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Paediatrics (IODC) > Implications of dental disease in children > Flashcards

Implications of dental disease in children Flashcards

Implications of the disease Implications of treatment of the disease

1
Q

Epidemiology: untreated caries

A

10th most prevalent disease worldwide

Affects 621 million children globally

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2
Q

Epidemiology: in the UK

A

Nearly 1/3 children aged 5 have caries

Rising to almost of half of 8yos

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3
Q

Implications of disease

A

Pain
Infection
General health
Psychosocial

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4
Q

Pain

A

An unpleasant sensory and emotional response to actual or potential tissue damage
Purely subjective

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5
Q

How common is dental pain?

A

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

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6
Q

Words used by children

A

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

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7
Q

Words to describe pulp testing

A

Uncomfortable
Sore
Hitting
Dizzy

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8
Q

Prevalence of pain

A 
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
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9
Q

Effects they describe (parents might describe)

A

Crying
Stopping them from playing
Missing school

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10
Q

Impacts they describe in their own words

A

Hurt/ toothache/ earache
Eating/ sleeping/ school and related activities
Annoyed, sad, grumpy and worse than most people

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11
Q

Signs in very young children

A

Pain on toothbrushing
During eating
Surprisingly, not crying at night

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12
Q

Chronic infection

A

Buccal sinus

Hypoplasia of permanent successor (Turner’s tooth)

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13
Q

Acute infection

A

Facial swelling
Pyrexia
May require hospitilisation

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14
Q

USA deaths

A

2 children died as result of caries over last few years

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15
Q

General health

A

Poor diet
-high sugar intake
Pain when eating
-makes diet even worse

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16
Q

Weight

A

May be lower in weight than peers

Catch up in weight following dental treatment

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17
Q

Height

A

Mean height between 10th and 25th percentiles in group with caries
Compared with mean height between 50th and 75th percentiles in caries-free group

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18
Q

Iron deficiency

A

Children who required higher no. of extraction had lower Hb

80% suffered iron deficiency

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19
Q

Psychosocial

A 
Oral health related quality of life measures:
-oral symptoms
-functional limitations
-social well-being
emotional well-being
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20
Q

Oral impact: 2014 Children’s Dental Health Survey

A

Pain was most common impact experienced
22% 12yos and 19% 15yos reported experiencing difficulty eating
12yos self-confidence was lower in those with disease

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21
Q

Smiling

A

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

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22
Q

Implications of treatment of disease

A

Not little adults
Short attention span
Fear of unknown

23
Q

Child dental anxiety

A

1/5 of children have dental anxiety

Varies with age and unequal gender distribution (higher with females)

24
Q

Impact of dental anxiety on children

A

Oral health status
Oral health-related QoL
Waiting lists
Travel

25
Q

Impact of dental anxiety on dental professionals

A

Cause of occupational stress

Time-consuming

26
Q

Impact of dental anxiety on dental services

A

Financial implications
Higher rates of missed/ cancelled apts
Referrals to specialist services demand

27
Q

“Children-ese”

A

Problems with communication a recurring theme in interviews with children with dental anxiety
Evidence that improving communication < dental anxiety

28
Q

Communication problems described by children

A

Less info provided than required
Problems understanding language
Lack of opportunities for children to participate

29
Q

Slow handpiece “Children-ese”

A

buzzy bee

30
Q

Airotor “Children-ese”

A

Whizzy brush

Mr Whistle

31
Q

Triplespray/ inhalation sedation “Children-ese”

A

Magic wind

32
Q

LA “Children-ese”

A

Jungle juice

Sleepy juice

33
Q

Giving LA “Children-ese”

A

Spray your teeth off to sleep

34
Q

Rubber dam “Children-ese”

A

Rubber raincoat

35
Q

Rubber dam clamp “Children-ese”

A

Clip or button

36
Q

Fissure sealant “Children-ese”

A

Tooth paint

37
Q

Suction “Children-ese”

A

Hoover

38
Q

Amalgam “Children-ese”

A

Silver star

39
Q

LA

A

Topical (numbs gingiva)
Explain how it might feel to be numb
Small amounts of treatment

40
Q

Conscious sedation

A

Anxious children may require pharmacological behaviour management
Most commonly nitrous oxide/ oxygen

41
Q

Types of conscious sedation

A

Oral
Transmucosal
Intravenous (for older children)

42
Q

General anaesthetic epidemiology

A

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

43
Q

Minor risks of GA

A

Nausea
Vomiting
Headache

44
Q

Impact of a GA from children

A

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

45
Q

Major risks of GA

A

Mortallity rate 1:250000 - 1:2million
Highest in infants and >70 years
5 children died between 1996-1999 while having GA for dental treatment

46
Q

Guidance about GA

A 
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
47
Q

Lifetime risk of death from GA

A

1:250000

Lower than lightning strike, alcohol poising, pedestrian accident

48
Q

Benefits of treatment under GA

A

One visit
Multiple procedures
Cost-effective

49
Q

Success of treatment

A

< pain
Eating more
Sleeping better
Improved OHQoL

50
Q

Minimising impact of dental caries

A

Prevention (according to Delivering Better Oral Health) - LEARN CHILD BITS
Community OH promotion
< child dental anxiety

51
Q

Community OH promotion

A

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

52
Q

Reducing child dental anxiety

A

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
53
Q

Your teeth: you are in control

A

1) Challenge unhelpful thoughts
- normalises dental anxiety
- provides info
2) Enhance control
- message to dentist
- stop signal contract
3) Reflect and plan reward

Paediatrics (IODC) (9 decks)

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