Assessing the Child and Family Flashcards

1
Q

What are the key recommendations for Prevention of Dental caries in Children?

A
  • Provide all children with personalised oral health promotion advice
  • Encourage and support children to brush teeth or brushed for them at least twice a day with fluoride toothpaste
  • Advise children and parent/carer about how healthy diet can help prevent caries
  • For all children place fissure sealants on permanent molars as early as poss after eruption
  • For all children aged 2 and over apply sodium fluoride varnish at least twice a year
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2
Q

What are the aims when providing dental care for children?

A
  • Prevent disease in primary and permanent dentition
  • Reduce risk of child experiencing pain or infection or acquiring treatment induced dental anxiety if dental caries occurs
  • For child to grow up feeling positive about oral health and with skills and motivation to maintain it
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3
Q

What are the priorities of the dental team to achieve these aims?

A
  • Involve child and parent/carer in decisions about childs oral health
  • encourage parent to take responsibility for childs oral health and give advice for at home
  • Obtain valid consent
  • Relieve pain or infection if present
  • Apply preventative measures in relation to childs risk of developing caries
  • Focus on prevention of caries in permanent before management of caries in primary
  • If caries in permament then diagnose early and manage properly
  • Manage caries with technique that maximises tooth exfoliation without pain or infection and minimses risk of dental induced anxiety
  • Identify as early as poss if concern about parent/carers ability to comply with dental health preventative advice and contact other professionals like GP, Childsmile etc.
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4
Q

What are the stages in assessment and planning of a child?

A
  • Assessing the child and family
  • Provide additional support if needed
  • Defining needs and developing personal care plan
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5
Q

What are the main components when providing care for a child?

A
  • If child is in pain then manage pain
  • Caries prevention
  • If caries present then manage caries
  • Recall
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6
Q

When should the first assessment be carried out of the child?

A
  • Before 6 months old to determine if parent/carer can be encouraged to adopt optimum caries preventative practices
  • Reviewed regularly as circumstances change
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7
Q

What does a comprehensive assessment include?

A
  • Parent/Carer motivation and responsibility
  • Patient history
  • Clinical examination
  • Caries risk assessment
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8
Q

Why is gaining a rapport with the child and Parent/carer important?

A
  • May be feeling stressed, apprehensive or guilty
  • All members of team are important
  • Essential for participation of the child’s oral health
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9
Q

How to gain rapport with child and parent/carer?

A
  • Clinician or dental nurse take primary responsibility to welcome child or family to avoid confusion
  • Welcome child as they enter surgery
  • Make eye contact and greet by name and introduce self
  • Gain rapport with parent/carer and discuss how they can support and encourage child in surgery
  • Involve child as much as poss in all conversations and avoid talking over them
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10
Q

What factors contribute to difficulty in establishing healthy behaviours?

A
  • Education, Family health or social issues e.g. deprivation
  • Individuals with differing life priorities
  • Complex child care arrangements
  • Children/families with intellectual, medical, mental health, physical or other disabilities
  • Parent/carer lack knowledge or motivation regarding prevention of dental disease
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11
Q

How to take a history for a child?

A
  • Confirm reason for attendance and begin to asses oral health expectations and motivation of child and parent/carer
  • Take full medical and dental history and ensure this is kept up to date
  • Take social history to determine what adult provides care, What days and times are easiest for parent/carer, name of medical practice, name of nursery or school
  • Ask about caries experience in parent and siblings
  • Ask about toothbrushing habits
  • Ask about diet
  • Previous dental experiences
  • Consider anxiety questionnaire if needed
  • Ask parent/carer if any difficulty in bringing child in for dental visits
  • use info to form assessment and attitude and ability for preventative care
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12
Q

What to do when clinically assessing the child?

A
  • E/O
  • I/O
  • Plaque level
  • Childs or parent/carer toothbrushing knowledge
  • Assess dentition on clean and dry teeth using tooth by tooth approach and discuss with parent/carer
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13
Q

How do you assess primary dentition?

A
  • Diagnose carious lesions
  • Assess for pain and abscess/ infection
  • Assess risk of pain or infection developing before exfoliation (shedding primary teeth and being replaced by permanent)
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14
Q

What does a visual diagnosis of dental caries entail?

A
  • Assess on clean and dry teeth
  • Caries affected enamel has white chalky appearance
  • Enamel dentine junction caries, lesion appears opalescent white
  • Dentinal lesions appear darker
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15
Q

Why does caries affected enamel have a white appearance?

A
  • Acidic solutions from cariogenic plaque biofilm or acid etching solution disolve prism sheaths in enamel creating pores
  • Pores refract light, reflecting it back instead of letting it pass through
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16
Q

What indicates dentinal involvement of caries?

A
  • Opalescent enamel adjacent to a stained fissure
  • White opalescent enamel at marginal ridge indicates proximal lesion with dential involvement
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17
Q

Stained pit or fissure findings

A
  • If stained pit or fissure with no adjacent white opalescent enamel and no obvious radiographic signs
  • Indicates carious lesion confined to enamel fissure
  • No indication for restorative intervention
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18
Q

What is not an acceptable method to detect presence of carious lesions in pits and fissures?

A
  • Probing damages pits and fissures
19
Q

What is an arrested carious lesion?

A
  • Carious lesion that does not progress
  • Assume all carious lesions are active unless evidence to suggest they are arrested
20
Q

How to assess the activity of enamel lesion clinically?

A
  • Are they rough or smooth
  • Arrested enamel surface lesions usually feel smooth to a ball ended probe lightly drawn across surface
    -If surface feels rough or probe drags then lesion is active
21
Q

How to assess activity of lesions on exposed dentine clinically?

A
  • Are they hard or soft
  • Hardness of dentine determined by caries excavator lightly drawn across surface
  • Softer the lesion, the more active it is
  • Harder lesions appear shiny
  • Softer lesions appear more matt and more active
  • Colour of carious dentine not always reliable indicator as some arrested are dark and some are pale
22
Q

How to judge caries on a radiograph?

A
  • Does lesion extend to enamel-dentine junction
  • Outer third dentinal lesion
  • Middle third dentinal lesion
  • Inner third dentinal lesion
23
Q

How old does a child have to be get a bitewing radiograph?

A
  • 4 or above
24
Q

If radiographs have been taken previously, when can you next take another one?

A
  • For children at increased risk of developing caries its 6-12months
  • For all other children 2 years
25
Q

On a radiograph what can you mistake for proximal caries on a radiograph of the upper dentition?

A
  • Cusp of Carabelli
  • Triangle shaped radiolucency seen on mesial of maxillary 2nd primary molar and maxillary first perm molars
26
Q

How to take bitewing radiographs of children?

A
  • Ensure justification for taking radiographs is in notes
  • Consent
  • Use age appropriate language e.g. I’m going to take some pictures of your teeth
  • Use film/plate holders where possible (if not consider using adhesive tabs)
  • Reassure child
27
Q

What is the classification for occlusal carious lesions in Primary teeth?

A

Initial - Noncavitated, dentine shadow or minimal enamel cavitation
- Radiograph outer third dentine
Advanced - Dentine shadow or cavitation with visible dentine
- Radiograph middle or inner third dentine

28
Q

What is the classification for Proximal carious lesions in Primary teeth?

A

Initial - White spot lesions or shadow
Radiograph - Lesion confined to enamel

Advanced - Enamel cavitation and dentine shadow or cavity with visible dentine
Radiograph - May extend into inner third dentine

29
Q

What is the classification for Anterior carious lesions in Primary teeth?

A

Initial - White spot lesions but no dentinal caries
Advanced - Cavitation or dentine shadow

30
Q

What is the classification for pulpal involvement of carious lesions in Primary teeth?

A

Pulpal involvement - Any tooth with clinical pulpal exposure or no clear separation between carious lesion and dental pulp radiographically

31
Q

What is the classification for near to exfoliation carious lesions in Primary teeth?

A
  • Clinically mobile
    Radiograph - Root resorption
32
Q

What is the classification for Arrested caries carious lesions in Primary teeth?

A
  • Any tooth with arrested caries and where aesthetics is not priority
33
Q

What is the classification for unrestorable carious lesions in Primary teeth?

A
  • Crown destroyed by caries or fractures
  • Or pulp exposed with pulp polyp (pain/infection free)
34
Q

What is the classification for occlusal carious lesions in Permanent teeth?

A

Initial - Noncavitated enamel carious lesions, white spot lesions, discoloured or stained fissures
Radiograph - Up to EDJ or not visible

Moderate - Enamel cavitation and dentine shadow or cavity with visible dentine
Radiograph - Up to and inc middle third dentine

Extensive - Cavitation with visible dentine or widespread dentine shadow
Radiograph - Inner third dentine

35
Q

What is the classification for Proximal carious lesions in Permanent teeth?

A

Initial - White spot lesions or dentine shadow, enamel intact
Radiograph - Outer third dentine

Moderate - Enamel cavitation or dentine shadow
Radiograph - Outer or middle third dentine

Extensive - Cavitation with visible dentine or widespread dentine shadow
Radiograph - Inner third dentine

36
Q

What is the classification for Anterior carious lesions in Permanent teeth?

A

Initial - White spot lesions but no dentinal caries

Advanced - Cavitation or dentine shadow

37
Q

What is the classification for Pulpal involvement carious lesions in Permanent teeth?

A
  • Any tooth with clinical exposure or no cleat separation between carious lesion and dental pulp radiographically
38
Q

What is the classification for Unrestorable carious lesions in Permanent teeth?

A
  • Crown destroyed by caries or fractured
  • or pulp exposed with pulp polyp (pain/infection free)
39
Q

What obtaining a pain history from child what do you need to consider?

A
  • Child may not report pain reliably
  • Use input of parent/carer as well as child
  • Ask any problems eating or drinking
  • Any changes to sleeping pattern
  • Use of painkillers
40
Q

What does a sinus usually look like and where is it found?

A
  • Sinuses if present not always obvious
  • Usually located on non-attached mucosa adjacent to attached mucosa
  • Slight cleft or notch may be seen in adjacent gingival margin
41
Q

What indicators must you look for in established dental infections?

A
  • Tenderness to percussion in a non-exfoliating tooth
  • Alveolar tenderness, sinus or swelling
  • Non-physiological mobility (compared to health contralateral tooth) when tooth gently rocked bucco-lingually with points of tweezers placed on occlusal surface
  • Radiographic signs inc inter-radicular radiolucency
42
Q

What factors are associated with development of caries?

A
  • Clinical evidence of previous disease
  • Dietary habits, especially frequency of sugary foods and drink consumption
  • Social history, esp socioeconomic status
  • Use of fluoride
  • Plaque control
  • Saliva
  • Medical history
43
Q

How do you assess caries risk based on postcode of the child?

A
  • Home postcode can be used to identify whether a child lives in relatively disadvantaged area
  • e.g. Quintiles 1-3 in Scottish Index of Multiple Deprivation (SIMD) considered disadvantages
  • SIMD postcode lookup available of NHS national services Scotland website
44
Q

Define dental neglect

A

The persistent failure to meet a child’s basic oral health needs, likely to result in the serious impairment of a child’s oral or general health or development