3. Prevention & Management of Dental Caries in Children

Question 1

What factor is most likely to improve oral health of all pre-school children ?

Answer 1

Water fluoridation.

Question 2

Which treatment is of highest priority in following a treatment plan ?

Answer 2

Relief of pain.

Question 3

When treatment planning, which of the following LA techniques should be carried out first ?

Answer 3

Simple restorations requiring LA in upper jaw.

Question 4

What is not wanted from the parents/carers of a small child when treatment planning?

a. Showing the child that they are nervous

b. Consent

c. Motivation toward appropriate dietary improvements

d. Willingness to help aid good oral hygiene

Answer 4

Showing the child they are nervous.

Question 5

Which factors do we not need to take into consideration when formulating a treatment plan for a child?

a. Caries risk

b. Medical history

c. Plan made for child’s best friend

d. Social background

Answer 5

Plan made for child’s best friend.

Question 6

Which of the following would not alter your treatment plan?

a. Child has congenital cardiac disease

b. Allergy to latex

c. Need for prevention

d. Need for General Anaesthetic

Answer 6

C - need for prevention.

Question 7

What factors do not need to be considered in the mixed dentition phase?

a. Size of the maxillary sinuses

b. Development of all permanent teeth

c. Developing malocclusion

d. Growth of the child

Answer 7

A - size of maxillary sinuses.

Question 8

What should form the first component of any treatment plan?

a. Prevention

b. Diet advice and oral hygiene instruction

c. Restorative Treatment

d. Relief of pain

Answer 8

D - relief of pain.

Question 9

Which of the following is not a major factor in a preventive treatment plan for a child?

a. Fluoride therapy

b. Oral hygiene instruction

c. Water fluoridation

d. Fissure sealing

Answer 9

C - water fluoridation.

Question 10

What is the lowest amount of fluoride that needs to be ingested by a child to result in toxicity ?

Answer 10

5mg/kg body weight.

Question 11

What are the two factors you need to know to assess fluoride toxicity ?

Answer 11

Patient weight.
Fluoride strength.
Amount ingested.

Question 12

How should you manage a fluoride overdose <5mg/kg ?

Answer 12

Give calcium orally i.e. milk and observe for a few hours.

Question 13

How should you manage a fluoride overdose 5-15mg/kg ?

Answer 13

Give calcium orally i.e. milk, calcium gluconate, calcium lactate and admit to hospital.

Question 14

How should you manage a fluoride overdose of >15mg/kg ?

Answer 14

Admit to hospital immediately for cardiac monitoring and life support.
Child will be given IV calcium gluconate.

Question 15

Why is there modern protocols in place now against induction of vomitting after fluoride poisoning ?

Answer 15

Risk of aspiration.

Question 16

What are 5 modes of fluoride delivery ?

Answer 16

Supplements.
Mouthrinse.
Toothpaste.
Varnish.
Water supply.

Question 17

What amount of fluoride in toothpaste that should be recommended for 2 year old chin ?

Answer 17

1000ppmF.

Question 18

What strength of fluoride is Duraphat varnish ?

Answer 18

22,600ppmF.

Question 19

When should topical fluorides (other than toothpaste) be taken ?

Answer 19

Different time for brushing - don’t drink or eat for hour after varnish application.

Question 20

What correct drug info should be written on a prescription to allow a tube of Duraphat 2,800ppm toothpaste to be dispensed ?

Answer 20

Sodium fluoride 0.619% toothpaste.

Question 21

When should a parent be using a toothbrush for their child ?

Answer 21

When their first deciduous tooth erupts.

Question 22

For a low risk 6 month old child - what brushing regime should be recommended ?

Answer 22

Smear of 1000ppmF toothpaste for 2x daily brushing.

Question 23

For all children aged 2 and over, how often should sodium fluoride varnish be applied ?

Answer 23

At least 2x annually.

Question 24

For all children, when should fissure sealants be placed on permanent molars ?

Answer 24

As soon as they erupt.

Question 25

What should be taken into consideration when planning on managing caries ?

Answer 25

Time to exfoliation.
Site and extent of lesion.
Risk of pain or infection.
Absence or presence of infection.
Preservation of tooth structure for space maintenance.
Avoidance of anxiety.
Number of teeth affected.

Question 26

How should a child in pain due to pulpitis in vital primary tooth with irreversible symptoms with no radiographic evidence of dental abscess be managed ?

Answer 26

Pulpotomy - preserve tooth and to avoid need for XLA.

Question 27

What is molar incisor hypo mineralisation (MIH) ?

Answer 27

Common developmental condition - hypo mineralisation of systemic origin of 1-4 permanent first molars, frequently associated with affected incisors

Question 28

What are the 4 scores in a plaque index - assessment of toothbrushing in children ?

Answer 28

10/10 - tooth perfectly clean.
8/10 - plaque line around cervical margin.
6/10 - cervical third of crown covered.
4/10 - middle third covered.

Worst score in each sextant should be recorded. Indicative of toothbrushing.

Question 29

What is the standard and enhanced prevention toothpaste dosage which should be recommended for children ?

Answer 29

Standard risk so standard prevention - 1000-1500ppmF.

Increased risk so enhanced prevention - 1350-1500ppmF and for 10+y/o, consider 2800ppmF.

Question 30

What amount of toothpaste should be used for children under 3 y/o ?

Answer 30

Smear.

Question 31

What amount of toothpaste should be used for children over 3 y/o ?

Answer 31

Pea-sized amount.

Question 32

What treatment plan should be followed for fissure sealants in all children ?

Answer 32

Place sealants in all pits and fissures of permanent molars as soon as possible after eruption.

Question 33

What is the first line material for placing fissure sealants on children ?

Answer 33

Resin based sealants (BisGMA), where moisture control cannot be achieve, GIC with fluoride varnish.

Question 34

For children requiring enhanced prevention approach, what teeth should have fissure sealants placed ?

Answer 34

Palatal pits of upper lateral permanent incisors.
Occlusal and palatal surfaces of Ds, Es and first and second permanent molars.

Question 35

How should moisture control be achieved in children with placement of fissure sealants ?

Answer 35

Moisture pack and cotton wool rolls.

Question 36

How do you ensure tooth is clean before placement of fissure sealants ?

Answer 36

Wipe with cotton wool roll or toothbrush with no toothpaste.

Question 37

What etch should be used for placement of fissure sealants ?

Answer 37

35% phosphoric acid.

Question 38

What are 3 things about a fissure sealant which should be checked after application ?

Answer 38

Air blows.
Flash.
Integrity.

Question 39

How often should sodium fluoride varnish (5%) be applied to children as part of Standard Prevention ?

Answer 39

2x a year from age 2.

Question 40

How often should sodium fluoride varnish be applied to children as part of Enhanced Prevention ?

Answer 40

4x year from age 2.

Question 41

From what age can a alcohol-free sodium fluoride mouthwash be recommended in addition to fluoride varnish ?

Answer 41

From age 7.

Question 42

For how long should it be recommended to not consumed foods or drink for after fluoride varnish application ?

Answer 42

30 mins.

Question 43

For how long should a child wait to brush their teeth after application of fluoride varnish ?

Answer 43

4 hours.