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Flashcards in Tucker Deck (32)
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How should a infant oral healthcare vist be viewed

  • foundation for a lifetime of preventative education and dental care can be built to assure optimal oral health in childhood


Early Intervention: Recommendatoins

  • Advise parents on their own oral health and transmission of cariogenic bacteria from caregiver to infant
  • Dental home
  • Provide caries prevention info
  • assess caries risk
  • provide information to parents regarding oral conditions to infants:
    • pacifiers
    • teething
    • trauma
    • growth and developement
  • Ankyloglossia ifnromaton
  • Natal and neonatal teeth 


When should the Child's First dental exam occur?

  • at the tie of reuption of first tooth or no later than 12 months


Informed consent for exam

  • Only legal guardian can give consent for an exam or tx 


Normal Behavior

  • Pre-cooperative
    • 3 y.o. or less
    • No psychosocial developement to understand the need to cooperate and interact positively
    • Self-centered/ego-centric perception
    • interact and listen to parent/caregiver exclusively
    • Expected to cry=Normal
      • upsets parents
      • try to minimize, but can't eliminate


Knee-to-Knee Exam

  • Parent sits upright in normal chair
    • face dentist
  • Parent holds the child in their lab w/child facing the parent
    • child's leg straddling parents waist
  • Dentist sits in chair with knees touchng parents knees
  • Parents and Dentists thighs form the table
  • Child lies on back with head in dentists lab
  • Dentisst supports back, controls head, and assists mouth opening if necessary
  • Parent supports child, holds and controls childs hands with their own hands, and limits leg movement with elbows


Benefits of Knee-to Knee Exam

  • allows child to remain in parents lab and their control
  • helps reduce anxiety in the child and patient
  • Establish roles before start of exam bc parents want to help verbally and physically
    • parent=silent observer


Communication with parents

  • initiate before first dental appointment
  • can be do through
    • Front desk staff
    • Pre-appointment letter/packet
  • can include health history that the parent can fill out before appointment
  • don't want to overwhelm parent with to much information


What you should communicate to parent before first appointment

  • At time of the appointment their child will be the focus of communication
    • Parents want to talk to you and this will prevent you from focusing on their child/patient
  • Explain importance of allowing Direct communication b/w the child and dentist
    • direct communication is necessary 
    • not communication when the parent repeats questions/instructions
  • Let parents know up front that you will talk to them at length after the exam
    • if they are insistent on talking before exam, have staff occupy child while you step away to talk
    • have staff available for child after appointment also so the parent can pay attention


Topics to review with parents

  • Always address their chief concern
  • oral hygiene instruction
  • feeding habits
    • especially night-time
    • limit sippy-cup/bottle use
  • Etiology of caries
  • Expectations for future
    • eruption pattern for primary teeth
    • exfoliation pattern
    • normal situations that may cause concern
  • Importance of routine recall
  • Expectations for future dental visits


Addressing chief concern

  • Parents w/no concern and know the need to establish a dental home
    • so only present to have the initial exam
  • Parents w/a concern
    • usually very anxious about any perceived problem in a child at this age
    • address with patient first
    • don't let it keep you from addressing other areas of communication that are important to first exam
  • May present w/a child w/ECC or S-ECC and they think that you are going to resolve at initial appointment
  • let the patients know what to expect for this appointment and future appointments


Oral Hygiene Instruction

  • Frequency
    • at least twice a day
  • Duration
    • 2 minutes
      • adequate
      • perception of brushing longer than actual time involved
  • Technique
    • horizontal scrub technique-most effective
    • Floss interproximal contacts if present
  • Guidance
    • parents brushing their theeth very important for children at young ages


Feeding habits

  • Sippy-cup (no-spill cups)
    • used primarily to prevent spills
    • Bad for them to constantly use and why
    • no bottles or sippy-cups at night in crib/bed
  • Once child is past nursing, only water at night if thirsty
  • If child has unlimited access to the Sippy Cup
    • should only contain water b/w meals


Caries Etiology Explanation

  • Caries formation requires 4 things
    • Time
      • brushing frequency important
    • Tooth/Host
      • biofilm formation
    • Bacteria
      • thorough cleaning
    • Fermentable carbohydrates
      • affects oral pH
  • If we can control and remove any of these, we can prevent cariest formation


Behavioral Expectations for future dental visits

  • Discuss appropriate behavior expectations for differrent age groups


Procedural expectations for future dental visits

  • Let parents know what to expect for their child
  • helps communicate that we are tailoring the care to be sensitive to their child needs
  • General indications and expectations for radiographic examination
  • integral part of gaining informed consent


Child Friendly Office Design

  • Office design will form first impression of child and parent
  • Front Desk staff will be first point of contact with most parents and patients as they enter
  • Make the child feel comfortable and "at home"
  • Reduce anxiety associated w/the visit
  • Increase the child's willingness to listen and communicate


Communication with Young Children

  • White Coat Syndrome
  • How to approach a child on first encounter
    • getting down on their level
    • physically lower yourself so not to be imposing
    • friendly demeaner
    • speak in child friendly terms/language
  • Behavior Guidance techniques:
    • Tell, Show, Do
    • Reinforcement
    • Behavior Modeling
    • Voice control


White Coat Syndrome

  • Clinically observaed elevation of BP in patients when dealing with medical or dental procedures or personnel
  • Used generally to refer to anxiety/fear that is often the cause of the elevated BP
    • especially in pediatric populations
  • Due to previous trips, children associate the white coat with pain/injections


Anticipatory Guidance

  • way of conveying information to the patient that helps them undertand what should be expect
  • age 0-3
  • categories of information required:
    • oral and dental development
    • fluorides
    • Non-nutritive habits
    • Diet and Nutrition
    • Oral Hygiene
    • Injury Prevention


Prevention of Caries

  • Easier to prevent caries than to treat after the carious lesion has developed
  • Cheaper from a family/individual and societal standpoint to prevent oral disease vs treat


Expectations for normal dental developement

  • Many 1 y.o. presents to establish dental home but have not teeth
    • important to know the average age of eruption for primary teeth
      • there are normal variations form this average
  • When to expect primary teeth to exfoliate and when to expect permanent teeth eruption
  • Common patterns of eruptions
    • permanent mandibular central incisors erupt lingual to primary mandibular central incisors and before exfoliation


Anticipatory guidance for primary dentition: Eruption and Exfoliation


Anticipatory Guidance for Permanent Dentition: Eruption and Exfoliation


Importance of Periodic Exam

  • Important in prevention of dental caries and early detection of other oral pathology
  • allows caries and pathology to be cauht earlier
  • allows for more conservative treatment
  • Tailored recall interval
    • to the needs of the patient is vital to maintaining the dental home conept
    • requires patients caries risk assessment


Cariest Risk Assessment

  • essential element of contemporary clinical care for infants, children, and adolescents
  • Framework for classifying caries risk based on a set of physical, enviromental, and general health factors


Caries Risk Assessment Tool (CAT)

  • dynamic instrument
  • will be evaluated and revised as new evidence arises 
  • is qualitative instead of quantitative


When using CAT, clinicians should:

  • be able to visualize a childs teeth and mouth
    • have access to reliable historian for nonclinical date 
  • assess all 3 components of careis risk
    • clinical conditions
    • enviromental characteristics
    • general health conditions
  • be familiar with footnotes that clarify use of individual factors
  • a child's ultimate risk classification is determined by the highest risk category where they have a risk indicator
    • changed for the current tool


Caries-risk assessment form for 0-5 year olds

  • intended for phsicians and other non-dental healthcare provider
  • different b/w current form and previous form
    • caries risk is judged based on majority of factors rather than category of highest risk


Caries-risk assessment form for >6 year olds

  • intended for dental providers
  • Evaluation of data and risk is determined by dental provider
  • intended for the majority of evidence be used, but one item can be weighed more heavilty based upon judgement