Clinical aspects of prevention Flashcards
Give examples of professional preventative methods we can use
- Diet diary
- Nutritional sport
- Behaviour modification
- Engaging patients
- Plaque scores
- Oral health guidance and support
- Fissure sealants
- Fluoride varnish
how can we identify a patients risk factors
- Medical hits
- Social history
- Saliva flow
- Dietary habits
- Exposure to fluoride
- Clinical evidence of previous caries
- Siblings
For behavioural cadges to be successful what must you tell the patient?
The severity of the outcome if they do not change their habits
How susceptible they are to negative consequences
What can we use to emphasise the patients the importance of effective plaque removal?
Plaque disclosing tablets
What do you need for dental caries to form and progress?
- Bacterial plaque
- Tooth surface
- Refined carbohydrates
- Time
What can we do if we have identified a patient as high risk fro dental caries?
- We can use duraphat varnish or clinic
2. Can prescribe durphat toothpaste
What is special about duraphat toothpaste?
It has 2800ppm fluoride for under 16s
Has 5000+ppm for over 16s
Alongside OHI how else can we support Unger patients and protect them from developing caries?
By sealing tier pits and fissures b doing fissure sealants
What do we do once we have received a completed diet sheet?
We need to identify the frequency of cariogenic food ad see if the patient is taking any hidden sugars they may not be aware of
What is the main advice we give in regards to diet?
Reduce the FREQUENCY of sugary snacks
Give examples of patients who may be at higher risk of developing caries
- Infants, toddlers and the elderly
- Patients with reduced salivary flow
- Increased carbohydrate intake due to medical problem
- Recreational drug users who have a craving for sugar
Give examples of professions hat may be at a higher caries risk
- Athletes taking sports drinks
- Food or drinks samplers
- Night shift workers (may snack more or take energy drinks to stay up)
How can we identify levels of dry mouth?
By using the Challacombe scale
What is the purpose of the Challacombe scale?
It is a way to identify and quantify if your patient has xerostomia
What does a score of 1 on the Challacombe mean?
Mirror sticks to buccal mucosa
What does a score of 2 on the Challacombe mean?
Mirror sticks to tongue
What does a score of 3 on the Challacombe mean?
Saliva is frothy
If patient scored 1-3 on the challacombe scale what does this indicate and what should you do?
Indicates mik dryness
May not need treatment of management but recommend:
1. Sugar free gum for 15 mins twice a day
2. Increase water intake
What does a score of 4 on the Challacombe mean?
No saliva pooling in floor of mouth
What does a score of 5 on the Challacombe mean?
Tongue shows generalised shortened papillae (mild depapiliation)
What does a score of 6 on the Challacombe mean?
Altered gingival architecture (smoother)
If patient scored 4-6 on the challacombe scale what does this indicate and what should you do?
Indicated moderate dryness
- Chewing sugar free gum may be required
- Saliva substitutes and topical fluoride may be helpful
- Monitor and identify cause of dryness
What does a score of 7 on the Challacombe mean?
Glassy appearance of oral mucosa especially palate
What does a score of 8 on the Challacombe mean?
Tongue lobulated/ fissured
What does a score of 9 on the Challacombe mean?
Cervical caries on more than 2 teeth
What does a score of 10 on the Challacombe mean?
Debris on palate or sticking to teeth
If patient scored 7-10 on the challacombe scale what does this indicate and what should you do?
Indicated severe drynes
- Saliva substitutes and topical fluoride
- NEED to identify cause of hypo-salivation
- Possible specialist input may be needed condition worsens
Give examples of mediations that can cause xerostomia
- Antihistamines
- High blood pressure meds
- Antidepressants
4 Diuretics - Inflammatories
- Steroids
Whatmight put the elderly in a high risk caries group
Patients on liquid medications
Name some the most prescribed liquid medications
Lactulose, Ensure, Amoxicillin, Fortisip, morph sulphate, amoxicillin, gaviscon, oramorph, paracet
Give the 5 steps we take when giving dietary counselling
- Identify high risk patients
- Take a detailed dietary history
- Set goals
- Develop an action plan
- Monitor and review
Other than dietary advice how can we minimise plaque deposits in patients
- Mechanical plaque removal
- Recommend electric toothbrushes
- Interdental cleaning
- Fluoride toothpaste
