Assessing the Child and Family Flashcards
1
Q
What are the key recommendations for Prevention of Dental caries in Children?
A
- 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
2
Q
What are the aims when providing dental care for children?
A
- 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
3
Q
What are the priorities of the dental team to achieve these aims?
A
- 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.
4
Q
What are the stages in assessment and planning of a child?
A
- Assessing the child and family
- Provide additional support if needed
- Defining needs and developing personal care plan
5
Q
What are the main components when providing care for a child?
A
- If child is in pain then manage pain
- Caries prevention
- If caries present then manage caries
- Recall
6
Q
When should the first assessment be carried out of the child?
A
- Before 6 months old to determine if parent/carer can be encouraged to adopt optimum caries preventative practices
- Reviewed regularly as circumstances change
7
Q
What does a comprehensive assessment include?
A
- Parent/Carer motivation and responsibility
- Patient history
- Clinical examination
- Caries risk assessment
8
Q
Why is gaining a rapport with the child and Parent/carer important?
A
- May be feeling stressed, apprehensive or guilty
- All members of team are important
- Essential for participation of the child’s oral health
9
Q
How to gain rapport with child and parent/carer?
A
- 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
10
Q
What factors contribute to difficulty in establishing healthy behaviours?
A
- 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
11
Q
How to take a history for a child?
A
- 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
12
Q
What to do when clinically assessing the child?
A
- 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
13
Q
How do you assess primary dentition?
A
- 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)
14
Q
What does a visual diagnosis of dental caries entail?
A
- 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
15
Q
Why does caries affected enamel have a white appearance?
A
- 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
16
Q
What indicates dentinal involvement of caries?
A
- Opalescent enamel adjacent to a stained fissure
- White opalescent enamel at marginal ridge indicates proximal lesion with dential involvement
17
Q
Stained pit or fissure findings
A
- 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
18
Q
What is not an acceptable method to detect presence of carious lesions in pits and fissures?
A
- Probing damages pits and fissures
19
Q
What is an arrested carious lesion?
A
- Carious lesion that does not progress
- Assume all carious lesions are active unless evidence to suggest they are arrested
20
Q
How to assess the activity of enamel lesion clinically?
A
- 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
21
Q
How to assess activity of lesions on exposed dentine clinically?
A
- 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
22
Q
How to judge caries on a radiograph?
A
- Does lesion extend to enamel-dentine junction
- Outer third dentinal lesion
- Middle third dentinal lesion
- Inner third dentinal lesion
23
Q
How old does a child have to be get a bitewing radiograph?
A
- 4 or above
24
Q
If radiographs have been taken previously, when can you next take another one?
A
- For children at increased risk of developing caries its 6-12months
- For all other children 2 years
25
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
26
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
27
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
28
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
29
What is the classification for Anterior carious lesions in Primary teeth?
Initial - White spot lesions but no dentinal caries
Advanced - Cavitation or dentine shadow
30
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
31
What is the classification for near to exfoliation carious lesions in Primary teeth?
- Clinically mobile
Radiograph - Root resorption
32
What is the classification for Arrested caries carious lesions in Primary teeth?
- Any tooth with arrested caries and where aesthetics is not priority
33
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)
34
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
35
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
36
What is the classification for Anterior carious lesions in Permanent teeth?
Initial - White spot lesions but no dentinal caries
Advanced - Cavitation or dentine shadow
37
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
38
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)
39
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
40
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
41
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
42
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
43
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
44
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
