Assessing the Child and Family Flashcards
What are the key recommendations for Prevention of Dental caries in Children?
- 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
What are the aims when providing dental care for children?
- 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
What are the priorities of the dental team to achieve these aims?
- 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.
What are the stages in assessment and planning of a child?
- Assessing the child and family
- Provide additional support if needed
- Defining needs and developing personal care plan
What are the main components when providing care for a child?
- If child is in pain then manage pain
- Caries prevention
- If caries present then manage caries
- Recall
When should the first assessment be carried out of the child?
- Before 6 months old to determine if parent/carer can be encouraged to adopt optimum caries preventative practices
- Reviewed regularly as circumstances change
What does a comprehensive assessment include?
- Parent/Carer motivation and responsibility
- Patient history
- Clinical examination
- Caries risk assessment
Why is gaining a rapport with the child and Parent/carer important?
- May be feeling stressed, apprehensive or guilty
- All members of team are important
- Essential for participation of the child’s oral health
How to gain rapport with child and parent/carer?
- 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
What factors contribute to difficulty in establishing healthy behaviours?
- 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
Define dental neglect
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
How to take a history for a child?
- 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
What to do when clinically assessing the child?
- 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
How do you assess primary dentition?
- 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)
What does a visual diagnosis of dental caries entail?
- 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
Why does caries affected enamel have a white appearance?
- 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
What indicates dentinal involvement of caries?
- Opalescent enamel adjacent to a stained fissure
- White opalescent enamel at marginal ridge indicates proximal lesion with dential involvement
Stained pit or fissure findings
- 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
What is not an acceptable method to detect presence of carious lesions in pits and fissures?
- Probing damages pits and fissures
What is an arrested carious lesion?
- Carious lesion that does not progress
- Assume all carious lesions are active unless evidence to suggest they are arrested
How to assess the activity of enamel lesion clinically?
- 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
How to assess activity of lesions on exposed dentine clinically?
- 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
How to judge caries on a radiograph?
- Does lesion extend to enamel-dentine junction
- Outer third dentinal lesion
- Middle third dentinal lesion
- Inner third dentinal lesion
How old does a child have to be get a bitewing radiograph?
- 4 or above
If radiographs have been taken previously, when can you next take another one?
- For children at increased risk of developing caries its 6-12months
- For all other children 2 years
On a radiograph what can you mistake for proximal caries on a radiograph of the upper dentition?
- Cusp of Carabelli
- Triangle shaped radiolucency seen on mesial of maxillary 2nd primary molar and maxillary first perm molars
How to take bitewing radiographs of children?
- 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
What is the classification for occlusal carious lesions in Primary teeth?
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
What is the classification for Proximal carious lesions in Primary teeth?
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
What is the classification for Anterior carious lesions in Primary teeth?
Initial - White spot lesions but no dentinal caries
Advanced - Cavitation or dentine shadow
What is the classification for pulpal involvement of carious lesions in Primary teeth?
Pulpal involvement - Any tooth with clinical pulpal exposure or no clear separation between carious lesion and dental pulp radiographically
What is the classification for near to exfoliation carious lesions in Primary teeth?
- Clinically mobile
Radiograph - Root resorption
What is the classification for Arrested caries carious lesions in Primary teeth?
- Any tooth with arrested caries and where aesthetics is not priority
What is the classification for unrestorable carious lesions in Primary teeth?
- Crown destroyed by caries or fractures
- Or pulp exposed with pulp polyp (pain/infection free)
What is the classification for occlusal carious lesions in Permanent teeth?
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
What is the classification for Proximal carious lesions in Permanent teeth?
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
What is the classification for Anterior carious lesions in Permanent teeth?
Initial - White spot lesions but no dentinal caries
Advanced - Cavitation or dentine shadow
What is the classification for Pulpal involvement carious lesions in Permanent teeth?
- Any tooth with clinical exposure or no cleat separation between carious lesion and dental pulp radiographically
What is the classification for Unrestorable carious lesions in Permanent teeth?
- Crown destroyed by caries or fractured
- or pulp exposed with pulp polyp (pain/infection free)
What obtaining a pain history from child what do you need to consider?
- 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
What does a sinus usually look like and where is it found?
- 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
What indicators must you look for in established dental infections?
- 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
What factors are associated with development of caries?
- 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
How do you assess caries risk based on postcode of the child?
- 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
