caries risk and prevention planning Flashcards
what is the definition of dental caries?
> Is a multifactorial, dynamic process caused primarily by the complex interaction of cariogenic bacteria with fermentable carbohydrates on a tooth surface over time
when does dental caries occurs?
> Caries occurs when the net demineralising flux prevails over the net remineralisation flux
what are caries risk factors?
> Caries risk factors are anything that affects this balance
what are the pathological factors that cause demineralisation?
> acid producing bacteria
> sub normal saliva flow and or function
> frequent eating/ drinking of fermentable carbohydrates
> poor oral hygiene
what are the protective factors that cause remineralisation?
> saliva flow and components
> remineralization (fluoride, calcium, phosphate)
> antibacterials (fluoride, chlorhexidine, xylitol)
> good oral hygiene
what is the caries risk in NI relative to England based CDHS 2013?
> obvious decay at 5years - England = 31%, NI = 40%
> obvious decay at 12 years - England = 32%, NI = 57%
> obvious decay at 15 years - England = 44%, NI = 72%
what was the impact of caries based on the CDHS 2013?
> 22 % of 12 year olds and 19% of 15 year olds respectively reported experiencing difficulty eating in the past three months.
> 35% of 12 year olds and 28% of 15 year olds reported being embarrassed to smile or laugh due to the condition of their teeth.
> 35% of the parents of 15 year olds reported that their child’s oral health had impacted on family life in the last six months
> 23% of the parents of 15 year olds took time off work because of their child’s oral health in that period.
when is a Childs first dental assessment?
> First assessment is when the first tooth erupts or by one year of age
what does comprehensive assessment of a patient social, medical, dental status allow you to determine?
> risk of developing caries
> also predicts rate of disease disease progression
what are some evidence based risk indicators based on the SDCEP 2018?
> Previous Caries experience (any decayed, missing or filled teeth)
> Visible plaque on maxillary incisors is excellent predictor in young children
> Caries in primary teeth increases caries risk in permanent teeth
> Resident in an area of deprivation
> Caries/restorations in anterior teeth
> Healthcare worker’s opinion
when should you carry out a caries risk assessment?
> Should be done regularly as can change/ is non static
> Caries risk assessment is undertaken as part of the history and examination and
> Determination of caries risk assessment should be undertaken before formulating a treatment plan
based on a history, what are some caries risk factors you should consider?
> Previous and current caries experience
> Significant Medical History e.g. Special needs, chronic ill health (increased risk of developing disease or increased risks associated with management of disease), regular sugar containing medication.
> Salivary flow, xerostomia, previous radiation
> Diet
> Drinks- Use of sweetened drinks regularly/bottle in bed
> Poor oral hygiene
> Fluoride usage
> Family caries experience (consider parents, siblings)
> SES and mother’s education
> Regular dental attendance
based on a dental exam, what are some caries risk factors you should consider?
> Visible plaque
> Gingivitis
> Hypomineralisation/ hypoplasia of enamel
> Deep pits/ fissures
> Defective restorations
> radiographic caries
When a child is too small for the dental chair, what is the solution for a dental exam?
> knee to knee exam
what are the principles of treatment planning in paediatric dentistry?
> Must be individualised
> Should foster a positive dental attitude
> Whilst aiming for adulthood with optimal dental health
> Realistic and flexible and achievable
> Must show empathy and focus on motivating parents and patients SCDEP 2010
what should each paediatric treatment plan comprise of?
> Relief of pain
> Prevention
> Behaviour Management / Acclimatisation
> Operative procedures
- Consider stabilization
- Logical treatment progression building on each previous visit
- Prioritise 6’s
> Recall and reinforcement of preventive advice
what age can a child brush there teeth on their own?
> 7
> they’ll only have the dexterity by then
when should caries risk be considered when treatment planning?
> Radiographic Investigations Frequency
> Preventive care/ Interventions
> Operative treatment
> Recall Intervals
what is the radiographic investigations frequency for a high caries risk patient?
High Caries Risk:
> 6-12 monthly bitewing radiographs until no new or active lesions are apparent
what is the radiographic investigations frequency for a low caries risk child?
Low Caries Risk Child:
> Bitewing radiographs taken at 12-18 month intervals in primary dentition and 2 year intervals in permanent dentition
when are baseline radiographs taken based of the SCDEP?
> Do base line bitewings from 4 years old, when contacts close – if not justify why you didn’t take them
what caries prevention care would you give a new parent with babies?
> If on a bottle, at night only water
> Never put juice, sweetened milk/soya milk in bottle- cultural variations
> X2 daily brushing with smear > 1000 ppm F tooth paste
> Stop bottle by 1 yo
> Reduce freq of sugary
drinks and foods
> Free flowing cups by 6 months
what advice should be given for children up to 3 years old in the prevention of caries based off the toolkit?
> breast feeding provides the best nutrition for babies
> from 6 months of age infants should be introduced to drinking from a free flow cup, and from age one year feel for a bottle should be discouraged
> sugar should not be added to weaning foods or drinks
> parents/ careers should brush or supervise brushing
> as soon as teeth erupt in the mouth, brush them twice daily with a fluoridated tp
> brush the last thing at night and on one other occasion
> use fluoridated tp containing no less than 1000ppm fluoride
> it is good practice to use only a smear of tp
> the frequency and amount of sugary food and drinks should be reduced
> sugar free medicines should be recommended
what advice should be given children aged 3-6 in the prevention of caries based off the toolkit?
> Brush at least twice daily, with a fluoridated toothpaste
> Brush last thing at night and at least on one other occasion
> Brushing should be supervised by a parent/carer
> Use fluoridated toothpaste containing more than 1,000 pm fluoride
> It is good practice to use only a pea size amount
> Spit out after brushing and do not rinse, to maintain fluoride concentration levels
> The frequency and amount of sugary food and drinks should be reduced
> Sugar-free medicines should be recommended
what professional intervention should be carried out in all children aged 3-6 for caries prevention based off the tool kit?
> apply fluoride varnish to teeth two times a year (2.2% Naf-)
what advice should be given to children aged 0-6 who are giving concern (eg those likely to develop caries, those with special needs) for prevention of caries based off the tool kit?
All advice for children aged 3-6 plus:
> Use fluoridated toothpaste containing
1,350-1,500ppm fluoride
> It is good practice to use only a smear or pea size amount
> Where medication is given frequently or long term request that it is sugar free, or used to minimise carlogenic effects
what professional intervention is needed for patients aged 0-6 giving concern for caries prevention based off the toolkit?
> Apply fluoride varnish to teeth two or more times a year (2.2% NaF-)
> Reduce recall interval
> investigate diet and assist adoption of good dietary practice in line with the eatwell plate
> Where medication is given frequently or long term, llaise with medical practitioner to request it is sugar free, or used to minimise cariogenic effects
what advice would you give patients aged from 7 and above in the prevention of caries based off the toolkit?
> Brush at least twice daily, with a fluoridated toothpaste
> Brush last thing at night and at least on one other occasion
> Use fluoridated toothpaste (1,350-1,500pm fluoride)
> Spit out after brushing and do not rinse, to maintain fluoride concentration levels
> The frequency and amount of sugary food and drinks should be reduced
what professional intervention is needed for children aged 7 years and older for the prevention of caries based off the toolkit?
> apply fluoride varnish to teeth two times a year (2.2% NaF-)
what are patients giving concern to the dentist based off the tool kit?
> those with obvious active decay
> ortho appliances
> dry mouth
> other predisposing factors
> those with special needs
what advice would you give to patients over 7 years old giving concern to the dentist for the prevention of caries based off the toolkit?
> all of the points for above 7 plus =
> use fluoride mouth rinse daily (0.005% NaF-) at a different time to brushing
what professional intervention is required for patients showing concern over the age of 7 based for the prevention of caries based off the toolkit?
> Fissure seal permanent molars with resin sealant
> Apply fluoride varish to teeth two or more times a year (2.2% NaF-)
> For those 8 years upwards with active caries prescribe daily fluoride rinse
> For those 10+ years with active caries prescribe 2800 ppm fluoride toothpaste
> For those 16+ years with active disease prescribe either 2,800ppm or 5,000ppm fluoride toothpaste
> Investigate diet and assist to adopt good dietary practice in line with the eatwell plate
how can caries risk effect operative treatment?
caries risk may affect =
> Possible need for stabilisation stage
> Material choice in proximal lesions
- Pulp Rx/conventional PMC
- Hall Crown - (cavitated IP decay)
- Composite
- RMGIC
- Extraction - (multiple pullpally involved teeth)
( - Non cavitated decay – consider fs)
( - Cavitated occlusal decay consider ART)
