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
