4 Prevention of dental caries

Question 1

What is caries?

Is it preventable?

Answer 1

a disease of the dental hard tissues caused by the action of microorganisms, found in plaque, on fermentable carbohydrates

yes at an individual level

Question 2

what is the impact of caries on pre-school children

Answer 2

aesthetic problems
loss of function
pain
infection - abscess

Question 3

What is the distribution of caries related to in scotland

Answer 3

poverty - ‘hard to reach children’

25% of scottish children have 75% of the disease

Question 4

What are risk indicators in children

Answer 4

• oral hygiene
• diet
• bacterial exposure
• socioeconomic status
• breast/bottle feeding
• fluoride exposure
• parental smoking
• parental oral health status

Question 5

what is early childhood caries also known as

Answer 5

nursing caries

Question 6

where does early childhood caries typically effect

Answer 6

upper anterior and molar teeth

Question 7

what is the typical cause of nursing caries

Answer 7

inappropriate use of feeding cups and bottles

Question 8

how can you prevent caries?

Answer 8

• diet
• fluoride
• oral hygiene

Question 9

Are there benefits to taking fluoride during pregnancy?

Answer 9

no, fluoride goes through placenta but not enough to do anything

focus is on topical use of fluoride rather than systemic

Question 10

What should the dental teams stance on breastfeeding be?

Answer 10

should support and promote breastfeeding

BUT

on demand overnight breastfeeding will cause caries
WHO recommends breastfeed til 2
but really should be stopped after about a year cause of effects on teeth

A lot of crying gets blamed on teeth, probably isn’t that

Question 11

What should the dental teams stance on feeding cups be

Answer 11

use of a feeding cup rather than a bottle should be recommeded from 6 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

Question 12

What should the dental teams stance on sweetened food and drinks be

Answer 12

The use of sweetened drinks should not be advocated but where there is a strong suspicion that they are being used:

• meal times only
• dilute as much as possible
• take through a straw which should be held at the back of the mouth
• encourage the use of non-sugar sweeteners in particular xylitol in food and drink
• use sugar free chewing gum, particularly containing xylitol
• clinicians should prescribe sugar-free medicines wherever possible

Question 13

what are the only safe drinks to have between meal times

Answer 13

milk and water

Question 14

What medicines should be prescribed

Answer 14

sugar free
dose given at mealtimes where not available
never after tooth brushing at night

Question 15

what are safe snacks to recommend

Answer 15

milk/water
fruit
savour sandwiches
crackers and cheese
bread sticks
crisps (although sugar molecules help shaped crisps maintain their shape e.g. hula hoops)

Question 16

How can you assess a patients diet

Answer 16

diet diary (four days, one day as a weekend)

Question 17

How can someone intake fluoride

Answer 17

water
toothpaste
supplementary self-delivered
- drops
- tablets
- mouth rinse
professionaly delivered
- APF gels (seldom used)
- varnishes (should be applied to all children at least twice yearly)
- slow release devices

Question 18

What is the optimum fluoride level in water

Answer 18

1.0ppm F

Question 19

is there any fluoridated water in scotland

Answer 19

no

Question 20

how many people in the uk recieve fluoridated water

Answer 20

5.5 million (7%)

Question 21

What is the advice for brushing children’s teeth

Answer 21

• should be started as soon as the first primary teeth erupt
• children under the age of 8 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

Question 22

How much F should be in child formulations of toothpaste

Answer 22

1000ppm

Question 23

How much F should be in standard formulations of toothpaste

Answer 23

1400-1500ppm

Question 24

How much F should be in enhanced formulations of toothpaste (prescribed only)

Answer 24

2800ppm (duraphat)

need to make sure only that person uses it, toxic to young children

Question 25

F strength for first tooth eruption to 3 years

Answer 25

1000ppm

Question 26

F strength for 4-16 years (standard risk)

Answer 26

1000-1500ppmF

Question 27

F strength for high risk under 10yrs

Answer 27

1500ppm

Question 28

F strength for high risk over 10 years

Answer 28

2800ppm (prescription only)

Question 29

F strength high risk 16 and over

Answer 29

5000ppm F (prescription only)

Question 30

What age should only have a smear of toothpaste (0.1ml)

Answer 30

children under 3

Question 31

What age should have a pea sized amount of toothpaste

Answer 31

children 3 and over (0.25ml)

Question 32

advice for toothbrushing practice?

Answer 32

spit don’t rinse
manual or powered toothbrushes are both effective
use a small headed manual brush