4 Flashcards
is caries preventable?
yes
what is the impact of caries on pre school children?
- aesthetic problems
- loss of function (larger chunks)
- pain
- infection
what is a child abscess like?
Unlike adult which is apex and root tip child is below floor of pulp chamber get intra oral swelling as bone spongey so infiltrates it
Painful, pus - some called gum boil
what is the population skew of distribution of caries?
25% of Scottsih children have 75% of dental caries
Strongly related to poverty.
- Hard to reach children
- Lower socio-economic groups
- Hard to access because low school attendance , lack of attendance at medical/dental appointments, poor diet
early childhood caries a.k.a.
nursing caries
what is the pattern of nursing caries/
typically affects the upper anterior and molar teeth
what is a typical cause of nursing caries?
inappropriate use of feeding cups and bottle
3 methods of nursing caries prevention
- diet and nutrition
- fluoride
- oral hygiene
what is the dental message on breast feeding?
breast feed till 2 (rare nowadays)
wean off at approx. 1
no on demand overnight feeding from around 4 months
- over 6 months overnight feeding can lead to caries
all dependent on weight of child
why is breastfeeding best for babies?
best nutrition
antibodies
• Dip in maternal antibodies at around 6 months - own immune system into pain - causes crying, fever
what is the specific feature of a feeding cup that should be used for babies?
free flow spout
non spill types in most shops are not good for dental development as munch/bite to get fluid
• Should drip when turn over
what kind of drinks should not be put in babies’ cups?
drinks containing free sugar
why shouldn’t babies/children be put to bed with a bottle?
higher chance of caries if drink has sugar (even milk) as can form over night
can choke on it
causes irregular sleep
what is an issue with soya milk?
cariogenic
only be used when medically indicated
what should the dentist recommend when they have a strong suspicion sugary drinks are being consumed?
only have at mealtimes (special occasions maybe)
dilute as much as possible and sugar free versions
take through a straw held a back of mouth on top of tongue
what is important to consider if medication is needed?
sugar free formulations where possible
if not possible taken at mealtimes
pros and cons of cheese as a snack
high energy (good for toddlers)
non-cariogenic
may actively protect against caries (neutralise acid)
can lead to obesity
safe snack
- milk/water
- fruit (wary of dried)
- savoury sandwhiches
- crackers and cheese
- bread or veg sticks
- crisps (if plain classic not manufactured ones)
what are the positives of carrying out a 4 day diet diary?
can be specific to them - individual advice
actual likes and dislikes taken into consideration
- advise on when best to eat them
sources of fluoride
- water (none in scotland)
- toothpaste
- supplementary self-delivered (seldom used - drops, tablets and mouthrinse)
- professionally delivered (gels, varnishes, slow-release devices)
when should tooth brushing commence/
as soon as first primary/deciduous teeth erupt
children brushing teeth
in general, under the age of 7/8 need assistance to brush their teeth by an adults as they lack the dexterity to do so properly
level of fluoride in child formulation toothpaste
1000ppm
e.g. Aquafresh Milk teeth
level of fluoride in standard toothpaste
1400-1500ppm
e.g. colgate total, aquafresh little and big teeth
toothpastes given out in Childsmile
level of fluoride in enhanced fluoride toothpastes
2800ppm
e.g. duraphat toothpaste
prescription only
toothpaste strength recommendations for first tooth eruption (3 years) standard risk kids
1000ppmF
toothpaste strength recommendations for 4-16 years standard risk kids
1000-1500ppmF
toothpaste strength recommendations for high risk kids under 10 years
1500ppmF
toothpaste strength recommendations for high risk kinds 10 and over
2800ppmF (prescription only)
toothpaste strength recommendations for high risk 16 and over
5000ppmF (prescription only)
amount of toothpaste for children under 3
smear of toothpaste
approx. 0.1ml
amount of toothpaste for children for children 3 or over
pea sized amount
approx. 0.25ml
fluorosis
enamel defect when too much fluoride is exposed to teeth
white flecks (mild) brown patches (severe)
good toothbrushing practices
Spit out excess, do not rinse.
- Dry brush
Manual or powered toothbrushes are both effective when using a fluoride toothpaste.
- Use a small headed manual brush.
- Power toothbrush use small round oscillating head
A Cochrane Review has indicated that tooth brushing is more effective when using a powered brush with a small round, oscillating head compared to manual brushing.
- Take into account patient situation when recommending products
what should be done if more than 5mg of F per kg body weight has been consumed?
give calcium orally (milk) and observe for a few hours
what should be done if more than 5-15mg of F per kg of body weight has been consumed?
Give calcium orally (milk, calcium gluconate, calcium lactate) and admit to hospital
what should be done if more than 15mg of F per kg body weight has been consumed?
Admit to hospital immediately, cardiac monitoring and life support, intravenous calcium gluconate.
- Can be poisoned (fluoride toxicity
what information is needed to assess risk of fluoride toxicity?
weight of person
how much toothpaste ingested
strength of toothpaste ingested
when should flossing be taught?
from 12 years - adult dentition now so no mobile teeth and have manual dexterity skills
use of fluoride mouth rinses
- Not recommended for children under the age of 6.
- Even over 6 need to assess the child’s ability to properly expectorate.
types of professionally applied fluorides
- APF gels (not really used often)
- varnishes
fluoride varnishes
Duraphat – first and most widely used
- Yellow, banana taste
Now get different flavours and some are white
Concerns over asthmatic or atopic (highly allergenic) children
- Has resin from tree in it which commonly causes reactions
practice based caries prevention
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.
Fluoride varnish can be administered for high risk adults
Good for dentine sensitivity too
community based caries prevention
Health education
- Is a process that results in individuals or groups having increased knowledge related to health.
Health promotion
dental and dietary health eduction
Is a process that results in individuals or groups having increased knowledge related to health.
The sugar reduction campaign is currently being helped along by anti-obesity public health campaigns.
- Obesity crisis is helping to reduce sugar
health promotion
Supports individuals in translating their health knowledge into positive behaviours and lifestyles.
The rationale is to increase the community’s day-to-day capacity and ability to follow a healthy lifestyle.
- Need to become habit – lifestyle change (diets are phases – don’t work in general)
Health promotion activities should be directed at a wide variety of areas likely to impact on health,
- e.g. Social, economic and structural environments as well as the policies of public and local institutions.
techniques used to diagnose of dental caries
bitewing radiographs
- Fibre-optic transillumination.
- Temporary tooth separation (gently push teeth apart using blue rubber bands over a couple of days)
- Air abrasion
- CO2 Laser
- Electric caries meter
