Implications of dental disease in children Flashcards
Implications of the disease Implications of treatment of the disease
Epidemiology: untreated caries
10th most prevalent disease worldwide
Affects 621 million children globally
Epidemiology: in the UK
Nearly 1/3 children aged 5 have caries
Rising to almost of half of 8yos
Implications of disease
Pain
Infection
General health
Psychosocial
Pain
An unpleasant sensory and emotional response to actual or potential tissue damage
Purely subjective
How common is dental pain?
Very few researchers have actually asked children about their experience of dental pain
We don’t know how children describe dental pain
-could think it was earache
-never experienced this kind of pain before
Words used by children
McGill Pain Questionnaire useful in adults
Most children don’t use these words or don’t know them
Stabbing, burning, dull, pressing
“Like lots of bees stinging me”
Weird
Words to describe pulp testing
Uncomfortable
Sore
Hitting
Dizzy
Prevalence of pain
Appears to be approx 50% of children with caries Pain more likely if caries present -at young age -2 or more surfaces -disease in lower molars
Effects they describe (parents might describe)
Crying
Stopping them from playing
Missing school
Impacts they describe in their own words
Hurt/ toothache/ earache
Eating/ sleeping/ school and related activities
Annoyed, sad, grumpy and worse than most people
Signs in very young children
Pain on toothbrushing
During eating
Surprisingly, not crying at night
Chronic infection
Buccal sinus
Hypoplasia of permanent successor (Turner’s tooth)
Acute infection
Facial swelling
Pyrexia
May require hospitilisation
USA deaths
2 children died as result of caries over last few years
General health
Poor diet
-high sugar intake
Pain when eating
-makes diet even worse
Weight
May be lower in weight than peers
Catch up in weight following dental treatment
Height
Mean height between 10th and 25th percentiles in group with caries
Compared with mean height between 50th and 75th percentiles in caries-free group
Iron deficiency
Children who required higher no. of extraction had lower Hb
80% suffered iron deficiency
Psychosocial
Oral health related quality of life measures: -oral symptoms -functional limitations -social well-being emotional well-being
Oral impact: 2014 Children’s Dental Health Survey
Pain was most common impact experienced
22% 12yos and 19% 15yos reported experiencing difficulty eating
12yos self-confidence was lower in those with disease
Smiling
45% of children with caries said they felt sad about teeth
35% 12yos and 28% 15yos reported being embarrassed to smile/ laugh
31% ashamed to smile
Children with decay rated smiles less +vely
Parents also less +ve about thei smiles
Children with decay showed less teeth when smiling
Implications of treatment of disease
Not little adults
Short attention span
Fear of unknown
Child dental anxiety
1/5 of children have dental anxiety
Varies with age and unequal gender distribution (higher with females)
Impact of dental anxiety on children
Oral health status
Oral health-related QoL
Waiting lists
Travel
Impact of dental anxiety on dental professionals
Cause of occupational stress
Time-consuming
Impact of dental anxiety on dental services
Financial implications
Higher rates of missed/ cancelled apts
Referrals to specialist services demand
“Children-ese”
Problems with communication a recurring theme in interviews with children with dental anxiety
Evidence that improving communication < dental anxiety
Communication problems described by children
Less info provided than required
Problems understanding language
Lack of opportunities for children to participate
Slow handpiece “Children-ese”
buzzy bee
Airotor “Children-ese”
Whizzy brush
Mr Whistle
Triplespray/ inhalation sedation “Children-ese”
Magic wind
LA “Children-ese”
Jungle juice
Sleepy juice
Giving LA “Children-ese”
Spray your teeth off to sleep
Rubber dam “Children-ese”
Rubber raincoat
Rubber dam clamp “Children-ese”
Clip or button
Fissure sealant “Children-ese”
Tooth paint
Suction “Children-ese”
Hoover
Amalgam “Children-ese”
Silver star
LA
Topical (numbs gingiva)
Explain how it might feel to be numb
Small amounts of treatment
Conscious sedation
Anxious children may require pharmacological behaviour management
Most commonly nitrous oxide/ oxygen
Types of conscious sedation
Oral
Transmucosal
Intravenous (for older children)
General anaesthetic epidemiology
Dental caries most common reason for hospital admissions in children
In England alone, ~60,000 hospital admissions of children U19yo with diagnosis of dental caries in 2016/17
Majority 5-9yos
Estimated cost of £40 million per year in England
Numbers going up
Minor risks of GA
Nausea
Vomiting
Headache
Impact of a GA from children
Pre-op: hunger, being scared/ worried
Post-op: discomfort from IV canula, nausea, bleeding, tiredness, disturbed eating
Satisfaction with resolution of problem, rewards and attention from family
Major risks of GA
Mortallity rate 1:250000 - 1:2million
Highest in infants and >70 years
5 children died between 1996-1999 while having GA for dental treatment
Guidance about GA
Only done in hospitals with critical care unit if anything goes wrong Explain risk of death "a conscious decision" GA services modernised Provision of GA in hospital settings
Lifetime risk of death from GA
1:250000
Lower than lightning strike, alcohol poising, pedestrian accident
Benefits of treatment under GA
One visit
Multiple procedures
Cost-effective
Success of treatment
< pain
Eating more
Sleeping better
Improved OHQoL
Minimising impact of dental caries
Prevention (according to Delivering Better Oral Health) - LEARN CHILD BITS
Community OH promotion
< child dental anxiety
Community OH promotion
Targeted community-based fluoride varnish programmes in schools or care homes
Targeted provision of toothbrushes and toothpaste (postal or through health visitors or school)
Supervised tooth brushing in nurseries and schools
Healthy food and drink policies in childhood settings
Fluoridation of public water supplies
Influencing local and national government policies
Reducing child dental anxiety
Development of self-help CBT resources
- resources developed based on principles of Cognitive Behavioural Therapy
- used child-centred approach
- resources for children with accompanying resource for parents and dental professionals
Your teeth: you are in control
1) Challenge unhelpful thoughts
- normalises dental anxiety
- provides info
2) Enhance control
- message to dentist
- stop signal contract
3) Reflect and plan reward
