question 33

Question 1

nursing bottle caries explain disease

Answer 1

• Maxillary incisors, 1st molars and mandibular canines worst affected. Lower incisors protected by tongue
• Rampant caries if there is ≥10 lesions per year. Lower anteriors affected

Question 2

nursing bottle caries

prevention - toothbrush

Answer 2

• Prevention
  o Toothbrushing with fluoride tooth paste
   1450ppmF, <3 smear, ≥3 pea-size
   Encourage brushing x2 daily morning and last thing at night, supervised brushing until child can brush effectively, spit don’t rinse, two minutes with correct technique
   2800ppmF only suitable for children aged 10-16

Question 3

nursing bottle caries

prevention - diet

Answer 3

• Prevention

o Dietary advice
 Limited consumption of sugary food/drink - confine to meal times to reduce acid attacks
 Drink only water or milk between meals, snack on healthy low-sugar foods - fresh fruit, veg, cheese, breadsticks
 Do not place sugary drinks, fruit juices, sweetened milk or soy formula milk in feeding bottles or pacifiers – if child has bottle at bedtime only water
 Do not eat or drink, apart from tap water after brushing at night
 Be aware of hidden sugars in foods – yoghurts, cereals, crisps
 Awareness of acidic content of drinks and keep fizzy drinks to mealtimes – a straw can help

Question 4

nursing bottle caries

prevention - what else

Answer 4

• Prevention

o Fissure sealants
 Placed in all fits and pissures of permanent molars asap after eruption
 Resin based first choice, GI may be used in pre-cooperative or partially erupted cases where moisture control is difficult
o Fluoride varnish 22,600ppmF
 All children ages 2 years and over can have F varnish applied at least twice per year, but up to 4 times
 CI’d in children hospitalised due to severe asthma or allergy in last 12 months or those allergic to sticking plasters – colophony
 Supplement with F MW after age 7

Question 5

nursing bottle caries

consent ga and concerns

Answer 5

• Explain to parent that as child is in pain and several of the teeth are unrestorable, unfortunately these teeth will need to be extracted
• Explain that a full assessment will be carried out to devise a plan as to which teeth can be saved and those that need to be removed
• Inhalation sedation useful option at 5 years and over, IV sedation useful in teenagers. Explain that as child is not suitable for sedation and is unlikely to be able to accept treatment normally, and due to the extent of caries and fact that the child is in pain, I feel that referral for extraction of these teeth under a GA is the best option
• Explain that the GA would involve the child being put to sleep for treatment. This is carried out in a hospital setting by a fully qualified anaesthetist. The procedure will take place in an operating theatre with an experienced team present
• Compared with sedation, GA is generally believed to be associated with greater risks – the most extreme of these being the fact that there is a risk that your child may not wake up from a GA, however this is less than 1:100,000