SDCEP Prevention and Management of Dental Caries in Children

Question 1

What are the aims when providing dental care for children?

Answer 1

• safeguarding wellbeing of child
• prevent disease in primary/permanent dentition
• reduce risk of child experiencing pain/infection
  -reducing risk of child developing treatment related anxiety

Question 2

When should the first child dental assessment be?

Answer 2

Before the child is six months old

Question 3

If you have concerns about dental compliance or attendance of a child, who should you contact?

Answer 3

• parent in first instance
• child’s health visitor
• school nurse
• GMP
• Childsmile dental health support worker
• social worker

Question 4

What should the social history of a child include?

Answer 4

• which adults provide care for the child
• which days/times are easiest for the parent/carer to bring child
• name of medical practise they attend
• name of school/nursery attended

Question 5

How can you help the younger child with an examination?

Answer 5

child sits on parents knee facing them & leans back onto dentists lap

Question 6

What makes proximal caries detection in primary teeth difficult?

Answer 6

broad contact points of primary. dentition

Question 7

What is the radiograph interval for children with high caries risk?

Answer 7

6-12 months

Question 8

What is the radiograph interval for children with low caries risk?

Answer 8

2 years

Question 9

What approach can you take if a child is very anxious/hesitant to get dental bitewings?

Answer 9

systemic desensitisation

Question 10

What is MIH?

Answer 10

hypomineralisation of systemic origin of 1-4 permanent first molars, frequently associated with affected incisors

Question 11

What does a plaque score of 10/10 indicate?

Answer 11

perfectly clean tooth

Question 12

What does a plaque score of 8/10 indicate?

Answer 12

plaque line around cervical margin

Question 13

What does a plaque score of 6/10 indicate?

Answer 13

plaque covering cervical third of crown

Question 14

What does a plaque score of 4/10 indicate?

Answer 14

plaque covering middle third of crown

Question 15

What factors are known to be associated with development of caries? (make up the caries risk assessment)

Answer 15

• clinical evidence of previous disease
• dietary habits (sugar)
• socioeconomic factors
• use of fluoride
• plaque control
• saliva
• medical history

Question 16

What SIMD scores are indicative of disadvantage?

Answer 16

SIMD 1-3

Question 17

Which children are more likely to have dental anxiety?

Answer 17

• children with high caries
• children with parents who have dental anxiety

Question 18

What can be used to assess a childs dental anxiety level?

Answer 18

MCDASf

Question 19

At what age can MCDAS be used?

Answer 19

8 years and older

Question 20

What is the aim of behavioural management?

Answer 20

to promote a positive attitude to dental care & facilitate ongoing prevention and care

Question 21

List some different behavioural management strategies to manage paediatric patients:

Answer 21

• Enhancing control
• Tell, show, do
• Behaviour shaping & positive reinforcement
• Structured time
• Distraction
• Relaxation
• Systemic desensitisation

Question 22

What is the motivational interviewing approach?

Answer 22

SOARS
- seek permission
- open questions
- affirmations
- reflective listening
- summarising

Question 23

How can you encourage toothbrushing habit formation?

Answer 23

• identify a convenient time and place for the preventive behaviour to occur eg after breakfast
• identify triggers eg putting on pyjamas
• review progress at followup appts

Question 24

What evidence backs up toothbrushing with fluoride?

Answer 24

SIGN guideline 138

Question 25

When do you use a smear of toothpaste?

Answer 25

under 3y/o

Question 26

When do you use a pea-sized amount of toothpaste?

Answer 26

3 years & over

Question 27

What toothpaste fluoride concentration should be used for standard prevention?

Answer 27

1000-1500ppmF

Question 28

What toothpaste fluoride concentration should be used for enhanced prevention?

Answer 28

Under 10 = 1350-1500ppmF Over 10 = 2800ppmF

Question 29

How does enhanced prevention for children at increased caries risk differ from standard prevention?

Answer 29

- Provide standard toothbrushing prevention at EACH VISIT - Hands on brushing instruction (3mins) AT EACH VISIT - Consider use of high fluoridated toothpaste -

Question 30

In which children do we place fissure sealants?

Answer 30

ALL children (first permanent molars) as early as possible

Question 31

At what age can you begin to place fluoride varnish?

Answer 31

2 years and over

Question 32

What factors influence the optimal outcome of extraction of first permanent molars?

Answer 32

- Calcification of the bifurcation of the 7 - Presence of all second premolars and third molars - Mild buccal segment crowding is present - Class I incisor relationship

Question 33

What non-caries removal technique can you use to manage proximal surface caries?

Answer 33

SEAL IT IN USING RESIN - separate the teeth - isolate the teeth with dam - etch surface of tooth & rinse well - apply resin sealant to the tooth surface to be sealed - check no excess pooling around gingiva - light cure and floss contact area

Question 34

What is ART?

Answer 34

Atraumatic Restorative Technique

Question 35

What caries treatment techniques are discussed in SDCEP paediatric document?

Answer 35

- site-specific prevention - no caries removal & seal with fissure sealant/infiltration - selective caries removal & restoration - stepwise caries removal & restoration - complete caries removal and restoration - extraction

Question 36

In which scenarios would you perform site-specific prevention?

Answer 36

- Initial proximal caries - Initial anterior caries

Question 37

In which scenarios would you perform no caries removal with fissure sealant/infiltration?

Answer 37

- Initial occlusal caries - Initial proximal caries

Question 38

In which scenarios would you perform selective caries removal and restoration?

Answer 38

- Moderate occlusal caries - Moderate proximal caries

Question 39

In which scenarios would you perform stepwise caries removal and restoration?

Answer 39

- Extensive occlusal caries - Extensive proximal caries

Question 40

In which scenarios would you perform complete caries removal & restoration?

Answer 40

- Moderate occlusal caries - Moderate proximal caries - Advanced anterior caries

Question 41

When is site-specific prevention suitable?

Answer 41

- primary tooth with an initial lesion in occlusal/proximal surface - primary anterior tooth with initial lesion - primary tooth with arrested caries or when tooth close to exfoliation - permanent tooth with initial lesion at proximal surface - permanent anterior tooth with an initial lesion

Question 42

What is the aim of site-specific prevention?

Answer 42

To stop enamel caries progressing and promote remineralisation of early lesions

Question 43

What is involved in site-specific prevention?

Answer 43

- Show parent/carer & child the carious lesion - Demonstrate effective brushing of the lesion - Give dietary advice - Apply fluoride varnish 4x a year - Keep a record of the site and monitor it for plaque biofilm build up/progression - If after 3 months active lesions are not arrested/showing signs or inactive lesions have become active consider alternative strategy

Question 44

When deciding not to remove caries & seal them in, what can you use to seal?

Answer 44

- PMC (hall technique) - BIS-GMA resin - GIC

Question 45

What is the aim of selective caries removal & restoration?

Answer 45

Remove sufficient carious tooth tissue to enable an effective marginal seal to be obtained with a bonded adhesive restorative material, inhibiting further progression of residual caries while minimising pulpal damage

Question 46

What is involved in stepwise caries removal & restoration?

Answer 46

- Gain access & remove superficial caries - Place a temporary bonded adhesive restoration - This inhibits further progression of residual caries whilst allowed reactionary dentine to be laid down - Stage 2 carries our 6-12 months later - Access cavity and remove caries and final restoration - Pulp will be further away from caries now

Question 47

What LA techniques are useful in children?

Answer 47

- Intra-papillary injection ("chasing anaesthesia") - The Wand

Question 48

What different dental services are available for children?

Answer 48

- GDPs - PDS or Community Dental Service - Hospital Dental Service

Question 49

What children benefit from PDS?

Answer 49

- Pre-cooperative children - Children with additional needs - Children requiring sedation

Question 50

What is the risk of death from GA for healthy children?

Answer 50

<1:100,000

Question 51

What information should be included in a paediatric referral letter for dental care?

Answer 51

- Your details - Pt details - Pt C/O - Clinicians concerns - MH + DH + SH - Summary of OH - Details of request (eg advice only, care plan, tx) - Enclosures such as radiographs/study models/photographs

Question 52

What guidelines can you refer to for safeguarding/child protection?

Answer 52

- GDC standards for the dental team - Child Protection Guidance for Health Professionals (from Scottish Gov) - GIRFEC

Question 53

What are the five key GIRFEC questions that practitioners need to ask?

Answer 53

- What is getting in the way of this child's wellbeing? - Do I have everything I need to help this child or young person? - What can I do now to help this child or young person? - What can my agency/profession do to help this child or young person? - What additional help, if any, may be needed from others?