Caries Prevention

Question 1

Describe early childhood caries

Answer 1

Also known as nursing caries

Typically affects the upper anterior and molar teeth

Question 2

What is the typical cause of nursing caries

Answer 2

Inappropriate use of feeding cups and bottles

Question 3

What are the main methods of caries prevention

Answer 3

Diet
Fluoride
Oral hygiene

Question 4

What benefit is there of pregnant women taking fluoride supplementation

Answer 4

None

Question 5

What should be recommended in terms of feeding bottles

Answer 5

Use a free-flow spout cup rather than bottle from 6 months
Drinks containing free sugars should never be put in a feeder bottle
Children should not be put to bed with a feeder bottle
Soya milk formulation is potentially cariogenic and should only be used when medically indicated

Question 6

What is recommended in terms of sweetened drinks

Answer 6

The use should not be advocated but where there is a strong suspicion they are begin used:

• mealtimes only
• dilute as much as possible
• take through a straw which should be held at the back of the mouth

Question 7

What drinks are safe to have between meals

Answer 7

Water and milk

Question 8

What is recommended in terms of sugar free medicines

Answer 8

Should be requested when available, where not, doses should be given at mealtimes and never after tooth-brushing at night

Question 9

Describe cheese as a snack

Answer 9

Good, high energy, non-cariogenic and may actively protect against caries

Question 10

What are safe snacks

Answer 10

Milk/water
Fruit
Savoury sandwiches
Crackers and cheese
Bread sticks

Question 11

What are the different sources of fluoride

Answer 11

Water
Toothpaste
Supplementary self-delivered - mouthwash
Professionally delivered - varnishes and slow/release devices

Question 12

Describe ideal tooth brushing in children

Answer 12

Should be started as soon as the first primary teeth erupt
Children under 8 lack the dexterity to brush their own teeth effectively
Young children should have their teeth brushed by an adult before bed and one other time in the day
Older children unable to brush their teeth effectively should be assisted

Question 13

What fluoride strengths are found in different toothpastes

Answer 13

Child formulations (not recommended) - 450-600 ppm
Child formulations - 1000ppm
Standard fluoride - 1400-1500 ppm
Enhanced fluoride (dura-hat) - 2800ppm

Question 14

What toothpaste strength recommendations should be given

Answer 14

First tooth eruption - 3 years - 1000 ppm
4-16 years - 1000-1500 ppm
High risk children under 10 - 1500ppm
High risk 10 and over - 2800 ppm (prescription only)
High risk 16 and over - 5000ppm (prescription only)

Question 15

How should fluoride toxicity be managed

Answer 15

By dosage
<5mg/kg - give calcium orally (milk) and observe for a few hours
5-15mg/kg - give calcium orally (milk, calcium gluconate, calcium lactate) and admit to hospital
>15mg/kg - admit to hospital immediately, cardiac monitoring and life support, IV calcium gluconate

Question 16

How should dental floss be used

Answer 16

In combination with brushing with fluoride toothpaste

For those with ortho/fixed pros, gingival recession - interdental cleaning may be a better option

Question 17

How can fluoride supplementation be given

Answer 17

Drops - from spoon
Tablets:
6m - 3y - 0.25mg/d
3y - 6y - 0.5mg/d
6y+ - 1mg/d

Question 18

What is recommended for fluoride mouthwash

Answer 18

Not recommended for children under 6

Even over 6, need to assess the child’s ability to properly expectorate

Question 19

Describe practice based prevention

Answer 19

Topical fluoride varnish should be applied to the dentition at least twice yearly for pre-school children assessed as being at increased risk of caries
Floss between contact areas
Fluoride varnish can be administered for high risk adults

Question 20

Describe health education

Answer 20

A process that results in individuals or groups having increased knowledge related to health

Question 21

Describe health promotion

Answer 21

Supports individuals into translating their health knowledge into positive behaviours and lifestyles

Question 22

Describe oral health promotion programmes

Answer 22

Aim to reduce the risk of early childhood caries, should be available for parents during pregnancy and postnatal
For young children should be initiated before the age of 3
Should address environmental, public and social policy changes in order to support behavioural change
Help of lay persons and non-dental health professionals

Question 23

How should radiographs be used in caries prevention

Answer 23

Bitewings every 6 months for high risk children
Every 12-18 months for low risk
60% of interproximal caries are missed if you do not take bitewings