Caries prevention and management Flashcards
(23 cards)
Contra-indications for the hall technique
Signs/ symptoms of irreversible pulpitis
Clinical/ radiographic signs of pulpal involvement/ pulpal exposure/ peri-radicular pathology
Crowns so broken down they might normally be considered un-restorable
Indications for the hall technique
Co-operative patient
Non-cavitated/ cavitated occlusal lesions where the patient is unable to accept - FS, partial caries removal or a conventional restoration
Proximal lesions - cavitated/ non-cavitated
How often should you give toothbrushing advice and instruction for standard vs enhanced prevention?
Standard - once a year for both
Enhanced - at every recall visit
When and what teeth should have FS for standard prevention?
Place sealants in ALL pits and fissures of FPM as soon as possible after eruption.
Check integrity of sealants at every visit and top up as required
When and what teeth should have FS for enhanced prevention?
FS all first and second permanent molars, and palatal pits on upper lateral permanent incisors, occlusal and palatal surfaces of D’s and E’s
Check integrity of sealants at every visit and top up as required
How often should sodium fluoride varnish be applied for standard prevention?
Applied twice a year to children 2 years and up
How often should sodium fluoride varnish be applied for ENHANCED prevention?
Apply 4 times per year for children 2+
What are the fluoride preparations in toothpaste that should be recommended for STANDARD prevention?
under 3 years - smear of toothpaste minimum 1000ppm fluoride.
3-6 years - pea-sized amount of toothpaste, minimum 1000ppm fluoride
7+ - pea-sized amount toothpaste 1350ppm-1500ppm fluoride
What are the fluoride preparations in toothpaste for ENHANCED prevention?
Recommend use of 1350-1500ppm fluoride toothpaste for children up to 10 years old
Prescribe 2800ppm high fluoride toothpaste children 10-16 years old
5000ppm for 16+
What is the function of SDF?
De-sensitisation of non-carious tooth lesions
Arrests caries
Indications for SDF?
Active dentinal carious lesions that are easily cleansible
Teeth with exposed root surfaces causing dentine hypersensitivity
MIH
Pre-co-operative children
Good OH
What are the contra-indications for SDF?
Pulpal pain
Dental abscess/ infection
Radiographic signs of pulpal invovlement or PA pathology
What are the advantages of SDF?
Can maintain space in primary dentition if it avoids extraction
Useful for improving co-operation in pre-co-operative children
May avoid extractions/ invasive dental procedures
Quick
Avoids LA
Painless
Disadvantages of SDF?
Aesthetics - stains carious portion of the teeth black
Difficult to monitor success
Relies to some extent on cleansability of the lesion and patient’s OH
How often is recall appointment for standard vs. enhanced?
Standard - 12 months
Enhanced - every 3-6 months
What are the 7 components of the caries risk assessment?
sausage dog acronym!!
Can someones feed my overweight sausage dog
Clinical evidence of previous caries
Social history
Fluoride use
Medical history (including medications)
Oral hygiene
Salivary buffering
Dietary habits
What are the 8 elements of the preventative caries programme?
xtra old teeth vanish, so dentist’s fix mouths
Xtra old teeth vanish, so dentist’s fix mouth
X-rays (radiographs)
OHI
Toothpaste (fluoride strength)
F Varnish
Supplementation (F)
Diet advice
Fissure sealants
MH/ medication
Presentation of nursing bottle caries
- Most commonly affects upper anterior teeth, D’s and lower canines (lower anterior teeth generally unaffected as protected by tongue during sucking of bottle and saliva from sublingual salivary gland)
- White spots on teeth (typically near the gum-line)
- Can progress to brown/ black cavitation very quickly
Pain/ sensitivity (dependant on age, child may present with not wanting teeth brushed, struggling to eat etc.)
Aetiology of nursing bottle caries
Going to bed with a bottle containing anything other than water (including baby milk formula)
Poor OH + unassisted by parent
Using a bottle rather than free-flow spout
Nursing bottle caries history - what to ask parent
- Take pain history if relevant
- Where is the pain?
- When did the pain come on/ when did you notice appearance of teeth?
- Probably unable to describe character - too young
- Any other issues?
- How long does the pain last?
- Any analgesia? How much and does it work? Within limits?
- Feeding bottle to bed?
What is in the feeding bottle?
What do you explain to the parent of a child with nursing bottle caries about how it occurs?
- Bottle delivers liquid slowly and prolongs contact with teeth
- Less saliva at night time - protective function decreased
- Suckling on bottle keeps sugary liquid pooled around upper front teeth
High sugar content in baby milk formula
What advice to give parent re nursing bottle caries
- Free-flow cup to replace bottle from 6 months
- No feeding overnight - only water if you have to
- Limit sugar intake - water only between meals (plain, un-sweetened milk OK with meals but still some sugar so not all the time as can contribute to decay, definitely no milk overnight)
- Minimise sugary drinks/ snacks - safe snacks = cheese, breadsticks, fruit, plain crisps
OHI - ENHANCED PREVENTION
Depending age of child
<3 years = 1450ppm smear
>3 years = 1450 pea
Assisted brushing until 7+
Brushing once any time during day, last thing at night - NO FOOD/ DRINK AFTER THIS
Spit don’t rinse
What management (other than general advice) may be considered for someonw with nursing bottle caries?
- Extraction of carious teeth if required (discuss GA + risks vs benefits)
- GIC restorations
- Fluoride varnish
SDF
