Assessing the Child Patient Flashcards
What are the elements of the assessment of dental caries in children?
- parent/carer motivation and responsibility
- patient history
- clinical examination
- caries risk assessment
What are some factors that can contribute to the difficulty in establishing healthy behaviours?
- education, family or social issues
- indivuduals with differing life priorities
- complex child care arrangements
- parent/carers lack of knowledge for the prevention of dental disease
- children/families with intellectual, medical, metal/physical health or other disabilities
What does the DCby1 stand for?
Dental check by 1 years old
What is the aim of the DCby1 initiative?
- get the child to see a clinician as soon as their first teeth come in, before their birthday
What shoulve be included in the revelant medical history of a child?
- CVS
- CNS
- Respiratory
- Drugs/medication
- allergies
What should be included in the social history of a child?
- number and age of siblings
- influence of social status
- distance travelled
- parental attitude towards dental health
What should be included in the relevant dental history of a child?
- pattern of dental attendance
- previous dental experience
- history of fillins/LA/GA
E/O examination of a child should include …
- physical development
- intellectual development
- speech
- hands (dexterity)
- head and neck (same as adult)
- how comfortable is the patient in the chair
I/O examination is dependent on cooperation of a child, What should be included?
- soft tissues
- hard tissues
- oral hygiene
- plaque disclosure
What shoud be recorded when reporting the occlusion of a child?
- overjet
- overbite
- molar relationships
- cross bite
- habit- thumb sucking , dummies
What is the IOTN?
Index of orthodontic needs
a screening process for children in mixed dentition phase
What is an overjet?
- how far forward the teeth are
- horizontal overlap
What is an overbite?
- vertical overlap
- excessie vertical distance between upper and lower front teeth
What are the characteristics of the O’Leary Plaque index?
- records the presence of plaque on all teeth
- mesial, distal, buccal, palatal/lingual surfaces discussed
When should you record plaque scores in children?
- at each examination particularly if child is at an increased caries risk
- on open carious lesions at recall visits for lesions where prevention-alone strategy has previously been selected
What are the possible BPE codes for children 7-11 years old? Why is this?
0,1,2
this is because of false pocketing
What are the possible BPE codes for children aged 12-17?
full range of BPE codes
0,1,2,3,4,*
permanent teeth have erupted
Who should the the simplified BPE be performed on?
patients under 18
What are the index teeth for the simplified BPE?
UR6 UR1 UL6
LL6 LL1 LL6
How should the primary dentition be assessed for caries, pain and sepsis?
- diagnose carious lesions
- assess for pain and sepsis
- assess the risk of pain and sepsis before exfoliation
How should you deal with arrested caries in a primary tooth and why?
- leave behind
- reinforce OHI, TB
- fluoride varnish
- avoids potential trauma from extraction/restoration of tooth
What is essential for the visual diagnosis of the presence of caries?
- ensure all teeth are clean
- ensure all teeth are dry
- well illuminated
What is not an acceptable technique for diagnosis caries in pits and fissures?
probing
When is probing an acceptable method of assessing caries activity? Why ?
already exposed dentine
helps to establish whether dentine is hard or soft
What does an ICDAS restoration and sealant code of 0 indicate?
tooth not restored or sealed
What does an ICDAS restoration and sealant code of 1 indicate?
partial sealant
What does an ICDAS restoration and sealant code of 2 indicate?
full sealant
What does an ICDAS restoration and sealant code of 3 indicate?
tooth coloured restoration
What does an ICDAS restoration and sealant code of 4 indicate?
amalgam restoration
What does an ICDAS restoration and sealant code of 5 indicate?
stainless steel crown
What does an ICDAS restoration and sealant code of 6 indicate?
porcelain, gold, PFM, crwon or veneer
What does an ICDAS restoration and sealant code of 7 indicate?
lost or broken restoration
What does an ICDAS restoration and sealant code of 8 indicate?
temporary restoration
What does an ICDAS caries surface code of 0 indicate?
sound tooth surface
What does an ICDAS caries surface code of 1 indicate?
first visual change of enamel
What does an ICDAS caries surface code of 2 indicate?
distinct visual change of enamel
What does an ICDAS caries surface code of 3 indicate?
enamel breakdown, no dentine visible
What does an ICDAS caries surface code of 4 indicate?
underlying dentinall shadow (not cavitated into dentine)
What does an ICDAS caries surface code of 5 indicate?
distinct cavity with visible dentine
What does an ICDAS caries surface code of 6 indicate?
extensive distincy cavity with visible dentine
What does an ICDAS score of 97 indicate?
tooth extracted as a result of caries
What does an ICDAS score of 98 indicate?
tooth missing for other reason
What does an ICDAS score of 99 indicate?
unerupted
What does an ICDAS score of P indicate?
implant
When should you start taking bitewings of children and why?
from the age of 4
this is when they have started developing contacts in their primary dentition
Why should bitewing radiographs be used as an adjunct to diagnosisng caries in children aged 4 and above?
broad contact points of primary dentition make approximal caried difficult to see in clinical examination alonw
When is there a valid reason/justification for not taking radiographs? What must you do in this case?
if you are able to assess proximal surfaces clinically
you must record this justification in the notes
What equipment can you use for taking a bitewing in a child?
F speed, size 0 film
film holder
adhesive tabs (less compliant children)
What is the size of a size 0 film?
22mm x 35mm
What is the disadvantage of using an adhesive tab ? What is the alternative in this case?
more overlaps present
makes it difficult to assess proximal lesions
may opt for an OPT instead
What are the treatment options for dental sepsis in a child?
- extraction
- pulp therapy if possible
- in exceptional circumstanded, monitor asymptomatic dental sepsis for up to 3 months while the child is acclimatised to the dental environment
What are the indications of established dental sepsis?
- interradicular radiolucency
- tenderness to percussion of a non-exfoliating tooth
- alveolar tenderness, sinus/swelling
- non- physiological mobility
What is a sinus?
this is where there is pus exiting the soft tissue
An indication of dental sepsis
How can you assess the risk of pain or sepsis developing before exfoliation?
- extent of a lesion
- site of lesion (interproximal where biofilm removal is difficult?)
- activity of lesion
- time of exfoliation- how long will it take before exfoliation
- number of other lesions present in dentition
- anticipated cooperation of child now and in the future
- anticipared cooperation of parent/carer with preventive measures
- range of clinical procedures the clinician is able or willing to provide
- medical status child- taking medications containing sugars?
In a case where there is clinically evident signs and symptoms of pain or sepsis but it is likely for exfoliation without further issues, what is the management strategy to be employed?
closely monitor patient
patient is given **enhanced prevention **
Give an example of an enhanced prevention technique?
modification of carious lesion to be self cleansing. Flouride more able to get into lesion, less likely to progress
What is the caries risk a deciding factor for?
recall and bitewing interval
What are the evidence based indicators of a child being at increased risk of developing caries within the next 3 years?
- previous caries experience- DMFT
- resident in area of deprivation- home postcode
- healthcare workers opinion- referal from health visitor, public health nurse, dental health support worker who has identified need for additional preventive care
What are the 3 caries prevention interventions we do for all patients, including those of low risk?
- check diet
- OHI- TB technique
- topical fluoride
What component of fluoride varnish carries a risk of allergy development?
colophony
What is the concentration of fluoride in fluoride varnish?
22 600 ppm
2.26% NaF
How often should fluoride varnish be applied for low risk children?
every 2 years
Outline a comprehensive oral health assessment/focussed oral health review
- assessment of patient history- MH,SH,DH, anxiety
- assessment of oral health status- H/N, I/O, periodontal
- diagnosis and risk assessment- from diagnosis, assess risk information
- personal care plan
