Caries prevention Flashcards
What are some preventive interventions required for all children?
- Encourage parents/carers to register child with dentists as early as possible, before or as soon as first tooth appears and attend regular
- Ensure all children receive Standard prevention appropriate to age
- If child at increased risk of developing caries, in addition to Standard prevention ensure they get Enhanced Prevention
- When giving preventative advice, ensure both child and parent/carer is involved in discussion
- After relief of any pain, carry out preventive interventions for permanent teeth before treatment of primary (e.g. fissure seal first permanent molars before managing carious primary teeth)
What is a key recommendation and what evidence is there for it?
- Provide all children with personalised oral health promotion advice
- SIGN guideline 138
- Facilitate daily toothbrushing with fluoride toothpaste
- Based on recognised oral health behaviour theory and models
- Be specific to individuals and tailored to their needs and circumstances
What are the five steps for health behaviour change using motivational interviewing?
Step 1
- Explore current practice and attitude using a motivational interviewing approach
- Gain empathy (SOARS)
Seek permission
Open questions
Affirmations
Reflective listening
Summarising
- Develop discrepancy, roll with resistance
- Elicit change talk
Step 2 - Educational intervention
- Improve knowledge and skills
Step 3 - Action Planning
- Set time, date and place to start
Step 4 - Encouraging habit formation
- Achieve sufficient repetition
Step 5 - Repeat at each recall visit
How do you develop an individualised action plan to encourage Childs habit formation?
- Identify good time and place for preventative behaviour to start e.g. toothbrushing after breakfast and last thing at night
- A date (ideally from day of appointment) and who will carry it out
- Identify a trigger to remind child/parent/carer when to carry out e.g. when child gets ready for bed
- Agree a date to review
- Agree action plan and write down for child/parent if necessary
- Record in notes
- At next visits, encourage and give further support whilst reviewing current, change if needed
- Assess parent/ carer or childs ability to comply with action plan, if in doubt collab with other healthcare professionals like school nurse, childsmile dental health support worker and include in action plan
What is a key recommendation regarding toothbrushing?
- Encourage and support all children to brush their teeth or have teeth brushed for them at least twice a day using fluoride toothpaste
Recommend
- Use of amount of toothpaste and fluoride conc suitable for childs age and caries risk level
- Supervised brushing until child can brush his/her teeth effectively
- Children don’t rinse mouth after toothbrushing (spit don’t rinse)
What is the fluoride toothpaste recommended for child under 3 years?
- Use a smear of toothpaste
Standard risk = Standard prevention = 1000-1500ppmF-
Increased risk = Enhanced prevention = 1350-1500ppmF-
What is fluoride toothpaste recommendation for child aged 3 and over?
- Use pea-sized amount
Standard risk = Standard prevention = 1000-1500ppmF-
Increased risk = Enhanced prevention = 1350-1500ppmF- (Age 10+ consider 2800ppmF-)
What are the Standard Prevention recommendations for Fluoride toothpaste for all children?
- At least once a year advise or remind child and parent/carer all of these recommendations
- Brush thoroughly twice a day, first thing in morning and last at night (no food or drink after nighttime)
- Use age appropriate toothpaste containing fluoride
- Spit don’t rinse
- Supervise young children until they can brush teeth effectively
- Demonstrate toothbrushing on child for approx 3mins annually
- Use action planning to encourage toothbrushing
- Advise parent/carer to start brushing as soon as first primary tooth erupts
- Advise parent/carer not to allow child to eat or lick toothpaste
- Emphasis to teenagers importance of reg brushing or oral health and additional positive effect on appearance and general health
What are the Enhanced Prevention recommendations for Fluoride toothpaste for children at increased risk of caries?
- At each recall visit provide Standard Prevention toothbrushing advice
- Give hands on brushing instruction approx 3 mins to child and parent/carer at each recall visit
- Consider additional preventative interventions e.g. 1350-1500ppmF- for up to 10years and prescribe 2800ppmF- for 10-16years for limited period. Reg review required
- Utilise community/home support for toothbrushing that is available locally e.g. health visitor, school nurse, Childsmile dental health support worker
What is involved in the toothbrushing instruction technique?
- Empathise with parent/carer how hard it can be to brush small children teeth but give advice and reinforce importance
- Choose whether all same surfaces of one arch are brushed before moving on to another or all surfaces of a sextant of the mouth
- Demonstrate technique with child using mirror and ask them to show you on themselves or a toy teeth set
- Instruct short, scrubbing motion
- Two minutes and using a timer can help motivate child
- Eating or drinking something acidic then wait 30mins before brushing
- When first or second molars partially erupted empahsise getting occlusal surface as this can be missed
- Will child benefit from disclosing tablets or brushing charts where it can be recorder
- Consider providing free toothbrush and free toothpaste to children at increased risk
What is a key recommendation regarding diet in caries prevention?
- Advise all children and parent/carer about how healthy diet can help prevent caries, at intervals determined by their risk of developing dental caries
What is the Standard prevention dietary advice given to all children?
- At least once a year advise or remind about how healthy diet can help prevent caries including;
- Limit consumption of food and drinks containing sugar (less acid-attack)
Drink only water or milk between meals
- Cows milk virtually non-cariogenic
- Drinks with free sugars increases risk of caries
- Breastfeeding only recommended for first 6months, with appropriate supplements introduces up to 2years or beyond
- Full fat cow milk from 12months, after age of 2 can introduced semi-skimmed
- Skimmed milk only suitable for over 5years as it contains too few calories and minimal vit A
- Snack on healthier foods, low in sugar
- Don’t place sugary drinks, fruit juices, sweetened milk or soy formula in feeding bottles of pacifiers (only water at bedtime)
- Don’t eat or drink apart from tap water after brushing at night
Be aware hidden sugars in food
- Processed foods bad as contain free sugars
- Be aware acid content of drinks and restrict carbonated drinks to meal times
On food labels what is a high sugar content?
> 22.5g/100g in food
11.25g/100ml in drinks
- may be coloured red
On food labels what is a low sugar content?
<=5g/100g in food
<=2.5g/100ml in drinks
What are the Enhanced prevention dietary advice for children at increased risk of caries?
- Provide standard prevention advice at each recall visit, some may need more in-depth support such as motivational interviewing
Assess if beneficial to have;
- Diet diary over 3-5 day period with at least one at weekend
- Action planning to encourage change
- Utilise any community/home support for dietary change that’s available locally
