Developing the Personal Care Plan Flashcards
What elements are required for a care plan to be successful?
- tailored to a realistic assessment of childs ability to accept treatment
- aim to increase likelihood of behavioural change to improve oral health
- gain parent/carers support in bringing child for care and in supervising preventive interventions
What are the priorities of a paediatric personal care plan (start with the most important)?
- manage pain if present
- caries prevention
- managing caries (asymptomatic sepsis), if present
What must be included in ALL childrens personal care plan?
caries prevention
List some approaches for caries prevention
- toothbrush instruction
- diet advice
- fluoride application
What are the factors that complicate caries management in children?
- children can finde operative treatment unpleasant (white coat syndrome)
- clinicians can find operative treatment on children difficult to provide
- children with decay tend to have multiple teeth affected?
How would you possibly go about treating a child with caries lesions on multiple teeth?
GA to take all carious teeth out
Primary teeth have a limited life span, how does this simplify the treatment we are able to provide?
- as opposed to a restoration or extraction, slowing caries progression may be sufficient before subsequent exfoliation ot the tooth
Early childhood caries is also known as …
bottle caries
What is the aetiology of ECC?
- on demand night time feeding >1 years
- breast milk, formula
- juice or sweet drinks befoe nap/bed time (slow saliva production)
- dipping pacifiers in sweet drinks
How can ECC be prevented?
- only water at night time
- fluoride application
- changing bottle to cup (training cup) - children tend to fall asleep with their bottles
What is the first priority of a personal care plan in a child if no pain is present?
*[caries prevention]
keeping the 6s and the 7s free from both occlusal and approximal caries
What is the second priority of the personal care plan for children?
reduce the risk of caries in primary dentition resulting in pain and sepsis before it exfoliates
What should come first, preventive interventions for permanent teeth or treatment of primary teeth?
preventive interventions for permanent teeth should come before treatment for primary teeth
e.g. fissure seal permanent teeth before restoring permanent teeth
In the initial care plan, you should inform parent/carer of the expected number and duration of appointments. What should you keep in mind to maintain cooperation of the child?
splitting them into manageable bite sized chunks - dividing treatment into stages
predict more appointments than you think you will need
What was the relevance of the Law Reform Act 1969 in healthcare?
- permits a patient of 16, of sound mind to legally give valid consent
- does no preclude (prevent) children under 16 from giving consent
if <16 can understand proposed treatment proposed and they can come to an informed decision
A child under 16 is considered to be Gillick competent if…
- they are able to understand the nature of the treatment and purpose
- understand risks + limitations
- compare alternative, including no treatment
It is prudent to get a gillick competent child to discuss with their parent. True or false
True
In a case where the parent is unavailable for a gillick competent child, how should you treat this patient?
- childs best interest should be put first
- do the minimum treatment possible- the main priority should be resolving the pain
Parental responsibility is defined by …
the Children Act 1989
Parents are unable to delegate parental responsibility. True or false
false
In what instance to both parents have automatic parental responsibility of a child/.
if they are married at the time of conception
What is an easy opening question to ask fathers to detemine parental responsibility?
“Are you married dad or partner dad”?
In what instances does an unmarried father have parental responsibility?
- father has acquired PR via court order or PR agreement
- couple subsequently marry
- named on birth certificate
A legally appointed guadian has parental responsibility. How is a legal guardian appointed?
- court
- parent with PR in the event of their own death
Does a foster parent have parental responsibility?
they would not usually have responsibility but will know who has
Give examples of other situations where parental responsibility lie outside of the parents
- Court Residence Order concerning a child
- Local Authority designated in care order (but not when the child is beein looked after under section 20 of the Children Act- accomodated or in voluntary care
- Local authority or other authorised person holding an Emergency Protective Order (ususally not the foster parent) - so investigate
If a father is a “partner dad”, what further questions should you ask?
- are they named on birth certificate?
- do they have PR?
A 5 year old boy has attended with his child minder afer falling in the garden, loose teeth, child is very distressed. How would you go about providing care to this child?
- if mother or person with PR is contactable
- act in childs best interest - limit treatment to what is required to get child out of pain
- exam/emergency treatment only
- get second opinion from colleague (dual consent)
An 11 year old girl, attended with her father. Father divorced after he was married to the mother for 2 years following the child birth. Child lives with father, mother lives in the city. How would you go about checking parental responsibility for this child?
father has PR as he was married to the mother at conception
PR is not lost following a divorce so do not need to contact mum
A 15 year old boy attended unaccompanied with toothache. He described his compliants, able to give dental history and medical history. Lives with mum who is not well and has 4 other young kids so cannot make the surgery. How would you go about giving treatment to this child?
- assess whether he is gillick competent?
- if they are, then they can give consent
- limit to emergency treatment only
- contact mother for full course of treatment
What is the ideal sequence of treatment if a patient is not presenting with pain but has multiple carious lesions?
- prevention
- fissure sealant
- preventive restorations
- simple fillings
- fillings requiring LA but do not involve pulp
- more extensive restorative work
- extractions
What is a preventive resin restoration (PRR)?
A small cavity created (enamel biopsy) and restored; then fissure sealed
What is the better alternative option to a PRR if in doubt?
a high quality sealant
review
reinforce preventive advice
What is the choice of restoration for early caries (<1/3 into dentine) ?
fissure sealants
What is the general rule of thumb for delivering LA in children requiring work in both upper and lower arches?
Do the upper arch before the lower arch as LA easier to deliver
By appointments, how would you treatment plan the following patient:
* 8 years old
* MH clear
* irregular attender
* previous dental visits XGA of all Ds
* small cavity in LRE requiring restoration
* large cavities in all other Es requiring XLA
- visit 1: clinical assessment, care plan, diet sheet, TBI, plaque disclosure
- visit 2: collect diet sheet, plaque disclosure to assess TB, fissure sealant (one tooth), flouride varinsh
- visit 3: discuss diet sheet, make recommendations, fissure seal other teeth
- visit 4: restore LRE without LA, hall crown, repeat TBI
- visit 5: XLA URE with LA infiltration, discuss diet progress
- visit 6: XLA ULE and LLE LA, repeat TBI
