Caries Symposium 4 Flashcards
What are dental caries?
- A disease of the dental hard tissues caused by the action of microorganisms, found in plaque, on fermentable carbohydrates
What are possible impacts of caries on pre-school children? (4 points)
- Aesthetic problems
- Loss of function
- Pain
- Infection
What is the population skew of caries in Scottish children an d what is this strongly related to?
- Population skew - 25% of Scottish children have 75% of the disease
- Strongly related to poverty
What are various risk indicators for predicting the caries risk of children? (8 points)
- Oral hygiene
- Diet
- Bacterial exposure
- Socioeconomic status
- Breast/bottle feeding
- Fluoride exposure
- Parental smoking
- Parental oral hygiene status
Which teeth does early childhood caries/nursing caries usually affect?
- Upper anterior and molar teeth
What is a typical cause of the presence of nursing caries?
- Inappropriate use of feeding cups and bottles
What are the three main factors that will prevent the production of caries?
- Diet
- Fluoride
- Oral hygiene
In pregnancy, is there a benefit to the child of taking fluoride supplements?
- No
- Fluoride will not cross the placenta enough to be effective
Should the dental team support and promote breastfeeding and what advice should they give?
- Yes
- Dental advice: try to wean the child off of breastfeeding after a year and stop on-demand feeding at night after 4-6 months once the baby does not need it anymore
What should be recommended to use for a child after the age of 6 months, a feeding cup or a bottle?
- A feeding cup with a free-flow spout
What types of drink should never be put in a feeder bottle?
- Drinks containing free sugars
Should children be put to bed with a feeder bottle or cup?
- No
Which type of milk formula is potentially cariogenic and should only be used when medically indicated?
- Soya milk formula
- Needed for children who are lactose intolerant
The use of sweetened drinks should not be advocated but where there us a strong suspicion they are being used, what advice could you give the patient to reduce the harm to the teeth? (3 points)
- Mealtimes only
- Dilute them as much as possible
- Take them through a straw which should be held at the back of the mouth (the straw should be on top of the tongue to keep it away from anterior teeth)
In respect to food and confectionary containing free sugar, what advice should be given to prevent their harm to the teeth? (3 points)
- The consumption should be minimised and restricted to mealtimes only
- Dietary advice should encourage the use of non-sugar sweeteners, in particular Xylitol
- Patients should be encouraged to use sugar-free chewing gum, particularly containing Xylitol
When prescribing medicine to patients, what should the dentist ensure to include on the prescription in respects to sugar?
- They should prescribe sugar-free medicines whenever possible and should recommend the use of sugar-free forms of non-prescription medicines
- Have to write S/F on prescriptions to ensure it is sugar free
What drinks are safe to drink between mealtimes and what should you specify to the patient about these? ( 4 points)
- Plain Water
- Plain milk
- Tea and coffee
- Make sure that you say plain because if you don’t they may go and buy flavoured milk etc which is full of sugar
Sugar free medicines should be requested where available, where not available, when is it suggested the patient takes them? (2 points)
- Doses should be given at mealtimes
- Never give after toothbrushing at night
What is a good high energy food for toddlers, which is no n-cariogenic and may actively protect against caries? However, what are the health issues from eating too much of this food?
- Cheese
- Can’t eat too much of it as there are issues with a high salt and fat content
Are sugar free snacks likely to be cariogenic?
- No
What is preferable to eat? confectionary and beverages containing sugar substitutes or those containing sugar?
- Sugar substitutes
Give a list of safe snacks, that you can suggest to patients as an alternative to high sugar snacks? (6 points)
- Milk/water
- Fruit (fresh)
- Savoury sandwitches
- Crackers and cheese
- Bread sticks
- Crisps ( tricky one, if trying to give child something that is going to harm their teeth like sweets, crisps are probably a better alternative, however crisps with a shape or with a lot of flavouring will also have more sugar in it)
How many days should a diet diary be?
- 4 days, at least one day should be a weekend
What 4 ways can fluoride be given?
- In water
- Toothpaste
- Supplementary self-delivered
- Professionally delivered
What are the different forms of supplementary self-delivered fluoride? (3 points)
- Drops (seldom now used)
- Tablets (seldom now used)
- Mouthrinse
What are the different ways fluoride can be professionally delivered? (3 points)
- APF gels (seldom used)
- Varnishes (should be applied to all children at least twice yearly)
- Slow-release devices
How many people worldwide receive fluoride in the water?
300 million
How many people in the UK receive fluoride in the water?
5.5 million
What is the optimum level of fluoride when in water sources?
1.0ppm
Is water fluoridated in Scotland?
- No
When should toothbrushing be started?
- As soon as the first primary teeth erupt
At what age could it be thought that a child can brush their own teeth?
- Around 7/8
At what times of day should a young child have their teeth brushed?
- Before bed
- At one other time in the day
What is the concentration of fluoride in ‘child’ formula toothpastes? (2 points)
- 450-600ppm (not recommended in Scotland)
- 1000ppm (aquafresh milk teeth)
What is the concentration of fluoride in standard fluoride toothpaste?
- 1400-1500ppm (colgate total, aquafresh little teeth and big teeth)
What is the concentration of fluoride in enhanced fluoride toothpastes?
- 2800ppm (duraphat toothpaste)
- Have to have a prescription for this
What is the suggested fluoride concentration in toothpaste from first tooth eruption - 3 years for standard risk kids?
1000ppmF
What is the suggested fluoride concentration in toothpaste for standard risk kids 4 - 16 years?
1000-1500ppmF
What is the suggested fluoride concentration in toothpaste for high risk children under the age of 10?
1500ppmF
What is the suggested fluoride concentration in toothpaste for high risk people aged 10 and over?
2800ppmF (prescription only)
What is the suggested fluoride concentration in toothpaste for high risk people ages 16 and over?
- 5000ppmF (prescription only)
How much toothpaste would you use when brushing the teeth of children under the age of 3?
- A smear of toothpaste
- Following this recommendation will decrease the risk of mild fluorosis
How much toothpaste would someone aged 3 and over put on their toothbrush when brushing?
- A pea sized amount
- Following this recommendation will decrease the risk of mild fluorosis
What should you do with excess toothpaste when brushing?
- Spit out excess, do not rinse
What is more effective when brushing teeth with a fluoride toothpaste: manual or electric toothbrush?
- Both effective when using a fluoride toothpaste but Cochrane review indicated that tooth brushing is more effective when using a powered brush with a small round, oscillating head compared to a manual brush
What is the tolerable daily volume of toothpaste (mls) ingestion for children aged 1-3 (13kg) at 1000, 1500 and 2800ppmF?
1000 - 1.3mls
1500 - 0.86mls
2800 - Not recommended
What is the tolerable daily volume of toothpaste (mls) ingestion for children aged 4-8 (22kg) at 1000, 1500 and 2800ppmF?
1000 - 2.2mls
1500 - 1.46mls
2800 - not recommended
What is the tolerable daily volume of toothpaste (mls) ingestion for children aged 9-13 (40kg) at 1000, 1500 and 2800ppmF?
1000 - 10mls
1500 - 6.7mls
2800 - 3.6mls
When working out fluoride toxicity in a child what do you need to know about them? (3 points)
- Weight of child
- How much they have swallowed
- Strength of the toothpaste
If someone has had a toxic dose of <5mg/kg of fluoride what should you do?
- Give calcium orally (milk) and observe for a few hours
When using a manual brush to brush teeth, what should the head of the brush be like?
- Small headed brush
What percentage of interproximal caries are missed if bitewing radiographs are not taken?
- 60%
How often should you take bitewing radiographs for low risk children?
- Every 12-18 months
How often should bitewing radiographs be taken for high risk children?
- Every 6 months
What are different techniques that can be used to diagnose caries? (7 points)
- Clinical exam
- Bitewing radiographs
- Fibre-optic trans illumination
- Temporary tooth separation
- Air abrasion
- CO2 laser
- Electric caries meter
What do oral health promotion programmes aim to do? (4 points)
- reduce risk of childhood caries
- For young children should be initiated before they’re 3
- Should address environmental, public and social policy changes in order to support behaviour change
- Help of lay persons and non-dental health professionals
What is health education?
- It is a process that results in individuals or groups having increased knowledge related to health
What are the community based prevention methods for caries prevention?
- Health education
- Health promotion
How often should fluoride varnish be applied for pre-school children assessed as being at increased risk of caries?
- At least twice yearly
For high risk caries children how often may fluoride varnish be applied?
- Every 4-6 months
Which children would you have concerns about applying fluoride varnish on to?
- Children that are asthmatic or have quite a lot of allergic reactions
What ages are not recommended to take fluoride mouth rinse’s?
- Under the age of 6
- Even over 6 need to be assess the child’s ability to properly expectorate
Previously, it was considered standard practice to administer and emetic and induce vomiting after someone has ingested a toxic dose of fluoride, why does modern protocol advise against this?
- Due to the risk of aspiration of vomitus
If someone has had a toxic dose of >15mg/kg of fluoride what should you do?
Admit to hospital immediately, cardiac monitoring and life support, intravenous calcium gluconate
If someone has had a toxic dose of 5-15mg/kg of fluoride what should you do?
Give calcium orally (milk, calcium gluconate, calcium lactate) and admit to hospital
What is another name for early childhood caries?
-Blank-
