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4 - misc > weans who canny brush their teeth > Flashcards

weans who canny brush their teeth Flashcards

1
Q

What is standard prevention for fissure sealants?

A

All pits and fissures of permanent molars as soon as possible after eruption
Check existing sealants for wear/integrity at every recall visit
Top up worn or damaged sealants

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2
Q

What is enhanced prevention for fissure sealants?

A

If unable to due pre-cooperative, then ensure fluoride varnish application is optimal and attempt again as cooperation improves
Consider GI as temp sealant on PE first and second permanent molars until tooth is fully erupted
Seal palatal pits on upper 2s, and occlusal and palatal surfaces of Ds, Es, FPM and SPM if likely to be beneficial

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3
Q

What materials can be used for fissure sealants?

A

Bis-GMA resin - first option
Glass ionomer

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4
Q

When should GI be used for fissure sealants?

A

If child is pre-cooperative
When concerns about moisture control
If tooth PE

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5
Q

What is standard prevention for fluoride varnish?

A

Apply sodium fluoride varnish (5%) 2x a year to children 2 years and over
Acceptable up to 4 times a year - 2 from Childsmile, 2 from dentist
If varnish applied within 24 hours, leave application until next visit

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6
Q

What is enhanced prevention for fluoride varnish?

A

Ensure sodium fluoride varnish applied 4 times per year to children 2 and up
Use of alcohol-free sodium fluoride mouthwash for children 7 and up at a different time from toothbrushing
Ensure optimal placement when fissure sealants not possible

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7
Q

What volume of fluoride varnish should be used?

A

Primary dentition - 0.25ml
Mixed dentition - 0.4ml
Permanent dentition - 0.75ml

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8
Q

What is the fluoride concentration of fluoride varnish?

A

22,600ppm

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9
Q

What is involved in caries risk assessment?

A

Clinical evidence
Diet
Social history
Fluoride use
Plaque control
Saliva
Medical history

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10
Q

List 5 behaviour management techniques

A

Communication
Enhancing control
Tell, show, do
Behaviour shaping and positive reinforcement
Distraction
Relaxation

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11
Q

What are the steps of motivational interviewing?

A

Seek permission
Open questions
Affirmations
Reflective listening
Summarising

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12
Q

What sized toothpaste should be used based on age?

A

under 3 - use a smear
3 and over - use a pea-sized amount

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13
Q

What is standard prevention toothpaste fluoride concentration?

A

1,000-1,500 ppm fluoride

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14
Q

What is enhanced prevention toothpaste fluoride concentration?

A

1,350-1,500ppm fluoride
If age 10+ consider 2,800ppm fluoride

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15
Q

What standard prevention advice should be given at least once a year?

A

Brush thoroughly twice a day, including last thing at night
Use age-appropriate amount of toothpaste 1,000-1,500ppm F
Spit, don’t rinse
Supervise until children can brush their teeth effectively

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16
Q

What enhanced prevention advice should be given?

A

Hands-on brushing instruction at each recall visit
Recommend 1,350-1,500ppm F up to age 10
Prescribe 2,800ppm for age 10-16 for a limited period

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17
Q

What is standard prevention diet advice?

A

Limit consumption of food and drinks containing sugar - confine to meal times
Drink only water or milk between meals
Snack on foods low in sugar eg - fresh fruit, carrot, oatcakes
Don’t place sugary drinks, fruit juices, sweetened milk or soy formula milk in feeding bottles or pacifiers
Do not eat or drink apart from tap water after brushing at night
Be aware of hidden sugars in foods
Be aware of acid content of drinks and restrict carbonated drinks to meal times

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18
Q

How is advanced caries not into pulp in primary teeth treated?

A

If only occlusal - selective caries removal and restore with composite, RMGIC or GIC - first choice of tx
Is child pre-cooperative then seal with Hall technique
If proximal lesion also present, seal with Hall technique

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19
Q

How is initial occlusal and proximal caries treated in primary teeth?

A

Occlusal - fissure seal and site specific prevention
Proximal - site specific prevention

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20
Q

How is advanced proximal caries in primary teeth treated?

A

Without removing caries, seal with hall technique
Alternatively - selective caries removal and restore with composite, RMGIC or GIC

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21
Q

How is advanced caries in anterior primary teeth treated?

A

Selective caries removal and restore with composite, RMGIC or GIC
Or complete caries removal and restore

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22
Q

How is reversible pulpitis treated in primary teeth?

A

Hall technique
If occlusal lesion - selective caries removal, avoiding the pulp
If diagnosis uncertain - temp dressing placed in cavity for 3-7 days and review symptoms

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23
Q

How is irreversible pulpitis treated in primary teeth?

A

Remove gross debris and apply corticosteroid antibiotic paste under a temp dressing
If cooperation permits, open pulp chamber and apply corticosteroid paste directly to pulp then place a dressing
Prescribe pain relief then carry out pulpotomy or XLA at later date
Alternatively if cooperation allows - pulpotomy or XLA

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24
Q

How should dental abscess/periapical periodontitis be treated in primary teeth?

A

Aim to remove source of infection and avoid or relieve pain
If child cooperative - XLA even if asymptomatic
In exceptional circumstances if tooth is restorable - consider pulpectomy which may require referral
If uncooperative refer to specialist

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25
Q

What are the indications for the Hall technique?

A

Carious primary teeth
Reversible pulpitis or if asymptomatic
Clear band of dentine between carious lesion and pulp on radiograph
Newly erupted FPM with severe MIH

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26
Q

What are the contraindications for the Hall technique?

A

Caries into the pulp
Irreversible pulpitis or apical periodontitis
Unrestorable teeth
Pre-cooperative and airway cannot be protected

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27
Q

What is the fluoride concentration of SDF?

A

44,800ppm fluoride

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28
Q

What are the advantages of SDF?

A

Quick
Painless
Non-invasive
Affordable
Helps prevent recurrent caries
Arrests caried
Silver is antibacterial
Fluoride remineralises enamel and dentine

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29
Q

What are the disadvantages of SDF?

A

Aesthetic - permanent blackening of the treated teeth
Temporarily stain soft tissues - days/weeks
If it contains ammonia, this can cause burns and has a bad taste - need to place toothpaste on top

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30
Q

How much fluoride do children need to swallow to risk fluorosis?

A

0.1mg F/kg body weight
1mg per day for a 1 year old
2mg per day for a 5-6 year old
There is no lower limit for fluorosis

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31
Q

What is the concentration of fluoride mouthwash?

A

225ppm
0.05%

32
Q

List the minor failures of Hall crowns?

A

Secondary caries
Crown worn, lost or needs other intervention
Crown lost but tooth restorable
Reversible pulpitis

33
Q

List the major failures of Hall crowns

A

Irreversible pulpitis
Apical periodontitis
Periapical radiolucency
Abscess
Crown lost and tooth unrestorable

34
Q

What is the sequence of eruption for primary teeth?

A

A, B, D, C, E
Lowers before uppers with exception of Bs
Teeth usually erupt within 3 months of their contralateral tooth

35
Q

When do As erupt?

A

4-6 months

36
Q

When do Bs erupt?

A

7-16 months

37
Q

When do Ds erupt?

A

13-19 months

38
Q

When do Cs erupt?

A

16-22 months

39
Q

When do Es erupt?

A

15-33 months

40
Q

How long does root development take?

A

1.5 years in primary teeth
3 years in permanent teeth

41
Q

What is the lowest amount of fluoride that needs to be ingested to result in toxicity and what does the amount depend on?

A

5mg/kg body weight
Depends on the weight of the child and the strength of the toothpaste

42
Q

How is fluoride overdose managed if <5mg/kg has been ingested?

A

Give calcium orally (milk) and observe for a few hours

43
Q

How is fluoride overdose managed if 5-15mg/kg fluoride has been ingested?

A

Give calcium orally (milk, calcium gluconate, calcium lactate) and admit to hospital

44
Q

How is fluoride overdose managed if >15mg/kg has been ingested?

A

Admit to hospital immediately, cardiac monitoring and life support
IV calcium gluconate

45
Q

What are the different levels of cooperation?

A

Pre cooperative
Children who lack cooperative ability
Potentially cooperative
Cooperative

46
Q

What is systematic desensitisation?

A

Planned behavioural management technique
Identify fear and phobia and try to overcome it
Don’t progress until child is calm at whatever the first stage it

47
Q

When should you refer a child for GA?

A

If in pain and pre-cooperative or lacks cooperation
If risks of GA are justified by the benefits

48
Q

What can be done while waiting for a GA?

A

Sugar free liquid antibiotics and analgesia
Give worsening advice
SDF

49
Q

What drug is used for ABs in children and when should it be used?

A

Phentoxymethylpenicillin
Systemic infection (lethargy and not eating)
Swollen face

50
Q

What syndromes are associated with missing teeth?

A

Down’s syndrome
Cleidocranial dysplasia
Ectodermal dysplasia

51
Q

What is dens envaginatus?

A

Talon cusp sticking out of tooth - causes issues with caries and aesthetics

52
Q

What is dens invaginatus?

A

Tooth within a tooth - tooth inside has its own root canal system
Dens in dente

53
Q

What is child abuse and neglect?

A

Anything which those entrusted with the care of children do, or fail to do which damages their prospects of safe and healthy development into adulthood

54
Q

What must be present for child abuse?

A

Significant harm to child
Carter has some responsibility for that harm
Significant connection between carer’s responsibility for child and harm to child

55
Q

What is GIRFEC?

A

Getting it right for every child
Guidance for child protection
2022 policy statement

56
Q

What does SHANARRI stand for?

A

Safe
Healthy
Achieving
Nurtured
Active
Respected
Responsible
Included

57
Q

What are the 3 parental concerns in child abuse?

A

Domestic violence
Drug and alcohol abuse
Mental health problems

58
Q

List 4 needs of children

A

Nutrition
Warmth, clothing and shelter
Hygiene and healthcare
Stimulation and education

59
Q

List 4 effects of general neglect

A

Failure to thrive
Inappropriate clothing - cold, sunburn
Ingrained dirt in nails, dental caries
Developmental delay

60
Q

What are the categories of abuse?

A

Physical
Emotional
Neglect
Sexual
Non-organic failure to thrive

61
Q

What is dental neglect?

A

Wilful failure of parent or guardian to seek and follow through with treatment necessary to ensure a level of oral health essential for adequate function and freedom from pain and infection

62
Q

What are the consequences of severe dental disease?

A

Toothache
Disturbed sleep
Difficulty eating/changes in food preferences
Absence from school

63
Q

What may dental disease put a child at risk of?

A

Teasing due to poor dental appearance
Repeated antibiotics
Repeated GA XLAs
Severe infection

64
Q

What are the signs of dental neglect?

A

Irregular attendance
Repeated failed appointments
Repeated late cancellations
Failure to complete tx
Returning in pain at repeated intervals
Repeated GA for dental XLAs

65
Q

What is the first stage of managing dental neglect?

A

Preventive dental team management
Raise concerns with parents, offer support, set targets, keep records and monitor progress

66
Q

What is the second stage of managing dental neglect?

A

Preventive multi-agency management
Liaise with other professionals - health visitor, school nurse, GMP, social worker to see if concerns are shared
See if child is subject to a CAF (common assessment framework)
Check if child is subject to a child protection plan
Letter to HV of children <5 who fail to respond to letter frmo dental practice

67
Q

What is stage 3 of managing dental neglect?

A

Follow local guidelines
Referral to social services - telephone and follow up in writing

68
Q

What is in the index of suspicion of physical abuse?

A

Delay in seeking help
Vague history, lacking in detail, vary with each telling
Account not compatible with injury
Parents mood abnormal
Childs appearance and interaction with parents abnormal
Child may say something contradictory
History of violence within the family
History of previous trauma

69
Q

What is expected of the dental team for neglect and abuse?

A

Observe
Record
Communicate
Not expected to diagnose

70
Q

What percentage carbamide peroxide is used for bleach and what does it break down to give?

A

10%
Breaks down to 3% hydrogen peroxide and 7% urea

71
Q

What is used to irrigaste for a pulpotomy and why?

A

Saline for both primary and permanent tooth because there is a vital pulp

72
Q

What is apexification?

A

Treatment to encourage root closure in a necrotic pulp
MTA used in immature teeth - send to specialist for MTA

73
Q

Why is vitapex used in primary root canals?

A

CaOH can cause early exfoliation of the tooth

74
Q

What questions about birth should be asked in MIH?

A

Was there an illness in last trimester of pregnancy
Was there a child illness in first 2 years of life
Was there an assisted delivery

75
Q

What is the aim of resin infiltration?

A

Alter the refractive index to make it closer to sound enamel

4 - misc (10 decks)

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