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caries in children Flashcards

1
Q

what are 3 aims while providing dental care for children?

A

prevent disease in primary and permanent dentition
reduce risk of child experiencing pain or infection
child grows up with skills and motivation to maintain OH

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2
Q

in what ordered you plan care for a child?

A

manage pain
provide caries prevention
manage caries/asymptomatic infection

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3
Q

what are the symptoms of reversible pulpitis?

A

pain to cold/sweet
tooth not TTP
resolves on removal of stimulus
tooth difficult to localise

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4
Q

how do you treat reversible pulpits?

A

restore

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5
Q

what are the symptoms of irreversible pulpitis?

A

spontaneous pain wakens child at night
does not resolve on removal of stimulus
pain to hot/cold
pain lasts hours
does not resolve with placement of dressing
no TTP

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6
Q

how do you treat irreversible pulpits in a primary tooth?

A

extraction or appropriate pulp therapy if cooperative

pre-cooperative - refer for extraction/treatment with sedation or GA

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7
Q

how do you treat irreversible pulpits in a permanent tooth?

A

RCT or extraction if cooperative
refer to specialist if uncooperative

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8
Q

what are the symptoms of dental abscess or periradicular periodontitis ?

A

spontaneous pain wakens child
tooth mobile
TTP
swelling, sinus or abscess
malaise

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9
Q

how do you treat an abscess or periradicular periodontitis?

A

antibiotics if spreading infection or systemic involvement
RCT or extraction
if pre-cooperative, refer for GA or sedation extraction, or refer to specialist care

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10
Q

what should you recommend when giving tooth brushing advice to child and parent

A

fluoride concentration and amount of toothpaste appropriate for age

spit don’t rinse

supervised brushing until child is effective

at least twice a day inc last thing at night

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11
Q

when do you used pea sized toothpaste

A

3+

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12
Q

when do you use a smear of toothpaste

A

<3

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13
Q

when can you give 2800ppmF toothpaste

A

10+

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14
Q

what is the standard caries risk fluoride content recommended

A

1000-15000ppmF

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15
Q

what is the increased caries risk F toothpaste content recommendation for under 10

A

1350-1500ppmF

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16
Q

what material do you use to fissuree seal sensitive MIH teeth?

A

GI cement

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17
Q

what is the minimum age for amalgam

A

15

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18
Q

give 5 examples of standard prevention for children

A

toothbrushing advice twice a year

3 min demonstration brushing annually

place sealant in pits and fissures of all permanent molars asap after eruption

sodium fluoride varnish 5% twice a year for 2+

diet advice once a year

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19
Q

4 diet advice points

A

limit sugar consumption

only water or milk between meals

snack on low sugar food such as fruit, carrot, oatcakes

don’t eat or drink except water after brushing at night

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20
Q

give 5 examples of enhanced prevention for children

A

at each recall give hands on brushing instruction to child and parent/carer

recommend 1350-1500ppm and 2800 in 10+

at each recall provide diet advice

sodium fluoride varnish four times a year or children 2+

fissure seal palatal pits in 2s and occlusal and palatal of Ds and Es 6s and 7s

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21
Q

define dental neglect

A

persistent failure to meet Childs basic oral health needs likely to result in serious impairment of Childs oral or general health or development

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22
Q

give 3 caries prevention methods in children

A

personalised oral hygiene advice

apply sodium fluoride varnish for children over 2 at least 2 times a year

for all children place fissure sealant on 6s as early as possible after eruption

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23
Q

when coming up with a treatment plan for a carious primary tooth, what should you take into consideration - give 3

A

time to exfoliation

absence or presence of infection

avoidance of treatment induced anxiety

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24
Q

treatment options for child with vital tooth with irreversible pulpitis symptoms

A

pulpotomy to preserve tooth

avoid need for extraction

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25
what percentage of school children world wide have caries experience?
60-90%
26
give an example of a population based caries prevention measure
water fluoridation
27
what takes priority in mixed dentition: prevention of caries in permanent management of caries in primary
prevention in permanent
28
what 4 elements are included in a comprehensive assessment of child
parent/carer motivation and responsibility patient history clinical assessment caries risk assessment
29
give 3 factors that can lead to difficult in establishing healthy behaviours in a child
deprivation lack of education or motivation in prevention of dental disease complex childcare arrangements
30
4 questions to ask about a childs dietry habits
do the take a bottle to bed, if so what in it what snacks do the have between meals how many portions of fruit and veg a day do they have sugary drinks
31
how can you help a younger uncooperative child get a dental examination?
sit them on parent/carer lap facing parent and then get them to lower their head into your lap while holding parent hands tell parent to keep encouraging and smiling and cuddle afterwards
32
best method for caries detection?
visual assessment on clean dry teeth with good light, radiographs can supplement
33
how does carious enamel differ to healthy enamel in colour
carious is white colour-due damaged enamel prisms in teeth refracting light instead of letting it pass through healthy is 98% mineralised and almost transparent
34
what layer of tooth is affected if there is white, matt, opaque chalky lesion on tooth
enamel caries
35
what layer of tooth is affected if there is intact, transparent enamel with opalescent lesion
dentine caries
36
why must teeth be dry to assess caries
saliva fills pores in enamel and has similar optical properties to enamel restores translucency in teeth and therefore hides caries
37
opalescent enamel next to a stained fissure indicates what?
dentine lesion
38
what does white opalescent enamel at marginal ridge indicate?
proximal dentine lesion
39
how can you assess if an enamel lesion is active or arrested
imaging and radiographic monitoring over time run probe over surface - should feel smooth like sound enamel and not drag if arrested
40
how can you assess if a dentine lesion is active or arrested
imaging and radiographic monitoring over time drag excavator over surface - dentine should be shiny and hard if arrested - if soft and matt likely to be active
41
frequency of bitewings in children is based on what
individual caries risk
42
what do you say to a parent concerned about exposing their child to x-rays
reassure that the risk from dental x-rays are very low and greatly outweighed by the diagnostic benefit BW is equivalent to a few days of background radiation
43
how often can children at increased risk of developing caries get bitewings?
every 6-12 months
44
how often can children at standard risk of developing caries get bitewings
every 2 years
45
what can you do to aid visualisation of enamel proximal caries and assess cavitation
use orthodontic seperators
46
what is the triangular radiolucency on the mesial surface of maxillary Es and maxillary 6s that is often mistaken for proximal caries
cusp of carabelli
47
valid reasons to not take radiographs in primary dentition
spacing allows examination of contact points pre-cooperative
48
define MIH
molar incisor hypomineralisation is hypomineralisation of systemic origin affecting 1-4 first permanent molars frequently associated with affected incisors
49
how does MIH compromise restorative outcome
abnormal etching and bonding pattern
50
3 important things to ask about when taking child pain history
changes in sleep use of analgesia problems eating or drinking
51
3 indicators of dental infection
TTP in non-exfoliating tooth alveolar tenderness, sinus or swelling radio graphic signs
52
3 things to consider when assessing risk of caries causing pain or infection before exfoliation
time to exfoliation activity of lesion extent of lesion
53
are clinical exposures of vital pulp likely to cause infection before exfoliation
no
54
is a dark coloured hard lesion likely to cause infection/pain before exfoliation?
no
55
are clinical exposures of necrotic pulp several years before exfoliation likely to cause pain/infection
yes
56
10/10 plaque score meaning
perfectly clean tooth
57
8/10 plaque score meaning
plaque gingival margin
58
6/10 plaque score meaning
plaque covering cervical third of tooth
59
4/10 plaque score meaning
plaque covering middle third of crown
60
which tooth do you record the plaque score for in each sextant
worst tooth
61
9 factors of caries risk assessment
evidence of previous disease social history medical history dietary habits use of fluoride saliva plaque control
62
3 ways to reduce child anxiety
welcoming letter telling them what will happen and how to prepare child anxiety questionnaire e.g. MCDAS behaviour management
63
4 behaviour management strategies
tell show do enhancing control distraction relaxation
64
3 components of communication
non-verbal words tone
65
how can you enhance control
stop and go signals
66
describe a behavior management technique useful for school age or older
relaxation 3 deep tummy breaths and breathe out slow
67
what does SOARS stand for in motivational interviewing
seek permission open questions affirmations reflective listening summarising
68
how often do you give dietary advice to standard prevention and enhanced prevention
at least once a year for standard every recall visit for increased risk
69
how would you give toothbrush instruction to child and carer
smear or pea all cheek surfaces all biting surfaces all palate surfaces/tongue side use short scrubbing motion shh shh shh sound is good 2 minutes
70
diet advice for general health
low saturates low salt low sugar low fat 5 a day
71
when should you place fissure sealant on 6s
as early as possible after eruption
72
where should you apply fissure sealant - standard and high risk?
occlusal pits and fissures of 6s buccal pits of lower 6s palatal fissures of upper 6s in high risk - also palatal pits of upper 2s and occlusal and palatal surfaces of Ds Es and 7s
73
first choice material for fissure sealant
resin based e.g. bis-GMA resin
74
when do you use GI for fissure sealant
uncooperative pt where moisture control is an issue PE tooth
75
fissure sealant procedure
clean and dry tooth isolate tooth using cotton wool rolls, dry guards and mirror etch the tooth apply resin to etched enamel light cure check integrity with probe
76
what etch should you use for fissure sealant
phosphoric acid
77
how far up the cusp should fissure sealant be
covers a third of the incline of the cusp
78
how do you place a GI fissure sealant
dry tooth if possible place GI on one finger and petroleum jelly on other apply GI finger firmly for two minutes rapidly switch to apply petroleum over GI to avoid moisture contamination
79
what percentage is fluoride varnish
5%
80
many fluoride varnishes contain colophony - who is at risk of allergic reaction to colophony
a child who has been hospitalised due to severe asthma or allergy in last 12 months allergy to sticking plaster
81
what alternatives are there for children at risk of colophony allergic reaction
colophony free varnish
82
what is the fluoride content in duraphat varnish
22600ppm
83
what volume of duraphat is used in 2-5 year olds
0.25ml
84
what volume of duraphat varnish is used in 5-7 year olds
0.4ml
85
post fluoride varnish advice
soft foods and liquids can be consumed from 30 mins after application wait at least 4 hrs before brushing teeth or chewing hard food
86
what are the signs and symptoms of infection/abscess?
swelling, redness, lymphadenopathy sinus or abscess TTP Mobility
87
if child is not cooperative enough to accept any type of fissure sealant to seal occlusal caries, what should you consider?
hall technique
88
advantage if hall technique
avoids iatrogenic damage to teeth from rotary instruments
89
what factors influence the optimal outcome e.g. no spacing, of extraction of the 6 in an 8-10 year old
bifurcation of 7s seen on OPT 2nd premolars and third molars present on OPT mild buccal segment crowding class 1 incisor relationship
90
how do you manage early enamel caries and promote remineralisation
effective brushing demonstration diet advice fluoride varnish 4x a year
91
what is the aim of a hall crown
to seal a carious lesion to alter plaque biofilm environment to slow or arrest caries progression
92
when is a hall crown suitable
advanced lesion in occlusal or proximal surface
93
how do you fit a PMC
sit child upright assess if separators needed select correct size - do not seat past contacts prior to cementation fill with GI luting cement seat over tooth check crown seated evenly - get child to bite down remove excess cement and clear contacts
94
when would you use separators for a hall crown
broad tight contact between adjacent teeth mesial drift of decayed teeth
95
how many canals does a maxillary primary molar have
3 - 2 buccal one palatal
96
how many canals does a mandibular
2 - mesial and distal
97
what is a balancing extraction
an extraction of a contralateral tooth to avoid centre line shift and maintain symmetry for developing occlusion
98
when should you consider balancing extraction
when one c is to be extracted one c has exfoliated prematurely centre line shift is developing after d extraction
99
how can you reduce discomfort of LA in child
topical distraction very slow injection technique
100
associated risk of GA
risk of death 1 in 100,000 - very rare
101
when is GA considered
all less invasive options have been considered if not tried young children who need extensive treatment or are unable to comprehend how to behave for treatment can't manage with prevention until able to accept treatment
102
three stages of intervention for child protection
preventative dental team (single agency) response preventative multi-agency response child protection referral
103
initial signs for child protection referral
history of injury changes over time or doesn't not explain injury/illness unexplained injuries Childs behaviour with parent/carer
104
what may indicate dental neglect
delay in seeking dental advice when child has pain or infection severe untreated dental disease dental disease with significant impact on child failure to complete/attend for treatment
105
what is GIRFEC
getting it right for every child involves practitioners working together to promote, support and safeguard the well being of children and young people
106
what are the GIRFEC 5 questions
what is getting in way of child's wellbeing do I have everything I need to help child what can I do now to help child what can my profession do to help this child what additional help may be needed

SDCEP (8 decks)

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