Prevention in Children

Question 1

What is the aim of preventive measures?

Answer 1

• Avoid onset/occurrence of disease
• Slow down progressive condition, so that tx not required

Question 2

When should a child’s first dental visit be?

Answer 2

Between 6-12 months of age, after 1st tooth erupts, no later than 1 year old (within 6 months of first tooth’s eruption)

Question 3

What is the recommendation for breastfeeding period?

Answer 3

0-6 months: exclusive breast feeding
6-12 months: continue along w introduction of complementary foods
- From 12 months of age, mothers who wish to continue breastfeeding should work closely with health practitioners to minimise potential risk of dental decay

Question 4

What are the recommendations for bottle-feeding?

Answer 4

• Infants should not be put to sleep with bottle containing fermentable carbs
• Start to drink from cup as they approach age 1

Question 5

What are the recommended amounts of juice children can consume?

Answer 5

<1yo: no fruit juice
1-3yo: 4 oz (<120ml)
4-6yo: 4-6 oz (120-180ml)
7-18yo: 8 oz (250ml)

Question 6

How many meals should children have a day?

Answer 6

3 main meals with 2-3 snacks, keep sugars to meal times

Question 7

Why should cups be used instead of bottles for cariogenic drinks?

Answer 7

Cups encourage quick drinking + lack pooling in mouth

Question 8

What is the amount of toothpaste that should be used for children?

Answer 8

<3y/o: smear amount of 1000ppm F
- Parents brush for child
3-6y/o: pea-sized amount of 1000ppm F
- Start teaching child how to brush themselves 5 y/o onward

Question 9

What are the recommendations for plaque control in children below 1 y/o?

Answer 9

Parents brush for child
0-6 months:
- Use gauze/finger slip toothbrush/damp washcloth to wipe alveolar ridges
- Make infant familiar with OH practices
6-8 months:
- Use nylon bristled toothbrush for teeth
- Continue use of gauze for gums

Question 10

What are some forms of fluoride (systemic and topical)?

Answer 10

Systemic
- Water fluoridation (0.45ppm in SG)
- Supplements (for high caries risk patients who drink low/non-fluoridated water)

Topical
- Home application – toothpaste/mouthwash
- Professional application – fluoride varnish

Question 11

What fluoride measures are not to be used in children <6y/o?

Answer 11

1. Fluoride mouthrinse
2. Fluoride gels

Question 12

What is the fluoride varnish that is applied professionally?

Answer 12

Duraphat: 5% NaF, 22,600ppm F

Question 13

What is the concentration of F in SDF?

Answer 13

44,800ppm F

Question 14

What is the mode of action of SDF?

Answer 14

Fluoride: remineralise tooth => strengthen tooth, prevents demin
Silver: anti-bacterial => prevent caries progression
Also reduces dentine hypersensitivity

Question 15

What are the indications for SDF?

Answer 15

• Active cavitated lesions with no pulpal involvement
• Individuals with behavioural or medical challenges
• Patients without access to dental care

Question 16

What are the contraindications for SDF?

Answer 16

• Silver allergy
• Significant desquamative gingivitis or mucositis
• Tooth with pulpal involvement

Question 17

What should be taken note of when applying SDF?

Answer 17

Max 1 drop per visit, not more than 5 teeth in a visit

Question 18

What is the purpose of SDF?

Answer 18

Not usually definitive tx, aims to halt caries progression, to restore after SDF tx

Question 19

What is the procedure for SDF application?

Answer 19

1. Cotton roll isolation
2. Dry tooth & apply solution onto carious lesion using microbrush/cotton pellet for 2-3min
3. Blot lesion w cotton pellet to remove excess
4. Evaluate 4-6 weeks later & determine if lesion arrested (will turn very black) => if no colour change, reapply
5. Treated lesions can be restored after SDF tx

Question 20

Knee to knee examination is most suitable for which age group?

Answer 20

1-3 years old

Question 21

Your patient is 2 years old and presents to you with caries on her anterior teeth. You have deemed the child is uncooperative for fillings. How often should the child visit the dentist?

Answer 21

Every 3 months

Question 22

3 year old patient presents with non-cavitated white spot lesions on anterior teeth.
- 2 older siblings have history of dental rehab under GA when they were young
- Sleeps with milk bottle containing formula milk
- Brushes twice a day with fluoridated toothpaste
What is the patient’s caries risk?

Answer 22

High

Question 23

What are the 5 aspect of preventive treatment for children?

Answer 23

1. Diet counselling
2. Plaque control
3. Fluoride
4. Fissure sealant
5. Timely recalls