Caries

Question 1

what is included in the caries risk assessment

Answer 1

• clinical evidence
• diet
• social history
• fluoride use
• plaque
• saliva
• medical history

Question 2

what are the 8 elements to the prevention plan

Answer 2

• radiographs
• toothbrushing instruction
• fluoride toothpaste strength
• fluoride varnish
• fluoride supplements
• diet adivce
• fissure sealants
• sugar free medication

Question 3

what are some symptoms of MIH

Answer 3

• pain while brushing, sensitive to temperature

Question 4

What are some factors to take into consideration when determining whether teeth affected by MIH are of poor prognosis?

Answer 4

oEnamel colour 
oLocation of deficits in order of severity 
oSensitivity from brushing/temp 
oAtypically shaped restorations 
oAny patient reported symptoms

Question 5

What are the indicators of dental infection?

Answer 5

o TTP in a non-exfoliated tooth
o Alveolar tenderness, sinus or swelling
o Non-physiological tooth mobility
o Radiographic signs

Question 6

-What is the standard caries prevention advice for all children?

Answer 6

o At least once a year
o Brush twice daily including last thing at night
o Use fluoride toothpaste (1000-1500ppm) depending on age
o Spit don’t rinse
o Supervise until they can brush their teeth effectively
o Demonstrate brushing (3 minutes annually)
o Create action plan to encourage toothbrushing

Question 7

When should you consider using a GI FS?

Answer 7

o When the child is pre-cooperative
o Concerns about moisture control
o On a partially erupted tooth

Question 8

What is the treatment for a child with irreversible pulpitis?

Answer 8

o For a cooperative and anxious patient
o If anxious gently remove gross caries and apply corticosteroid paste under temporary dressing
o If cooperative open pulp chamber under LA and apply corticosteroid paste directly onto pulp then place a dressing. Prescribe pain relief then carry out pulpotomy or extract

Question 9

What is the description of an unrestored primary tooth?

Answer 9

o Much of the crown has been destroyed by caries or has fractured off making the restoration impossible or the dental pulp has been exposed and has formed a dental polyp

Question 10

When is non-restorative cavity control suitable to carry out on a child?

Answer 10

o When a primary tooth has arrested caries or when the tooth is unrestorable or close to exfoliation
o A primary tooth with an advanced lesion where alternative methods are not feasible

Question 11

What are the steps for a conventional preformed crown preparation?

Answer 11

o Give LA
o Protect airway
o Consider rubber dam
o Remove caries
o Occlusal reduction sufficient enough to allow straight probe to be passed access the tooth when in occlusion
o Mesial and distal slices – use wedges and leave a wall of enamel to prevent iatrogenic damage
o Select correct size of PMC and adjust to fit with crown contouring plyers or root forceps

Question 12

What is the fluoride quantity we want in enhanced prevention for children under 10 and those 10+?

Answer 12

o For under 10 1350-1500ppm

o For 10+ 2800ppm

Question 13

What is involved in enhanced prevention?

Answer 13

o Provide standard prevention at each visit
o Give hands on brushing instruction to child and parent/carer at each visit
o Consider additional preventative interventions depending on child’s circumstances such as
 Recommend use of 1350-1500ppm fluoride up to 10 years old
 2800ppm toothpaste over 10
o Utilise any community/home support for toothbrushing that is available locally  health visitor, school nurse, DHSW

Question 14

What teeth are fissure sealed in standard prevention compared to enhanced prevention?

Answer 14

o Standard  pits and fissures of permanent molars as soon as possible after eruption
o Enhanced  same as standard but also palatal pits on upper lateral permanent incisors, and occlusal and palatal surfaces of Ds, Es, and first and second permanent molars

Question 15

In this scenario, what would James caries risk assessment be?

• James is a 2 year-old attending for his 1st visit and who is medically fit. There is no obvious caries and his teeth appear clean. He uses toothpaste given to him from nursery. Still drinks milk from a bottle and apple juice is his favourite drink.

Answer 15

overall risk low

	Clinical evidence -low 
	Diet - want to know more about when he is drinking apple juice and more about what he eats
	Social history - don’t know much 
	Fluoride - don’t know how much fluoride is in his toothpaste from nursery, but would assume it is 1450ppm so low risk 
•	Ideally for his age would want less 
	Plaque - low 
	Saliva - can’t say 
	Medical history - low

Question 16

in this scenarios what would Erin’s caries risk assessment be?

• Erin is a 3 year-old attending your practice in an area of high deprivation. She has a cardiac defect. Has no pain at the moment, but parents are concerned with her appearance as upper anteriors are demineralised and there is early occlusal caries on her lower E’s

Answer 16

overall risk high

o	Clinical evidence - high 
o	Social history - high 
o	Diet - can’t say 
o	Medical history - high 
o	Fluoride - can’t say 
o	Caries risk overall - high