Caries Risk Assessment and Prevention Flashcards
What are some risk factors to caries development?
- Previous caries experience
- Plaque/bacteria type
- Diet: Food Substrate, feeding habits (Time/Frequency of substrate intake, bottle feeding over night, sugary drinks)
- SE factors
- Oral hygiene
- Medical conditions (sugar based meds, dry mouth, special needs (lower access to care), defective glands)
- Enamel defect
- Level of parents’ education
- Geographic location (lack of F- and access to care)
What are some protective factors to caries development?
- Saliva
- Fluoride
- Remin agents
- Antimicrobial agents
- Brushing
What are some preventative measures to prevent childhood caries spread?
- Treating mother’s oral health to prevent vertical transmission
- Treat sibling’s oral health to prevent horizontal transmission
What are some available caries assessment tools?
- Caries management system (CMS)-Sydney
- CAMBRA (Caries Management by Risk assessment)
- AAPD: American Academy of Paediatric Dentistry
What are some preventative measures available in ADH?
- Antibacterials (chlorhex)
- Saliva test
- xylitol gum
- Sealants
- Fluoride
- Tooth mousse
What are some benefits and limitations of CAMBRA assessment tool?
-Some factors based on scienetific evidence
- No evidence of extent of success in individuals
- May not encompass all preventive/risk factors
- Lack of evidence to support population based preventative programs
- Success may be ‘temporary’, small overall reduction in population
- Should be modified to suit individual needs
- Only a tool, not a guaranteed solution
What preventative advice should be given to parents?
- Perinatal counselling
- Feeding practices
- Between meals snacking
- Brushing habits
- Interdisciplinary advice
- Growth and Development
What are the Australian guidelines for use of fluoridated toothpaste?
-Start brushing after first tooth erupts
0-17 months: brush without toothpaste
18months - 6 years: child toothpaste 400-550ppm
6 years +: 1000ppm standard adult toothpaste
However if high risk can bump up their dosage, e.g.
- 5 year old high risk goes straight to adult
- 3-4 year old high risk can just smear adult toothpaste over teeth–>preventative effect is greater than risk of getting fluorosis
- Note this only applies to motivated patients (if not brushing jsut get them to start)
When should fluoride mouthwashes be used in children? What is the fluoride concentration?
- Only above age of 6
- In high risk children at a time of day different from brushing–>no point straight after brushing as fluoride is already everywhere
- Use daily (Neutral NaF: 220-227ppm; acidulated NaF 200ppm)
- If lack motivation then use weekly neutral NaF 900-910ppm
What is the most effective method of professional fluoride application according to the literature?
-Fluoride varnish
How much fluoride is contained in fluoride varnish? How often should it be used?
22.3mg/mL
(22 300 ppm)
Used once every 6 months
What should you warn your patient about when applying fluoride varnish?
-It will feel sticky
What is the concentration of fluoride gel/foam? What are some restrictions of gel/foam usage? How is it applied?
Neutral NaF:
900-12 300ppm
Acidulated NaF:
12.3mg/mL
(12 300 ppm)
- Do not apply in kids less than 10 years of age due to risk of swallowing/fluorosis (fluoride varnish does not have this restriction)
- Put in trays and left in for 4 mintues, use suction with trays to reduce swallowing, re-apply every 6months
What are the usual toothpastes use and what are teh fluoride concentrations?
Kids:
Colgate (1-6): 400ppm
Macleans: 500ppm
Oral B: 500ppm
Adults
Colgate: 1000ppm
Colgate Total: 1450ppm
Neutrafluor: 5000ppm
What post-op instructions should be given after fluoride application?
No eating, rinsing or drink 30 minutes post application (but tell patient 1 hour)
What are the percentage reduction in caries of:
- Fluoride varnish
- Fluoride gel/foam
- Fissure sealants?
Varnish: 33% (about 1/3)
Gel/foam: 26% (about 1/4)
Fissure sealsnt: (50-87%) (over half)
What should you warn parents about when doing fissure sealants?
They won’t last forever
What is the toxic dose of fluoride?
3-5mg/kg in young children and frail adults–>GI problems
(thus in 2 year old weighing 10kg, 45g tube of toothpaste is the equivalent)
Lethal dose: 10mg/kg
(in 2 year old weighing 10kg, 90g tube of toothpaste is lethal)
*Warn parents to be careful of where they keep toothpaste
How should tooth mousse be used? What is the concentration of fluoride in toothmousse?
- As a last line, if patient is already doing the maximum, can add tooth mousse on top (this applies due to availability + pt motivation)
- Put over finger and wipe over teeth and leave overnight
- Good for enamel lesions, not dentine lesions
- Evidence limited vs fluoride applications
- Used with hyposalivation and white spot lesions
-Fluoride free
When should chlorhexidine be used in kids?
- High risk teenagers
- Otherwise not used often (it is hard enough to brush with kids, asking them to rinse with chlorhex will be harder)
- Use for 1 week at the start of each month, continue this routine for 3 months
