CS 4 - Prevention

Question 1

what is dental caries?

Answer 1

a disease of the dental hard tissues caused by the action of microorganism, found in plaque, on fermentable carbohydrates

Question 2

what is the impact of dental caries on pre-school children?

Answer 2

• aesthetic problems
• loss of function
• pain
• infection = may lead to time off school

Question 3

what are risk indicators in children?

Answer 3

○ Oral hygiene 
○ Diet 
○ Bacterial exposure 
○ Socioeconomic status 
○ Breast / bottle feeding 
○ Fluoride exposure 
○ Parental smoking 
○ Parental OH status

Question 4

where does early childhood caries / nursing caries tend to have the worst impact on?

Answer 4

Typically affects the upper anterior and molar teeth

Question 5

what is a typical cause of nursing caries?

Answer 5

Inappropriate use of feeding cups and bottles

Question 6

what 3 things are important in prevention?

Answer 6

• fluoride
• good oral hygiene
• diet

Question 7

is there a benefit to the child if a pregnant woman takes fluoride tablets during pregnancy?

Answer 7

no

focus should be on topical effect not systemic

Question 8

how does breastfeeding affect caries?

Answer 8

dental team should support and encourage breastfeeding
when child is 6 months however, breastfeeding at night time will cause caries - this should be educated against
try to wean child off around 1 year so caries impact is minimised for baby

Question 9

what should the child drink from from 6 months onwards?

Answer 9

a feeding cup with a free flow sprout should replace the use of a bottle

Question 10

what is the problem with soya milk formula?

Answer 10

it is potentially cariogenic

only be used when medically required ie if there is a lactose allergy

Question 11

what advice should be given in regards to sweetened drinks?

Answer 11

• encourage in moderation
• at meal times only
• dilute as much as possible (the pH is as low as fizzy drinks so can do as much damage to teeth)
• sugar free
• use a straw

Question 12

why should patient’s be encouraged to to use sugar-free chewing gum containing xylitol?

Answer 12

stimulates saliva
increases pH
helps wash away food after eating

Question 13

what actions should a dentist take regarding medicines and caries risk?

Answer 13

• write SF on prescription
• ask doctor to prescribe patient sugar free medications only for other health problems
• advise that medications containing sugar only be taken at meal times and never after tooth brushing at night time

Question 14

why is cheese a good snack?

Answer 14

non-cariogenic
may actively protect against caries
neutralises acids in the mouth
high energy food 
[be careful as cheese is high in salt and fat - think about general health advice when giving out oral health advice]

Question 15

what are examples of safe snacks?

Answer 15

• milk / water
• fruit (not dried fruit)
• savoury sandwiches (ham and cheese)
• crackers and cheese
• bread sticks
• crisps = standard flavour and shape eg walkers salt and vinegar (be careful with general health advice)

Question 16

what are the possible ways of getting Fluoride?

Answer 16

• Water
○ 1.0ppm F is optimum level
○ No fluoridated water in Scotland
○ Can be added in or be natural

• Toothpaste

• Supplementary self-delivered
○ Drops (seldom now used)
○ Tablets (seldom now used)
○ Mouth rinse

• Professionally delivered
	○ APF gels (seldom used)
	○ Varnishes (should be applied to all children at least 
            twice yearly)
	○ Slow release devices

Question 17

what is the typical age where children will have developed the dexterity to brush their own teeth?

Answer 17

around the age of 8

treat each children individually on their ability

Question 18

how much fluoride should be in toothpastes?

Answer 18

• Child formulations 450-600ppm
○ Eg macleans milk teeth, colegate 0-6
○ Not recommended in Scotland

• Child formulations 1000ppm
○ Aquafresh milk teeth

• Standard fluoride 1400-1500ppm
○ Standard adult toothpaste
○ Eg colgate total, aquafresh little teeth and big teeth

• Enhanced fluoride 2800 ppm
	○ Duraphat toothpaste
	○ Dentist prescription
	○ Used for high risk patients
	○ Should only be used by whoever was prescribed it - may have toxic effects on anyone else

Question 19

what are the recommended strengths of fluoride in toothpastes for patients?

Answer 19

• First tooth eruption - 3 years
○ 1000ppmF for standard risk kids

• 4 - 16 years
○ 1000-1500ppmF for standard risk kids

• High risk children under 10 years
○ 1500ppmF

• High risk 10 and over
○ 2800ppmF (prescription only)

• High risk 16 and over
○ 5000ppmF (prescription only)

Question 20

what is the amount of toothpaste a child should have when brushing their teeth?

Answer 20

• Smear of paste (approx 0.1ml) for children under 3
• Pea-sized amount (approx 0.25ml) for children age 3 plus
Following these recommendations will decrease the risk of milk fluorosis

Question 21

what is fluorosis

Answer 21

enamel defect, too much fluoride

Severe effects can cause ugly brown patches

Question 22

what is the tolerable daily volume of toothpaste ingestion?

Answer 22

1000ppm
> 1-3years (13kg) = 1.3mls
> 4-8years (22kg) = 2.2mls
> 9-13years (40kg) = 10mls

1500ppm
> 1-3years (13kg) = 0.86mls
> 4-8years (22kg) = 1.46mls
> 9-13years (40kg) = 6.7mls

2800ppm
> 1-3years (13kg) = not recommended
> 4-8years (22kg) = not recommended
> 9-13years (40kg) = 3.6mls

Question 23

how do you work out how much flouride ingestion is toxic?

Answer 23

need to know weight of child and amount of toothpaste swallowed to get a probable toxic dose
~ 5mg / kg body weight

Question 24

how do you manage fluoride toxicity?

Answer 24

• if they have ingested less than 5mg per kg give calcium orally (milk) and observe
• if they have ingested 5-15 mg / kg give calcium orally (milk, calcium gluconate, calcium lactate) and admit to hospital
• if they have ingested more than 15 mg / kg admit to hospital immediately, cardiac monitoring and life support, intravenous calcium gluconate

ps look up fluoride drops / tablets cos i didnt know how to make a q out of it and it didnt seem overly relevant lol could be wrong but here we are xoxo gossip girl

Question 25

what is health education

Answer 25

Is a process that results in individuals or groups having increased knowledge related to health

Question 26

what is health promotion

Answer 26

Supports individuals in translating their health knowledge into positive behaviour and lifestyles
needs to be habit forming
long term

Question 27

how can you diagnose caries?

Answer 27

○ Clinical exam 
○ Bitewing radiographs
○ Fibre-optic transillumination 
○ Temporary tooth separation
○ Air abrasion
○ CO2 laser
○ Electric caries meter

Question 28

how often should bitewing radiographs be taken in children?

Answer 28

every 6 months for high risk
every 12-18 months for low risk
Miss 60% of interproximal caries if do not take bitewings