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3RD yr- CCD1- Clinical > Comprehensive Treatment Planning > Flashcards

Comprehensive Treatment Planning Flashcards

1
Q

On average how many 5 year olds have decay

A

1/4 have tooth decay with on average 3-4 teeth affected

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2
Q

What non dental problems can arise as a result of tooth decay

A
  1. 28% of children missed on average 3 days from school because of dental pain and infections
  2. 38% of children have sleepless nights due to dental pain
  3. Parents need to take days off work to take care of children with dental pain
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3
Q

What is the average cost of a tooth extraction in a hospital for a children less than 6

A

£836

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4
Q

How much money was spent on tooth extractions in 2015-2016 for children under the age of 19

A

£50.5M

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5
Q

How much money was spent on tooth extractions in 2015-2016 for children under the age of 5

A

£7.8M

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6
Q

List some high risk groups for dental caries

A
  1. Social- low socioeconomic status
  2. Children with medical conditions
  3. Clinical - those with enamel defects
  4. Poor diet
  5. Lack of fluoride in water
  6. Poor oral hygiene
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7
Q

What are the effects of dental disease

A
  1. Pain and infection
  2. Difficulty eating, speaking, concentrating in school
  3. Growth can be effected
  4. Children may miss school
  5. Children with childhood caries may have increased risk of further caries in primary and permanent teeth
  6. Dental extraction may lead to orthodontic problems
  7. Preventable burden on NHS
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8
Q

List the 5 key points of the dental care philosophy

A
  1. Gain trust and co operation of child and patient
  2. Make an accurate diagnosis and devise a treatment plan
  3. Comprehensive preventative care
  4. Deliver care in a manner the child finds acceptable
  5. Use treatment and restorative techniques which produce an effective long lasting result
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9
Q

List the steps we ned to carry out before forming a treatment plan

A
  1. History
  2. Examination
  3. special tests
  4. Diagnosis
  5. Treatment plan
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10
Q

When taking a history for a child what do you need to find out

A
  1. Reason for attendance
  2. Complaints
  3. Past medical history
  4. Past dental history
  5. Social history
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11
Q

What do you need to record when finding out the reason for attendance for a paediatric patient

A

Is this appointment:

  1. A referral? If so by who
  2. An emergency appointment?
  3. A recall appointment?
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12
Q

What do you need to record when finding out the complain for a paediatric patient

A
  1. CURRENT complaint
  2. HPC

(NOT SOCRATES you’ll need to adjust your questioning)

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13
Q

What do you need to record when finding out the past medical history for a paediatric patient

A
  1. Standard questions on salud
  2. Duration, severity and quality of life
  3. Paediatrician
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14
Q

What do you need to record when finding out the past dental history for a paediatric patient

A
  1. Are they are regular attender?
  2. Previous treatments and experiences especially LA
  3. Behaviour
  4. Anxiety levels
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15
Q

What do you need to record when finding out the social history for a paediatric patient

A
  1. Social care involvement
  2. Who is in the family (carers, siblings etc)
  3. Language(s)
  4. Travel
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16
Q

How do we carry out an examination on a child?

A
  1. Extra oral same as adult

2. Intra oral

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17
Q

What do we look at during an intra oral exam on a child

A

Look at:

  1. Soft tissues
  2. Gingivae- modified BPE for over 7s
  3. Dental charting
  4. Occlusion
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18
Q

What things should you look out for when looking at the developing dentition

A
  1. Delayed eruption
  2. Extopic eruption of first permanent molars
  3. Premature unilateral loss of primary canines
  4. Abnormal or asymmetrical eruption patter/order
  5. Cross bites
  6. Prognosis of first permanent molars
  7. Palpate for permanent canines at age of 9
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19
Q

Name some special tests we can carry out on paediatric patients

A
  1. Radiographs
  2. Palpation
  3. Percussion
  4. Mobility
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20
Q

Which special test do we carry out on adults but should not do on children? Why?

A

We should not do ethyl chloride or EPT on carious primary teeth as:
It is unreliable and won’t give a good indication of vitality

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21
Q

When coming to a diagnosis what should we include?

A
  1. Comment on ability of patient to co operate
  2. Dentition stage (mixed, primary, permanent)
  3. Comment on oral hygiene and gingival status
  4. Dental caries listing teeth involved
  5. Pulpal/ periodontal pathology
  6. Developing dentition/ occlusion
  7. Any other issues
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22
Q

How might we describe a patients ability to co operate when writing up our diagnosis

A

Can be described as:

  1. Pre cooperative
  2. Potentially co operative
  3. Anxious
  4. Uncooperative
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23
Q

How might we describe a patients pulpal/periodontal pathology when writing up our diagnosis

A
  1. Presence of sinus or swelling

2. Intra radicular pathology

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24
Q

How might we describe a patients developing dentition/occlusion when writing up our diagnosis

A
  1. Molar incisor relationship
  2. Overjet
  3. Overbite
  4. Crowding
  5. Crossbites
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25
Q

Name the 3 approaches/strategies of paediatric dentistry

A
  1. Prevention only approach
  2. Biological
  3. Conventional
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26
Q

How do we decide which paediatric dentistry strategy we will adopt?

A

Depends entirely on the patient and can be affected by factors such as:

  1. Age
  2. Signs and symptoms
  3. Level of cooperation
  4. Medical history
  5. Parental motivation and wishes
  6. Access to treatment
27
Q

What is the aim of the preventative approach?

A

To reduce the cariogenic portal of the lesion by altering the environment of the plaque biofilm overlying the carious lesions through brushing and dietary advice

28
Q

What does the preventative approach include?

A
  1. Looking at diet and giving diet advice
  2. Fissure sealants
  3. Oral hygiene advice
  4. Fluoride use eg fluoride varnish
29
Q

Describe a case where we could adopt the preventative approach

A
  1. Asymptomatic
  2. No evidence of sepsis
  3. Parental motivation and consent evident
30
Q

Give examples of diet advice we might want to give parents and children

A
  1. Drink only water and milk between meals
  2. Snack on sugar free snacks
  3. Do not eat or drink after brushing at night
  4. Be aware of hidden sugars
  5. Try to limit acidic and sugary drinks to meal times
31
Q

Give examples of oral hygiene advice we might want to give parents and children

A
  1. Brush twice a day
  2. Use correct amount of fluoride toothpaste based on age
  3. Spit dont rinse
  4. Help children with brushing until at least the age of 7
32
Q

What is essential if you have decided to adopt a preventative only approach?

A
  1. Appointments every 3 months
  2. Serial plaque scores
  3. Fluoride varnish application
  4. Clinical photographs
33
Q

What documentation should we obtain before starting our preventative treatment?

A
  1. Record you have discussed with the parents
  2. Parental consent
  3. Parental understanding that treatment may be required in the future
  4. Close follow ups- DNAs and cancellations
34
Q

What is the aim of the biological approach

A

To completely seal a carious lesion from the oral environment so that the environment of the plaque biofilm is altered sufficiently to slow or even arrest caries

35
Q

What is the rationale for the biological approach?

A
  1. Some children struggle with LA
  2. If teeth are asymptomatic should children be prescribed general anaesthetic
  3. We know it is possible to arrest caries
36
Q

Which technique can we carry out if we adopt the biological approach?

A
  1. Hall technique

2. Fissure sealants

37
Q

What is the Hall technique?

A

Placing no prep preformed metal crowns on primary molars

38
Q

What is the probability of the tooth surviving following the hall technique without extraction or loss of crown

A

3 years: 73.4%

5 years: 67.6%

39
Q

What is the probability of the tooth surviving following the hall technique without extraction only

A

3 years: 86%

5 years: 80.5%

40
Q

What are some ion the advantages of the biological approach?

A
  1. Can be effective and is preferred to complete caries removal techniques by children, their carers and dentists
  2. Avoids need for LA and tooth preparation
  3. No risk of iatrogenic damage to adjacent teeth
41
Q

What ar some of the disadvantages to the biological approach

A
  1. Dependent on the quality of the seal fro success- if seal fails caries will progress
  2. Further clinical trials in primary care needed to consolidate evidence base
42
Q

Describe a patient in whom you may decide to adopt a biological approach

A
  1. Asymptomatic
  2. No evidence of sepsis
  3. Child can sit in the chair and follow instructions and is wiling to take radiographs
  4. Parents are on board
43
Q

How is a hall technique crown placed?

A
  1. Odontogenic bands are placed between teeth at least 3-5 days before crown placement to separate them slightly
  2. Assess the tooth shape, contact points and occlusion
  3. Protect the airway
  4. Size a crown (usually start with size 4)
  5. Load the crown with cement
  6. Fill the crown and first stage setting
  7. Remove excess cement, check fit and second stage setting
  8. Final clearance of cement
  9. check occlusion
44
Q

What do fissure sealants do?

A

They inhibit the progression of non caveatted carious lesions

45
Q

What are fissure sealants known as?

A

Secondary prevention

46
Q

What requirements must be fulfilled for us to consider placing fissure sealants?

A
  1. No cavitation

2. No radiolucencies on a bitewing radiograph

47
Q

Name the different types of fissure sealants

A

a1. Resin based sealants
2. GI sealants (fuji triage)
3. Polyacid modified resin sealant
4. Resin modified GI sealant

48
Q

Talk through the steps of fissure sealant placement

A
  1. Clean the pits and fissures
  2. Isolate the tooth
  3. Etch, wash and dry
  4. Apply bonding agent, cure
  5. Apply sealant
  6. Evaluate
49
Q

What hold you discuss with parents before placing fissure sealants

A
  1. It is a reasonably new technique
  2. Excellent homecare is required for into succeed
  3. Regular review and recall is imperative- further intervention may be required in the future
50
Q

After placing fissure sealants when should you follow up with the patient

A

Every three months until the Childs caries status moves to low caries risk

51
Q

What is considered a low caries risk

A
  1. No new lesions on 6s monthly bitewings
  2. Good plaque control
  3. Low cariogenic diet
52
Q

What is the aim of the conventional approach

A

Managing all caries and restoring oral health

This often requires full caries removal and restoration or extraction

53
Q

Out of the 3 paediatric approaches which is the gold standard

A

The conventional approach

54
Q

Describe a patient in whom you may decide to adopt a conventional approach

A
  1. Potentially co operative/ cooperative patients that can manage bitewings and LA
  2. Motivated patients
55
Q

List the principles fo treatment planning when you decide to adopt the conventional approach

A
  1. Formulate treatment plan visit by visit
  2. Order of care; simple to complex
  3. Preventative care running parallel to restorative care
  4. Behaviour management integral to treatment plan
56
Q

Which teeth do we aim to treat first (order fo care)

A
  1. Upper posteriors
  2. Lower posteriors
  3. Upper anteriors
  4. Lower anteriors
57
Q

What do you need to consider when planning your treatment if you adopt the conventional approach

A

Behavioural considerations:

  1. Pace child can tolerate
  2. Set realistic goals
  3. Consider LA, sedation or GA
58
Q

Which teeth should we prioritise in the conventional approach

A

Permanent teeth

Es and Ds

59
Q

What is the material of choice for paediatric patients

A

Composite

60
Q

If a tooth requires pulp therapy what will you need to do

A

Need to restore with SSC

61
Q

If treatment under LA is not possible what should you consider?

A
  1. Inhalation sedation

2. General anaesthesia

62
Q

Which of the 3 approaches is the best?

A

According to randomised trials there is no evidence of a difference among the 3 treatment approached for incidence or number of episodes of dental pain and or infection experienced by high caries risk patients

63
Q

What is a treatment needs list

A

A list of the current condition of the mouth and what needs to be done

64
Q

What can a treatment needs list include

A
  1. Prevention
  2. Stabilisation/ temporisation
  3. Restorable teeth
  4. Teeth with infection
  5. Orthodontic

3RD yr- CCD1- Clinical (7 decks)

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