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Clinical Knowledge 2 > Developing the Personal Care Plan > Flashcards

Developing the Personal Care Plan Flashcards

1
Q

What elements are required for a care plan to be successful?

A
  • 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
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2
Q

What are the priorities of a paediatric personal care plan (start with the most important)?

A
  1. manage pain if present
  2. caries prevention
  3. managing caries (asymptomatic sepsis), if present
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3
Q

What must be included in ALL childrens personal care plan?

A

caries prevention

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4
Q

List some approaches for caries prevention

A
  • toothbrush instruction
  • diet advice
  • fluoride application
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5
Q

What are the factors that complicate caries management in children?

A
  • 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?
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6
Q

How would you possibly go about treating a child with caries lesions on multiple teeth?

A

GA to take all carious teeth out

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7
Q

Primary teeth have a limited life span, how does this simplify the treatment we are able to provide?

A
  • as opposed to a restoration or extraction, slowing caries progression may be sufficient before subsequent exfoliation ot the tooth
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8
Q

Early childhood caries is also known as …

A

bottle caries

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9
Q

What is the aetiology of ECC?

A
  • 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
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10
Q

How can ECC be prevented?

A
  • only water at night time
  • fluoride application
  • changing bottle to cup (training cup) - children tend to fall asleep with their bottles
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11
Q

What is the first priority of a personal care plan in a child if no pain is present?

A

*[caries prevention]
keeping the 6s and the 7s free from both occlusal and approximal caries

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12
Q

What is the second priority of the personal care plan for children?

A

reduce the risk of caries in primary dentition resulting in pain and sepsis before it exfoliates

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13
Q

What should come first, preventive interventions for permanent teeth or treatment of primary teeth?

A

preventive interventions for permanent teeth should come before treatment for primary teeth

e.g. fissure seal permanent teeth before restoring permanent teeth

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14
Q

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?

A

splitting them into manageable bite sized chunks - dividing treatment into stages

predict more appointments than you think you will need

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15
Q

What was the relevance of the Law Reform Act 1969 in healthcare?

A
  • 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

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16
Q

A child under 16 is considered to be Gillick competent if…

A
  • they are able to understand the nature of the treatment and purpose
  • understand risks + limitations
  • compare alternative, including no treatment
17
Q

It is prudent to get a gillick competent child to discuss with their parent. True or false

A

True

18
Q

In a case where the parent is unavailable for a gillick competent child, how should you treat this patient?

A
  • childs best interest should be put first
  • do the minimum treatment possible- the main priority should be resolving the pain
19
Q

Parental responsibility is defined by …

A

the Children Act 1989

20
Q

Parents are unable to delegate parental responsibility. True or false

A

false

21
Q

In what instance to both parents have automatic parental responsibility of a child/.

A

if they are married at the time of conception

22
Q

What is an easy opening question to ask fathers to detemine parental responsibility?

A

“Are you married dad or partner dad”?

23
Q

In what instances does an unmarried father have parental responsibility?

A
  • father has acquired PR via court order or PR agreement
  • couple subsequently marry
  • named on birth certificate
24
Q

A legally appointed guadian has parental responsibility. How is a legal guardian appointed?

A
  • court
  • parent with PR in the event of their own death
25
Q

Does a foster parent have parental responsibility?

A

they would not usually have responsibility but will know who has

26
Q

Give examples of other situations where parental responsibility lie outside of the parents

A
  • 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
27
Q

If a father is a “partner dad”, what further questions should you ask?

A
  • are they named on birth certificate?
  • do they have PR?
28
Q

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?

A
  1. if mother or person with PR is contactable
  2. act in childs best interest - limit treatment to what is required to get child out of pain
  3. exam/emergency treatment only
  4. get second opinion from colleague (dual consent)
29
Q

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?

A

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

30
Q

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?

A
  • 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
31
Q

What is the ideal sequence of treatment if a patient is not presenting with pain but has multiple carious lesions?

A
  1. prevention
  2. fissure sealant
  3. preventive restorations
  4. simple fillings
  5. fillings requiring LA but do not involve pulp
  6. more extensive restorative work
  7. extractions
32
Q

What is a preventive resin restoration (PRR)?

A

A small cavity created (enamel biopsy) and restored; then fissure sealed

33
Q

What is the better alternative option to a PRR if in doubt?

A

a high quality sealant
review
reinforce preventive advice

34
Q

What is the choice of restoration for early caries (<1/3 into dentine) ?

A

fissure sealants

35
Q

What is the general rule of thumb for delivering LA in children requiring work in both upper and lower arches?

A

Do the upper arch before the lower arch as LA easier to deliver

36
Q

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

A
  • 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

Clinical Knowledge 2 (40 decks)

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