Childhood caries and caries risk assessment Flashcards
What contributes to high caries risk (6)?
Medical history Dietary habits Clinical evidence Social History Plaque control Use of fluoride
What aspects of medical history can make an individual a high caries risk? (4)
Medically compromised
Physical disabilities
Xerostomia (drug side effect)
Long term cariogenic medicine (try and prescribe sugar free)
What aspects of dietary habits can make an individual a high caries risk? (2)
Frequency of sugar intake
Frequency of in between meal snacking
(Stephens curve)
What aspects of clinical evidence can make an individual a high caries risk? (6)
Presence of new carious lesions Premature extractions Anterior caries or restorations Multiple restorations No fissure sealants Fixed orthodontic appliance
What aspects of social history can make an individual a high caries risk? (6)
Social deprivation High caries in siblings/ parents Low knowledge of dental disease Irregular attendance Readily available snacks Low dental aspirations
Which aspects of plaque control can make an individual a high caries risk? (2)
Infrequent / inefficient cleaning
Poor manual control
Which aspects of us of fluoride can make an individual a high caries risk? (3)
Drinking unfluoridated water
Using low/no fluoride toothpastes
No fluoride supplements (n.b. not routinely given to children)
What can be the serious consequences of caries in children? (2)
Block airways (due to inflammation) Stop eating/ drinking due to pain = dehydration, become very ill and death
What are the aims of caries risk assessment?
At treating the disease process rather than the outcome of the disease
What does caries risk assessment enable the dentist to do?
Individualise treatment - select and determines the frequency of preventative and restorative treatment offered for a patient
Enables anticipation of caries progression or stabilisation
What are the names of the 3 different epidemiological sources of information for paediatrics?
Children dental health survey
BASCD survey
National dental epidemiology programme for England, oral health survey of 5 y/o children
Tell me about the child dental health survey…
Done once every 10 years
The first one in 1973 (the most recent is 2013)
Tell me more about the BASCD survey…
2 year rolling programme
What was identified by the BASCD survey?
Regional differences are clear (and the same as previous)
Shown continuing overall improvements in decay in permanent teeth
No significant reduction in decay experience in primary teeth
No improvement in care index (proportion of children who have had treatment for their decay)
What was identified by the child dental health survey?
Obvious decay slightly decreased from 2003
50% 8 and 15 y/o have decay
Proportion of filled 5 y/o teeth has decreased
Caries experience with D3MFT across regions for 5y/o = NI - 61%, Wales - 52% and England - 41%
2/5 of 15 y/o have experienced problems related to the condition of their teeth or mouth
Severe or extensive tooth decay = NI - 19% 5 y/o and 36% 15y/o, Wales - 22% age 5 and 15, England - 13% 5 y/o and 14% 15 y/o
What was identified by the national dental epidemiology programme for england, oral health survey of 5 y/o children (2012)?
Overall tooth decay in 5 y/o has decreased from 30.9% to 27.9% since 2008
Proportion of children w/ untreated decay has decreased from 27.5% to 24.5% since 2008
Children w/ sepsis in their mouths has decreased from 2.3% to 1.7% since 2008
72.1% of 5 y/o are free from tooth decay (increase from 69.1% in 2008)
What is Early Childhood caries (ECC)?
The presence of at least 1 decayed (non cavitated or cavitated lesion), missing (due to caries) or filled tooth surfaces in any primary tooth in a child 71 months of age (just under 6 y/o) or younger
What is the most common type of early childhood caries?
Bottle caries
Why does the incidence of caries increase when children go to secondary school?
They get tuck shop money or walk pat the corner shop on their way in and buy sweets and fizzy drinks
Why is disclosing very good to help improve a childs brushing?
Often it is the same place that we miss and disclosing highlights this area for us
What are the dental issues related to cleft?
Increase in crowding = more difficult to brush teeth
At what age should oral hygiene start?
As soon as teeth erupt (this decreases risk of early childhood caries)
What is used to make oral hygiene more effective?
Small headed toothbrush with soft, round ended filaments, a compact angled arrangement, both long and short filaments with a comfortable handle
Which type of toothbrushes are the most effective (in removing plaque and decreasing gingivitis after 3 months of use)?
Oscillating rotating powered toothbrushes (rechargeable better than battery powered)
What are the different preventative strategies (7)?
Diet Fluoride (Radiographs) Fissure sealants Oral hygiene CPP-ACP Prevention of maternal s.mutans (e.g. sharing spook and licking off dummy etc.)
At what age should infants be encouraged to drink from a cup?
1 y/o
weaning from bottle 12-18 months
What are the different causes of Early childhood caries (ECC)?
Frequent consumption of drinks containing sugars in a bottle (bottle caries)
Long periods of exposure to cariogenic substrate
Low salivary flow at night
Parental history of active untreated caries
At what point does breast feeding at will become a risk for ECC?
Once teeth start coming trough
Should try and decrease frequency (natural source of sugar = 7% lactose)
What is the characteristic appearance of bottle caries?
No caries from lower c to c (bottle goes over tongue and salivary ducts)
What % of children having primary teeth xla under GA come back to have their 6’s removed?
50%
What are the characteristics of Early childhood caries (ECC)? (4)
Rampant caries (maxillary ant teeth)
Lesions appearing on posterior teeth later on
Canines usually less effected than incisors (later eruption)
Bottle often used as a pacifier to sleep
What are the consequences of Early childhood caries (ECC)?
Increased risk of new carious lesions
Increased treatment cost and time
Risk for delayed physical growth and development (if stop eating or drinking properly)
Loss of school days and increased days w/ restricted activity
Diminished oral health related quality of life
Hospitalisation and emergency room visits
How do we manage Early childhood caries (ECC)? (4)
Cessation of habit (dietary advice - i.e. diluting the milk gradually until all water)
Fluoride application
Build up of restorable teeth and xla if required (often under GA)
ADVICE ABOUT ECC NOT BLAME
What is the aetiology of Early childhood caries (ECC)?
Multifactorial
Related to frequent consumption of sugared drinks, often in a bottle or dinky cup
Night time usage associated w/ increased caries (decreased salivary flow = decreased buffering)
Milk = natural source of sugar
If weaning is difficult bottle feeding is often prolonged (need extra calories to grow)
Children who don’t sleep well being given bottle as comforter (difficult to break habit)
Linear enamel defects may be associated w/ increased risk
Prolonged on demand breast feeding
Why is it harder to keep teeth clean in individuals with amelogenesis imperfecta (AI)?
Tooth surface rough
Sensitive teeth
At what point is success at a review achieved? (5)
If bottle has stopped If OH practices have changed No progression of disease No new lesions Caries show signs of arrest (dark and hard)
How should you explain the diagnosis of Early childhood caries (ECC) to the mother?
Show affected teeth
Explain relationship between frequency and duration of contact between sugars and teeth
Explain what happens when teeth are in contact with sugars
Explain which drinks have sugar in them (including fruit juice)
Explain that during the night = increased damage due to less saliva (even milk is a problem at night)
What are the 3 main things about your mouth increase you caries risk?
Unsealed deep pits and fissures
Low saliva
Wearing intraoral appliance (fixed/partial dentures)
What makes an individual low caries risk (6)?
Fluoridated drinking water Brush teeth 2 X daily with 1000ppm + fluoride toothpaste Regular dental care Child is caries free Child has
What makes an individual high caries risk (6)?
Previous caries experience Poor oral hygiene Low socioeconomic status Medically compromised Night time drinks containing sugar (even milk) 3 + between meal sugar contacts per day
