3. Caries Prevention 0-16 Flashcards
Definition of dental caries
A disease of the dental hard tissues caused by the action of micro-organisms, found in plaque, on fermentable CHOs
Impact of caries on pre-school children (4)
Aesthetic problems
Loss of function
Pain
Infection
Caries risk indicators in children (8)
Oral hygiene Diet Bacterial exposure Socioeconomic status Breast/bottle feeding Fluoride exposure Parental smoking Parental oral health
Components of paediatric caries risk assessment (7)
Clinical evidence Dietary habits Social history Fluoride use Plaque control Saliva control Medical history
Components of paediatric caries prevention protocol (7)
Radiograph Fluoride varnish Toothpaste (1000/1450ppmF) Tooth brushing instruction/OHI Dietary counselling Fissure sealants Sugar free medicines
Features of early childhood caries (3)
Nursing caries
Typically affects upper anteriors and upper/lower molars (as tongue sits over lower molars)
Typically caused by inappropriate use of feeding cups and bottles (prolonged on-demand breastfeeding too)
Prevention incorporates diet, fluoride and oral hygiene, SIGN 83 (13)
Pregnant women should be advised that there is no benefit to the child of taking fluoride supplements during pregnancy (SIGN 83)
The dental team should support and promote breastfeeding
Use of a feeding cup rather than a bottle should be recommended from six months (free-flow spout)
Drinks containing free sugars should never be put in a feeder bottle
Children should not be put to bed with a feeder bottle or cup
Soya milk formula is potentially cariogenic and should only be used when medically indicated (lactose intolerance)
The use of sweetened drinks should not be advocated but where there is a strong suspicion that they are being used: mealtimes only, dilute as much as possible, take through a straw which should be held at the back of the mouth
Food and confectionary containing free sugar should be restricted to mealtimes only
Plain water or milk between meals
Sugar free medicines should be requested where available, where not available doses should be given at mealtimes and never after tooth brushing at night
Cheese is a good high energy food for toddlers, it is non-cariogenic and may actively protect against caries
Sugar free snacks are unlikely to be cariogenic
Confectionary and beverages containing sugar substitutes are preferable to those containing sugar (safe snacks – milk/water, fruit, savoury sandwiches, crackers and cheese, bread sticks, crisps)
Methods of obtaining fluoride (4)
Water
Toothpaste
Supplementary self-delivered (drops, tablets, mouthwash)
Professionally delivered (varnishes)
Paediatric toothbrushing instruction (4)
Should be started as soon as the first primary teeth erupt (should be started immediately if neonatal/natal teeth are present and kept)
Children under the age of eight lack the dexterity to brush their own teeth effectively
Young children should have their teeth brushed by an adult before bed and at one other time in the day
Older children who are unable to brush their own teeth effectively should be assisted
Fluoride in toothpaste (4)
Child formulation – 450-600ppm (not recommended in Scotland (Macleans Milk Teeth, Colgate 0-6)
Child formulation – 1000ppm (Aquafresh Milk Teeth, free pastes given out by health visitors/Childsmile programme)
Standard fluoride – 1400-1500ppm (Colgate Total, Aquafresh Little Teeth and Big Teeth)
• Enhanced fluoride – 2600ppm-5000ppm (Duraphat – 2800ppm only recommended for those over ten who require it; 5000ppm should not be given to a child under sixteen)
Toothpaste strength recommendation (4)
First tooth eruption until three years old - 1000ppmF- for standard risk kids
4-16 years old - 1000-1500ppmF- for standard risk kids
High risk children under ten years old - 1500ppmF-
High risk aged ten and over - 2800ppmF-
F concentration and amount of paste for kids (2)
Smear of paste (approx. 0.1ml) for children under 3
Pea-sized amount (approx. 0.25ml) for children aged 3 and over
Tooth brushing practice (3)
Spit out excess, do not rinse
Manual or powered toothbrushes are both effective when using a fluoride toothpaste
Use a small headed manual brush
Important information required for suspected fluoride toxicity (3)
Weight of child
Amount swallowed
Concentration of F in toothpaste
Management of fluoride toxicity (3)
<5mg/kg - oral Ca, observe for a few hrs
5-15mg/kg - oral Ca, admit to hospital
>15mg/kg - immediate hospital, cardiac monitoring, life support, IV Ca gluconate
Features of fluoride mouthwash for children (2)
Not recommended for children under the age of six
Even over six, the dentist must assess the child’s ability to properly expectorate
Types of professionally applied fluorides (2)
APF gels
Varnishes
Components of practice-based prevention (2)
Topical fluoride varnish should be applied to the dentition at least twice yearly for pre-school children assessed as being at increased risk of caries
Floss between contact areas
Components of community-based prevention (2)
Health education
Health promotion
Definition of health education
Process that results in individuals or groups having increased knowledge relating to health
Features of dental health education
Dental/dietary health education in isolation should not be undertaken as a community-based prevention approach, as studies have shown it does not work. It should form an overall prevention plan for individual patients
Definition of health promotion
Supporting individuals in translating their health knowledge into positive behaviours and lifestyles
Features of health promotion
Health promotion activities should be directed at a wide variety of areas likely to impact on health
Functions of oral health promotion programmes (4)
Aim to reduce the risk of early childhood caries should be available for parents during pregnancy and postnatal
For young children should be initiated before the age of three years
Should address environmental, public and social policy changes in order to support behaviour change
Help of lay persons and non-dental health professionals
Components of prevention 0-5 (8)
Diagnosis Clinical examination Bitewing radiographs Fibre-optic trans-illumination Temporary tooth separation Air abrasion CO2 laser Electric caries meter
Radiographs and risk categories for frequency (2)
Every 6mths - high risk kids
Every 12-18mths - low risk kids
