Prevention and Management of dental caries in children

Question 1

What does GIRFEC stand for?

Answer 1

Getting it right for every child.

Question 2

When should an assessment for a child first be carried out?

Answer 2

Before the child is 6 months old in order that parent/carers can be encouraged to adopt optimum caries preventative practices early.

Question 3

What is the definition of dental neglect for a child?

Answer 3

“The persistent failure to meet a childs basic oral health needs, likely to result in the serious impairment of a child’s oral or general health or development.”

Question 4

What would you see clinically if only the enamel is affected by caries?

Answer 4

The lesion will be matt, opaque, chalky white.

Question 5

What is a bitewing radiograph radiation dose equivalent to?

Answer 5

A few days worth of background radiation.

Question 6

How often should you take bitewings for children at increased risk of developing caries?

Answer 6

6-12 months.

Question 7

How often should you take bitewings for children at moderate/low risk of developing caries?

Answer 7

2 years.

Question 8

What is MIH?

Answer 8

Hypomineralisation of system origin of 1-4 permanent first molars, frequently associated with affected incisors. Second primary molars can similarly be affected.

Question 9

What factors are to be taken into consideration when determining whether teeth affected are of poor prognosis?

Answer 9

1. Enamel colour in order of severity and increasing likelihood of breakdown: white/cream, then yellow, then brown.
2. Location of the defects in order of severity: smooth surface, then occlusal surface/incisal edge, then cuspal involvement.
3. sensitivity to brushing or temperature
4. atypically shaped restorations.
5. any patient reported symptoms

Question 10

What are 7 risk factors known to be associated with development of caries?

Answer 10

• clinical evidence of previous disease
• dietary habits, especially frequency of sugary food and drink consumption.
• social history, especially socio-economic status
• use of fluoride
• plaque control
• saliva
• medical history

Question 11

What does MCDAS stand for?

Answer 11

Modified Child Dental Anxiety Scale

Question 12

Name 8 behavioural management strategies that you can use with anxious children/ patients.

Answer 12

1. Communication (non-verbal and verbal)
2. Enhancing control
3. Tell, show, do
4. Behaviour shaping and positive reinforcement
5. Structured time
6. Distraction
7. Relaxation
8. Systemic desensitisation

Question 13

It is imperative that ALL children receive caries prevention and appropriate behaviour management. True or false?

Answer 13

True

Question 14

What is the first priority when planning care/treatment for a child?

Answer 14

To keep the permanent molars free from caries, as these teeth are more likely to experience decay than other permanent teeth in a childs dentition.

Question 15

What is the second priority when planning care/treatment for a child?

Answer 15

Reduce the risk of any caries in the primary dentition resulting in pain or infection before the tooth exfoliates.

Question 16

What are the symptoms of reversible pulpitis?

Answer 16

Pain is provoked by a stimulus e.g cold/sweet and relieved when it is removed. The pain is intermittent, difficult for the child to localise and does not tend to affect the childs sleep. The pulp is still vital and the tooth is not tender to percussion. Management of the carious lesion alone may be enough to resolve inflammation, and allow pulpal healing.

Question 17

What are the symptoms of irreversible pulpitis?

Answer 17

Pain can occur spontaneously but if provoked by a stimulus is typically not relieved when stimulus is removed. The pain may last for several hours, may be difficult for the child to localise and may keep the child awake at night. The pain may be dull, throbbing, worse by heat and relieved by cold. No obvious sign and symptoms of infection such as TTP or PAP.

Question 18

What are the symptoms of a dental abscess?

Answer 18

Acute pain, likely to be spontaneous, will keep the child awake at night and can easily be located by the child. The tooth may show increased mobility and may be TTP. There may be clinical evidence of a sinus, abscess or swelling of radiographic evidence of PAP. When chronic the child may not report pain but other symptoms may be present.

Question 19

When should antibiotics only be prescribed?

Answer 19

If there is evidence of spreading infection (swelling, cellulitis, lymph node involvement) or systemic involvement (fever, malaise).

Question 20

Based on a review of the literature, SIGN guideline, recommended that oral health promotion strategies should:
A) Facilitate daily toothbrushing with fluoride toothpaste
B) Be based on recognised oral health behaviour theory and models such as motivational interviewing
C) Be specific to individuals, and be tailored to their particular needs.
D) All of the above.

Answer 20

D - all of the above.

Question 21

Current guidelines suggest a 5 stage approach to health behaviour change using motivational interviewing. What are the 5 steps?

Answer 21

1. Explore current practice and attitudes using a motivational interview approach (e.g SOARS).
2. Educational intervention (improve knowledge and skills).
3. Action Planning (set time, date and place to start).
4. Encourage habit formation (achieve sufficient repetition).
5. Repeat at each recall visit.

Question 22

What does SOARS stand for?

Answer 22

S - Seek permission
O - Open questions
A - Affirmations
R - Reflective listening
S - Summarising

Question 23

What is the amount and strength of fluoride toothpaste recommended for children under 3 years with standard risk of caries?

Answer 23

A smear and 1000-1500ppm.

Question 24

What is the amount and strength of fluoride toothpaste recommended for children under 3 years with increased risk of caries?

Answer 24

A smear and 1350- 1500ppm or for ages 10 and over consider 2800ppm.

Question 25

What is the amount and strength of fluoride toothpaste recommended for children over 3 years with standard risk of caries?

Answer 25

A pea sized amount and 1000-1500ppm.

Question 26

What is the amount and strength of fluoride toothpaste recommended for children over 3 years with increased risk of caries?

Answer 26

A pea sized amount and use 1350-1500ppm or for ages 10 and over consider 2800ppm.

Question 27

Describe standard prevention for toothbrushing for children that you must carry out at least once per year.

Answer 27

• Advise to brush thoroughly twice daily, including last thing at night.
• Advise to use the age appropriate amount of toothpaste.
• Advise to “spit dont rinse”
• Supervise children until they can brush their teeth effectively.
• Demonstrate brushing on the child
• Use action planning to encourage toothbrushing
• Advise parent/carer to start brushing at soon as first tooth erupts.
• Do not allow child to eat/lick toothpaste.

Question 28

Describe enhanced prevention for toothbrushing for children that you must carry out at each recall visit.

Answer 28

• Give hands on brushing instruction to the child and parent at each recall visit
• Utilise any community/home support for toothbrushing e.g health visitor or school nurse
• Consider increasing fluoride in toothpaste (1350-1500ppm under 10 and 2800ppm over 10).

Question 29

Describe standard prevention for diet in children that you must carry out at least once per year.

Answer 29

• Limit consumption of food and drinks containing sugar
• Drink only water or milk in between meals
• Snack on healthier foods, which are low in sugar
• Do not place sugary drinks, fruit juices sweetened milk or soy formula milk in feeding bottles
• Be aware of hidden sugars in food
• Be aware of acid content of drinks and restrict carbonated drinks to meal times

Question 30

Described enhanced prevention for diet in children that you must carry out at every recall visit.

Answer 30

• May require more in depth support to change dietary habits such as motivational interviewing
• A diet diary
• Utilise any home/community support that would encourage any dietary change. E.g health visitor

Question 31

Describe standard prevention for fissure sealants in children that you must carry out at every recall visit.

Answer 31

• Place sealants in all pits and fissures as soon as possible after first eruption. Resin based material is first choice otherwise use GI for uncoopertive children.
• Check sealants for wear/integrity.
• Top up worn or damaged sealants.

Question 32

Describe enhanced prevention for fissure sealants in children that you must carry out at every recall visit.

Answer 32

• Provide all of standard prevention as normal
• If unable to provide fissure sealants ensure fluoride varnish is applied.
• Consider using glass ionomer as temporary sealant on partially erupted first and second permanent molars until fully erupted.
• Fissure seal palatal pits on upper lateral permanent incisors, and the occlusal and palatal surfaces of Ds and Es, first and second permanent molars if beneficial.

Question 33

Describe standard prevention for topical fluoride in children that you must carry out at every recall visit.

Answer 33

• Apply sodium fluoride varnish (5%) twice a year to children aged 2 and over. It is acceptable to have fluoride varnish applied 4 times per year.

Question 34

Describe enhanced prevention for topical fluoride in children that you must carry out at every recall visit.

Answer 34

• Ensure that sodium fluoride varnish is applied 4 times per year to children ages 2 and older.
• If recommending use of an alcohol-free sodium fluoride mouthwash for children from 7 years of age in addition to fluoride varnish application, advise this should be used at different time than toothbrushing

Question 35

What contra-indications are there for use of fluoride varnish?

Answer 35

Fluoride varnish contains colophony therefore a child who has been hospitalised due to severe asthma or allergy in the last 12 months or who is allergic to elasterplast.

Question 36

How much fluoride is in Duraphat?

Answer 36

22,600ppm.

Question 37

What post op advice would you give to a patient after applying fluoride varnish?

Answer 37

Don’t eat or drink anything for 30 minutes and should wait at least 4 hours before brushing or chewing hard foods.