How does tell show do work for showing child handpiece?

A

Tell = about what we want to do
Show = show them handpiece, aspiration
Do = put aspirator in mouth, then turn on, then praise child, then put handpiece in mouth but dont turn on, then do same but turn on but not on tooth, keep praising until ultimately able to carry out tx

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20
Q

What is positive reinforcement?

A

This is where we positively praise and reinforce ideal behaviour and ignore the negative behaviour/undesirable behaviour to avoid drawing attention to it

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21
Q

What is structured time?

A

This is where we help child tolerate procedure by giving time limit - saying it will only last for 5 seconds at a time then a break

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22
Q

What is distraction?

A

Use of distraction to shift pts attention from dental setting
cartoons/aduio/scnearios

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23
Q

What is relaxation?

A

This is where we use techniques such s breathing and relaxing scenarios to distract pt and take mind of anxiety

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24
Q

What is systematic sensitisation?

A

This is where we teach child how to relax and break down procedure into stages, before moving onto next stage we ensure pt is calm

discuss management of stress and anxiety and teach techniques to manage

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25
Q

If pt has newly erupted 6 but caries in C what do we do?

A

Preventative tx of permeant tooth before primary tooth restoration (eg - F/S)

26
Q

If child is pre-coperative or cant cooperate what do we do?

A

Consider referral for sedation (after trying behaviour management techniques) or if pt has several teeth requiring XLa

27
Q

What do we do if a child has reversible pulpitis?

A

restore or place dressing and restore later

28
Q

What do we do if a child has irreversible pulpitis?

A

if pre-cooperative then try dress with corticosteroid paste and pain relief and can refer for sedation or GA

if cooperative can do extraction or pulp therapy

29
Q

What toothpaste for 0-3?

A

Smear 1000ppmF
HIGH and LOW RISK

30
Q

What toothpaste for 3-10? HIGH and LOW

A

High - 1450ppmF
Low - 1450ppmF

PEA SIZED

31
Q

What toothpaste for 10-16? HIGH? LOW

A

HIGH - 2800PPMF
LOW = 1450PPMF

PEA SIZED

32
Q

What toothpaste for 16+? high and low risk?

A

High = 5000ppmF
Low = 1450ppmF

PEA SIZED

33
Q

How often do we give OHI to standard risk pts?

A

yearly - explain, demo and advise

34
Q

How often do we give OHI in enhanced prevention?

A

Every visit - demo, hands on, additional prevention consideration (2800,5000ppmF)

35
Q

Toothbrushing instructions?

A

2x day, 2 mins, manual or electric brush
modified bass technique - 45 degree angle at gum line
30 second each quadrant - use of timer
supervised until 7/8 or can tie own shoes as when child has dexterity to do it themselves

36
Q

When do we give diet advice?

A

Standard - yearly at least (limit consumption of sugar/acidic foods, limit to mealtimes, avoid sugar/acidic drinks - only water and milk between meals, no brushing until 30 mins after eating and only water after brushing, only water in bottle overnight

Enhanced - every recall, consider diet diary (2 normal, 1 weekend day)

37
Q

What are F/S?

A

These are protective coating placed on permeant teeth to reduce caries risk as fissures are protected

Resin sealaers
GI

38
Q

How often do we F/S for high risk?

A

ALL PM AS ERUPT, NUCCAL BITS, PALATAL FISSURES, D E
in high risk - seal erupting molars, buccal groove lowers, palatal fissures upper, seal the upper laterals, Ds and Es

39
Q

IF child is high risk and we cant do F/S what do we do?

A

Ensure proper Fluoride varnish application

40
Q

If child is high risk and Perm molars are erupting what do we do?

A

Apply Gi as temp sealant until fully erupted and replaced with F/S resin

41
Q

How often do we F/S low risk?

A

SAME AS HIGH RISK BUT JUST PERM MOLARS ( NO REAL NEED TO DO LATERALS AND DS AND ES)

42
Q

How often do we apply fluoride varnish

A

4x year (usually 2x with child smile in nursery/school and 2x in practise - dont redo within 24 hrs - save to next visit) = HIGH RISK

LOW RISK = 2x year

43
Q

Strength of fluoride varnish?

A

22,6000ppmF

44
Q

Issues with fluoride varnish

A

Contains colophony

asthma
allergy to plasters!!

45
Q

In enhanced prevention what else do we offer to children in terms of fluoride use?

A

fluoride varnish 4x year
F/S
Fluoride mouthwash - 225ppmF at lunchtime

46
Q

How often do we take radiographs in standard risk children?

A

2 yearly

47
Q

How often do we take radiographs in high risk children?

A

6-12 months as per FGDP guidelines

48
Q

What fluoride supplements can we provide?

A

Fluoride mouthwash 225ppmF
Over 7

49
Q

What can we ensure about medication?

A

Sugar free - sugar free versions of medicines available - ensure this is requested from pharmacy

50
Q

What is recall for high risk children?

A

3 months

51
Q

What is recall for standard risk children?

A

6 months

52
Q

What is the hall technique?

A

This is a technique where the primary tooth requires no preparation - instead the aim is to seal in the carious lesion so the plaque biofilm is altered to slow down or arrest caries progression (must ensure there is clear band of dentine between the pulp and caries or else child not suitable for hall technique)

Does not require LA, tooth prep, caries removal so no risk of iatrogenic damage

53
Q

How do we do the hall technique?

A

size the crown, and then try it but dont press down or may be difficult to remove, place separators and pt leaves and returns 3-5 days later and we place SS crown (good for children less cooperative)

bond with GIC luting cement

54
Q

What are indications for a SSD?

A
  • Loss of >2 walls
  • Breakdown of marginal ridge
  • Following pulpotomy/pulpectomy
  • Severe MIH defects
55
Q

How to place SSC conventionally?

A
  1. LA
  2. Occlusal reduction
  3. Approximal reduction (section mesial and distal aspect for reduction)
  4. Crown selection by measuring MD width
  5. Isolate and dry tooth, try in crown
  6. Apply GIC to crown, seat, remove cement
  7. Check contacts and occlusion
56
Q

Sign crown has failed?

A
  • Rocking
  • Canting
  • Caries progression/new caries development
  • Crown lost
  • Periapical radiolucency
  • Abscess formation
57
Q

What is selective caries removal?

A

This is where there is an advanced lesion in primary teeth or permeant tooth with moderate lesions and we remove sufficient tooth tissue to allow a marginal seal to be obtained and inhibit further progression of caries, it allows us to minimise damage to pulp (reduces risk of pulp exposure and time taken)

58
Q

What is stepwise caries removal?

A

This is where we have a permanent tooth with extensive lesion

the aim is to avoid pulp exposure so we go in to tooth by gaining access, remove superficial caries to allow marginal seal, then restore to inhibit further progression, and aim is that tertiary dentine is deposited which protects the pulp and then 6-12 months later we re-access tooth and remove caries and restoree and have hopefully spared the pulp (reduce risk of pulp exposure)

59
Q

When may we use a non-restorative technique for caries?

A

Tooth close to exfoliation
primary tooth has advanced lesion child pre-cooperative and no other options feasible

60
Q

What must we do before GA referral?

A

Provide pain relief, prevention (enhanced), attempt tx with behaviour management techniques - ensure this has been attempted

then after exhausting this we need to refer

61
Q

What do we do before referral?

A

Pain relief - analgesia, ABX
Attempt behaviour modification
Temp dressing if able
ABX
Advise parent/child this is first visit for assessment - no promise of tx

62
Q

What do we include in GA referral?

A

My details - name, email, phone number, practise address
Pt details - name, DOB, CHI, Adress, phone number

Pts CO

Reason for referral - why? is it urgent or routine? has child had pain or swelling?

MH - allergies, medications, medical conditions

DH - prev tex, anxiety level, prev GA? prev ABX in last 6 months - type dose and freq, regular or irregular? what have we attempted so far?

SH - who is legal guardian? who consents? parental rights? nursery/school, who child lives with, any support? interpreter?

Summary of oral health status - caries, OH

Details of request - do we want advice? care plan? tx likely required (and what tx we can do locally - prevention)

Any relevant details and records - radiographs, study models, ortho correspondence

SCR BDS4 (15 decks)

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