Early Childhood Caries + Fluoride Flashcards
ECC (according to AAPD)
presence of 1 or more decayed (cavitated or non-cavitated), missing (due to caries), filled tooth surfaces in any primary tooth in a child 71 months of age or younger
types of ECC
- Type I: mild to moderate
- Type II: moderate to severe
- Type III: severe
severe ECC: 3 years and younger
any signs of smooth surface caries
severe ECC: ages 3-5 years old
- 1 or more cavitated, missing, filled smooth surface in primary dentition
- DMFT score greater than or = to 4 (age 3), >/= 5 (age 4), >/= 6 (age 5)
modes of transmission of cariogenic microorganisms
- vertical transmission
- horizontal transmission
modes of transmission: vertical
mother/primary caregiver to child
modes of transmission: horizontal
- child/other person via things to the patient
2 types of dental caries
- active
- inactive/arrested
active vs inactive caries: location
active - plaque retentive areas (pit and fissure, proximal, gingival)
inactive - not in plaque retentive areas
active vs inactive caries: plaque over the lesion
active - thick and/or sticky
inactive - not thick/sticky
active vs inactive caries: surface appearance
active - matte/opaque
inactive - shiny
active vs inactive caries: tactile feeling
active - rough enamel/soft dentin
inactive - smooth enamel/hard dentin
active vs inactive caries: gingival status
active - inflammation/BOP
inactive - no inflammation/no BOP
why do we need to classify active and inactive caries
- to know what should be prioritized when treating
- to assess if it will progress or not
- to know what type of treatment to do
associated risk factors for ECC
- bottle feeding
- breastfeeding
- free sugars
- oral hygiene
- fluoride
- socioeconomic factors
previous name for ECC
nursing bottle caries
why milk causes caries
sugar content
breastfeeding age (WHO)
until 24 months
breastfeeding age (ADA)
soon after child’s 1st birthday
WHO recommendation for free sugars
(strong recommendation) reduce intake of sugar to less than 10% of total energy intake
(conditional recommendation) further reduction of free sugar intake to below 5% of total energy intake
2 factors for free sugars
- age
- frequency of consumption
most cariogenic carbohydrate
sucrose
why sucrose is the most cariogenic carbohydrate
- combination of glucose + fructose
- small molecule; easily enters biofilm
- produces extracellular polysaccharide (dextran)
purpose of dextran
helps biofilm stick to the tooth surface, making it more difficult to remove
acid produced by energy production induced by sucrose
lactic acid
why children who do not have their teeth cleaned at night have higher risk of ECC
less saliva production at night = less protection from cariogenic microorganisms
minimum amount of recommended fluoride concentration
1000 ppm
professionally applied fluoride should be done…
every 6 months
best age for first dental visit
1 year old
children from low income families tend to:
- make first visit to dentist at older age
- less frequent dental visits
- visit only when there is an established dental problem
consequences of non-treatment of ECC
- cellulitis
- abscess
- dental problems
T or F: ECC is a preventable disease.
True
ways on preventing ECC
parent education
how to clean infant teeth as soon as they erupt
- washcloth
- soft bristle brush
recommended brushing for children
brush 2x a day with fluoride toothpaste and soft age-appropriate toothbrush
toothpaste amount: 2 years below
smear amount
toothpaste amount: 2 years and up
pea size amount
regular removal and prevention of its accumulation on teeth and adjacent gingival surfaces
plaque control
cornerstone of non-operative treatment
plaque control
T or F: Plaque can be washed away by action of saliva or by rinsing with fluids.
False; it cannot
T or F: Plaque re-attaches within minutes after cleaning of tooth surface
True
duration of time for plaque to form and become visible
24-48 hours
duration of time it takes for plaque to produce signs of gingival inflammation
48 hours
only practical means for improving oral health
daily mechanical removal of plaque
oral hygiene index and patient education: what patient should be instructed on
- objectives and goals of plaque control
- OH devices: toothbrush, toothpaste, fluoride, floss, etc.
- brushing technique
when brushing habits should start
as soon as 1st deciduous tooth erupts
age when potential brushing is needed
up to 6 years of age
age when children should still be supervised by an adult when brushing
up to 12 years of age
recommended brushing frequency
2-3x a day for 2-3 minutes
recommended toothpaste
fluoridated toothpaste (not less than 1000ppm)
age for smear (grain) amount of toothpaste
6 months to 2 years old
age for pea size amount of toothpaste
2-6 years old
toothbrush recommendation for pedia patients
- soft bristle toothbrush
- small head
- broad handle
toothbrushing methods
- roll - roll method/modified Stillman technique
- vibratory - Stillman, bass techniques
- circular - Fones technique
- vertical - Leonard technique
- horizontal - Scrub technique
toothbrushing method: roll
roll method, modified Stillman technique
toothbrushing method: vibratory
Stillman, Bass techniques
toothbrushing method: circular
Fones technique
toothbrushing method: vertical
Leonard technique
toothbrushing method: horizontal
Scrub technique
other toothbrushing methods
- Charters
- Bass
- Modified Bass
- Stillman
- Modified Stillman
bristles on cervical crown obliquely pointing
coronally, horizontal motion with rotations
Charters
bristles in sulcus 45 degree pointing apically, horizontal back and forward motion
Bass
bristles in sulcus 45 degrees pointing apically, horizontal motion with rotations to occlusal
Modified Bass
bristles in gingival margin obliquely towards the
apex; vibratory movements without moving the brush
Stillman
bristles in gingival margin obliquely towards the apex; vibratory movements with rotations towards occlusal
Modified Stillman
2 types of fluoride mouthrinse
- 0.05% NaF
- 0.2% NaF
frequency of rinse: 0.05% NaF
rinse once daily
frequency of rinse: 0.2% NaF
rinse once weekly
order of treatment plan
- Plaque control
- Chief complaint
- Preventive/Restorative procedures
- Pulp therapy
- Extraction
- Orthodontic/Prosthodontic care
- Recall
last step before patient can go after charting
fluoride application
3 types if professionally applied fluoride
- 2% sodium fluoride (gel)
- 1.23% acidulated phosphate fluoride (gel)
- 8-10% stannous fluoride
most common professionally applied fluoride
2% sodium fluoride (gel)
2% sodium fluoride: ppm and pH
8% 9,050 ppm fluoride ion
pH 7 (neutral)
1.23% acidulated phosphate fluoride: ppm and pH
12,330 ppm fluoride ion
pH 3.2
8-10% stannous fluoride: ppm and pH
19,500 ppm fluoride ion
pH 2.4-2.8
why 8-10% stannous fluoride is not used anymore
causes tooth discoloration
steps in fluoride gel application
- Correct sized trays to fit UL arches of
the patient - Minimal amount of gel that will permit
complete coverage of the tooth surfaces
(5ml per arch) - Px should sit upright
- Teeth must be cleaned and dried
- After UL trays are positioned, small
saliva ejector should be placed between
trays or in the vestibule - Instruct the patient not to swallow the gel
- Fluid gel should be left in the mouth for
4 mins - After trays are removed, excess saliva
and gel should be evacuated - Tell the patient to spit the remaining oral
fluid - Instruct the patient not to eat, drink or
rinse for 30 mins - Repeat every 6 months
fluoride varnish: %NaF
50 mg/ml NaF
fluoride varnish: ppm and pH
2.2% fluoride ion; 22,600 ppm
pH 7
where fluoride varnish is applied
clean, dry tooth surface
when fluoride varnish sets
in presence of moisture
duration of time fluoride varnish remains on tooth surface
12 hours
steps in applying fluoride varnish
- oral prophylaxis
- isolate
- dry
- apply
- patient instruction
post-op instructions after fluoride application
- no food/drinks (hard, sticky, abrasive food and hot beverages)
- no rinsing with water
- brush teeth after 12 hours
- repeat every 3 months/6 months
