Paedodontics: Treating Children in Primary Care

Question 1

What is the first point of contact for NHS dental care?

Answer 1

General Dental Service (GDS)

Question 2

Who can get free dental care in Scotland?

Answer 2

< age of 26

Question 3

How much does plastic restoration of a primary tooth cost?

Answer 3

£10.15

Question 4

How much does a preformed metal crown cost?

Answer 4

£26.60

Question 5

What are the roles of the GDP for children? [contractually]

Answer 5

• Capitation = check ups, scaling, prevention
• Childsmile = food & drink advice, fluoride varnish
• Emergency dental care
• Management of dental caries
• Molar incisor hypomineralisation management
• Simple ortho treatment

Question 6

What symptoms associated with molar incisor hypomineralisation may require management?

Answer 6

• hypersensitivity
• crumbling back teeth
• aesthetic concerns regarding incisors

Question 7

What management options are available for symptomatic molar incisor hypomineralisation?

Answer 7

• seal
• restore with plastic restoration
• PMC
• extraction and timing of this
• aesthetic management of incisors

Question 8

What simple orthodontic treatment may GDPs be required to carry out in children?

Answer 8

• removable appliances
• fixed appliances

Question 9

What factors are involved in caries development?

Answer 9

• personal factors = eg poverty, toothbrush habits
• oral environment factors = eg saliva
• time, tooth, bacteria, dietary carbohydrate

Question 10

What should be looked at when deciding a child’s caries risk assessment?

Answer 10

1. clinical evidence of previous disease
2. dietary habits
3. oral hygiene habits
4. exposure to fluoride
5. social history / socioeconomic status
6. saliva
7. medical history

Question 11

What can affect the makeup of saliva, leading to increased caries risk?

Answer 11

• diabetes [high blood sugar levels]
• asthma inhaler users [beta 2 agonists & corticosteroids]
• anticonvulsants
• antihistamines

Question 12

What are the 3 key elements of prevention in paediatric primary dental care?

Answer 12

• caries risk assessment
• behaviour modification
• tooth protection

Question 13

Behaviour modification is the 2nd element of prevention, what does it consist of?

Answer 13

• attendance patterns
• tooth brushing habits
• use of home fluoride
• drinking and dietary habits
• acclimitisation

Question 14

Give an example of a behaviour modifcation technique:

Answer 14

Motivation interviewing

Question 15

Tooth protection plays a role in paediatric prevention, what may be involved?

Answer 15

• application of 5% sodium fluoride varnish
• placement of fissure sealants
• prescription of 2800ppmF toothpaste
• SDF

Question 16

What is the fluoride content of SDF?

Answer 16

44800ppmF

Question 17

How does SDF work?

Answer 17

Synergistic effects
- occludes dentinal tubules
- silver is antibacterial
- fluoride encourages remineralisation

Question 18

Discuss the advantages of using SDF:

Answer 18

• safe
• simple easy quick
• non AGP
• non invasive
• evidence based

Question 19

Discuss the disadvantages of using SDF:

Answer 19

• stains caries black
• can cause temp tattoo
• relatively expensive
• metallic taste

Question 20

Why is caries progression faster in primary molars?

Answer 20

• wider contact points [more food trapping]
• larger pulps close to occlusal surface therefor faster spread

Question 21

From what age should dental bitewings be taken?

Answer 21

consider BWs from age 4

Question 22

What are examples of non invasive caries interventions?

Answer 22

• biofilm control
• remineralisation
• dietary control

Question 23

What are examples of micro-invasive caries interventions?

Answer 23

• sealing
• resin infiltrations

Question 24

What are examples of minimally invasive caries interventions?

Answer 24

ART [atraumatic restorative treatment]
- cleaning out decay using hand instruments

Question 25

What are examples of important variables that affect caries intervention in children?

Answer 25

• caries risk
• age of child & ability to cope
• length of time until tooth exfoliates vs survival rates
• choice of material

Question 26

Why might a child be referred to PDS?

Answer 26

• anxiety & phobia
• GA extractions
• sedation
• special needs
• vulnerable groups

Question 27

Why might a child be referred to HDS?

Answer 27

• management of severe caries
• medical conditions
• trauma
• dental defects
• multidisciplinary care

Question 28

What non dental services may you occasionally have to refer child patients to?

Answer 28

• child protection
• social services

Question 29

What is the most common type of sedation used in child patients?

Answer 29

Inhalation sedation

Question 30

What are some indications for use of conscious sedation in paediatric patients?

Answer 30

• child is anxious but co-operative
• treatment is straight forward
• treatment is not likely to damage childs attitude to treatment in future

Question 31

What are some contra-indications for use of conscious sedation in paediatric patients?

Answer 31

• severe dental anxiety where child cannot cooperate at all
• treatment required too extensive or complex
• child too young to understand how to use IS
• child cannot breathe through their nose

Question 32

What considerations decide if a child requires conscious sedation or GA?

Answer 32

• cooperation of child
• degree of anxiety
• degree of surgical trauma anticipated
• complexity of operative procedure
• medical status of child

Question 33

What are some negative impacts on paediatric dentistry of the COVID-19 pandemic?

Answer 33

• longer waiting times for GA
• smaller number of pts on GA list