Lecture 1

Question 1

medically compromised patient

Answer 1

any patient with any pre-existing conditions that may probably complicate treatment

Question 2

Thorough medical evaluation and risk assessment will:

Answer 2

• improve patient safety by preventing and reducing emergency situations
• improve their treatment outcomes
• facilitate early detection and prevention
• make sure that patient treatment is individualized and equitable.

Question 3

Common health conditions that can be caused by systemic health and affect oral health, or are caused by oral health and affect systemic health and affect dental management (10)

Answer 3

• Diabetes
• HTN
• Immunocompromised
• Allergies
• Pregnancy
• Asthma
• Heart conditions
• Respiratory conditions
• Cancer
• Alzheimer’s disease

Question 4

How is comprehensive patient medical evaluation accomplished?

Answer 4

Gather a detailed medical history, obtain vital signs, medical consults where indicated

Question 5

During the assessment portion of the process of care, we need to assess the patient to see if they are a risk for treatment. A patient’s risk is rated low, moderate or high based on:

Answer 5

1. their health
   ◦ ASA score (high ASA=higher risk), 2. 2. Oral and systemic conditions ( more systemic or uncontrolled systemic conditions or oral conditions= more complicated tx= higher risk)
   how complicated/extensive their tx
2. compliance and understanding for tx ( basically, if the patient does not understand their treatment, or isn’t compliant to their treatment, it may increase a risk for complications in the chair).

Question 6

Why do patients with special needs show poorer oral health?

Answer 6

They are underserved

Question 7

People who have some sort of special needs may not be get quality tx because

Answer 7

either a barrier on their end in finding and affording care or a barrier on the clinician end with either not wanting to serve them or being unfamiliar or not trained on how to help them.

Question 8

Barriers on the clinician end can be reduced by

Answer 8

Feeling more comfortable treating these patients, treat more of these patients, show greater future intention to treat these patients

Question 9

Normalization

Answer 9

Provide people with disabilities the same conditions and experiences as those without disabilities; making sure that people with special needs have access to care and receive it in a way thats as close to mainstream as possible

Question 10

How can we evaluate if a patient is a special needs patient? How do we move forward with these patients?

Answer 10

Evaluate if they can comply with OHI recommendations, if they have a special need complicates ability to provide care and figure out what alternatives to OHI and care need to be made

Question 11

How can we tailor treatment before, during and after treatment to prevent and be prepared for emergencies?

Answer 11

• Before: plan out appt time and determine if patient needs premed (prosthetic heart valve, recent heart valve surgery, infective endocarditis, congenital heart defects etc.)
• During: less chair time=less risk for emergency, less stress and pain=less risk of emergency, less invasive procedure= less risk of emergency
• After: Collaborate with primary health care providers to coordinate follow up care

Question 12

Most common chronic illness in children

Answer 12

Caries

Question 13

stats of children ages with caries

Answer 13

In primary teeth ages 2-5: 21%; In permanent teeth of children 6-11: 51%; 12-19 adolescents: 54%

Question 14

Severe consequences of children with caries that have not received treatment

Answer 14

can cause infection, pain, caries in permanent teeth, missing school, not being able to focus at school/ low grades, expensive dental work, not being able to chew properly, difficulty sleeping, poor self esteem

Question 15

Early childhood caries

Answer 15

A common type of caries that occurs in young children

Question 16

Etiology of early childhood caries (6)

Answer 16

• Low socioeconomic status (can’t afford healthy food)
• feeding ( high sugar intake)/ diet
• Eating time intervals and type of food
• lack of dental care/ no dental home
• no fluoride use
• history of caries in family/ genetics

Question 17

In early childhood caries, which teeth are first affected?

Answer 17

more common at incisors because of lack of saliva and eventually progress posterior

Question 18

Why are most incidences of childhood caries undiagnosed?

Answer 18

Parents or caregivers do not seek dental care at an early age

Question 19

Who plays a major role n preventing caries and initiating early treatment?

Answer 19

Clinicians

Question 20

What is the etilogy triad for caries?

Answer 20

Bacteria, teeth and sugars

Question 21

Etiology of caries: Its a multi factorial process caused by what factors?

Answer 21

environmental, behavioral, and host risk factors

Question 22

Describe the process of how caries form

Answer 22

• Oral bacteria (including mutans streptococci and lactobacilli) metabolize dietary carbohydrates into acids
• Acid demineralizes tooth enamel
• If the cycle of acid production and demineralization continues, the enamel will become weakened and break down into a cavity

Question 23

Cariogenic

Answer 23

Producing or promoting the development of tooth decay

Question 24

Etiology of caries: sugars

Answer 24

A. Insufficient time for demineralization process: After eating, bacteria in mouth produce acid that persists for 20-40 min, lowering the mouths normal ph in danger zone. After 40 mins, remineralization occurs when the acid is buffered by saliva.
If sugars are consumed frequently, there is insufficient time for the remineralization process to occur; The tooth is subjected to continued demineralization and the caries process progresses. If sugars are consumed infrequently, teeth are able to fully remineralize and the caries process halts.

Question 25

Any tooth surface can develop a cavity, but some surfaces are more prone like?

Answer 25

• Newly erupted teeth (due to immature enamel) • Teeth with developmental defects

Question 26

Difference between general dentists and pediatric dentists

Answer 26

• Both trained to take care of oral health • Pediatric dentist brings specialized skills and knowledge designed specifically for children • 2 to 3 year pediatric residency, includes education on: • Child psychology • Growth and development • Pediatric patient management techniques • Child-focused approach • Specialized equipment • Behavior management techniques • Oftentimes a fun and inviting environment for kids!

Question 27

Caries risk assessment

Answer 27

Is a tool used to determine a patient’s risk of developing dental caries. A CRA categorizes a patient’s risk for caries by using their medical hx, dental hx, clinical conditions (i.e existing caries, plaque etc.) and psychosocial history (diet, oral home care) . Helps clinician identify modifiable and non-modifiable risk factors and provides recommendations and education to reduce caries risk. Treatment is determined based on risk level. Clinician needs to use their own judgement. Always explain and educate pt on findings and discuss preventative strategies based on individual need. ◦ Low- 0; Moderate- 1-9; High- higher than 10; or one high risk factor (worth 10 points) 2 forms: Patients 0-6 and patient 6 and up

Question 28

CAMBRA

Answer 28

Evidence-based approach to preventing and managing cavities at the earliest stages It focuses on evaluating a patient's individual risk factors for developing dental caries and creates a personalized treatment plan based on risks, rather than just treating existing cavities • Involves assessing several factors to determine a patient's susceptibility to cavities: • Diet • Oral hygiene habits • Saliva flow • Fluoride use

Question 29

Common oral health risk factors for children and adolescents

Answer 29

Common oral health risk factors for children and adolescents include: **Dietary Habits** • High sugar consumption (sugary drinks, candy, processed foods) • Frequent snacking between meals • Prolonged use of sippy cups with liquids other than water **Oral Hygiene Practices** • Inadequate brushing and flossing techniques • Not using fluoride toothpaste **Socioeconomic Factors**¥ • Lower socioeconomic status • Limited access to dental care **Genetics and Family History** • Predisposition to tooth decay based on family history **Other Factors** • Certain medical conditions (dry mouth, developmental disabilities) • Poor nutrition and vitamin deficiencies • Lack of a "Dental Home"

Question 30

Having a dental home is important to

Answer 30

establish a trusting and ongoing care between provider and patient.

Question 31

Barriers to **finding dental care** for children

Answer 31

• financial • parent low dental literacy • dental care not accessible • language (parent and dentist do not speak same language; do not ask child (patient) to translate)

Question 32

Objectives when treating pediatric patients

Answer 32

Children need to learn the importance of profession dental care and should be taught how to have good dental habits. Visits should be focused on establishing rapport and trust, establishing positive oral habits and providing any other appropriate education , providing preventative therapy, and maintaining rapport thru lifespan. May need interventions like nutrition counseling, home care instruction, help establish habits, and safety practices.

Question 33

Anticipatory guidance for children meaning

Answer 33

Educating parents in advance about developmental milestones, how to manage child’s oral health at each stage and also potential oral issues and their preventative measures.

Question 34

AG for infant

Answer 34

**Growth and development** • Teething • Discomfort • Use of pain meds • Safe teething rings • No benzocaine products - risk of methemoglobinemia • Irritability • Low-grade fever • Excessive salivation • Maternal oral health is associated with infant oral health **ОНІ** • Rice grain-size toothpaste • Soft bristled brush • Brush BID • Check the appearance of teeth and gums • Lift upper lip to check for signs of decay • Establish dental home and come in for periodic exams • Discuss frequency **Nutrition** • Breastfeeding can aid in dental caries prevention • Discourage milk/formula use in bottle at night • Bottle nipple shape important with oral development • Avoid testing temperature of food with mouth, sharing utensils, or orally cleaning off bottle nipples • Helps prevent transmission of bacteria from the parent • Introduce a small cup when infant can sit up unassisted • Wean from a bottle by 12 months • Avoid introducing sugar until 2 years of age • No 100% fruit juice before 12 months • Limit to 4 oz/day from 1-3 years of age **Trauma/Injury prevention** • Awareness that injuries to the head, face, and mouth are common among infants • Never attempt to reinsert an avulsed baby tooth **Non-nutritive sucking** • Common habits • Pacifier • Thumb-sucking • Finger sucking • Should be limited to prevent: • Open bite • Crossbite • Narrow arch • Speech impediments

Question 35

Common oral conditions in infants

Answer 35

**Ankloglossia** • Short lingual frenum that can cause speech hindrance, feeding, and tongue movement. Needs surgical correction **Candidiasis** • White patch with inflamed underlying surface, white can wipe off, can apply Nystatin, in health will go away on it own **Primary herpetic gingivostomatitis** • Viral infection in mouth cause by HSV-1; usually latent but sometimes occurs in chilren at first exposure ◦ Gingiva will be red ◦ Mucousa will show hemorrhages ◦ Painful vesicles around oral cavity ◦ Fever ◦ Malaise (general feeling of discomfort) ◦ Lymphadenopathy ◦ Difficulty eating in ◦2 week duration ◦ Push fluids and can use pain meds ◦ Should heal without scars

Question 36

Common oral conditions in school aged children

Answer 36

**Primary herpetic gingivostomatitis** • Viral infection in mouth cause by HSV-1; usually latent but sometimes occurs in chilren at first exposure ◦ Gingiva will be red ◦ Mucousa will show hemorrhages ◦ Painful vesicles around oral cavity ◦ Fever ◦ Malaise (general feeling of discomfort) ◦ Lymphadenopathy ◦ Difficulty eating in drinking ◦ 2 week duration ◦ Push fluids and can use pain meds ◦ Should heal without scars

Question 37

AG for school aged children

Answer 37

Parent education **Growth and development** • Changes in the teeth and mouth • Orthodontic needs **Caries risk/prevention** • Sealants, fluoride • ОНІ **Nutrition** **Trauma/Injury prevention** • Sports-related • Avulsed tooth **Non-nutritive sucking habits**

Question 38

AG for adolescents

Answer 38

Parent/patient education **Growth and development** • Changes in the teeth and mouth • Orthodontic needs **Caries risk/prevention** OHI/fluoride use • Oral malodor **Nutrition** • Eating disorders • Frequency increases due to growth & development • Highest caries risk for males **Trauma/Injury prevention** • Sports-related • Piercings **Oral manifestations of STI** • HPV vaccine status **Use of tobacco and other substances**

Question 39

Toddlers patient management (1-3)

Answer 39

• Make sure to consider, evaluate and monitor eruption • Use child-friendly terms (reduces stress and anxiety) • Conduct thorough oral and physical exam (look out for signs of abuse; report) • Tell/show/do

Question 40

Preschoolers (3-5) management

Answer 40

• Happy visit • Child friendly verbiage • Modify chair; can remove headrest • Preferable that parent is not present

Question 41

School-aged children (6-11) management

Answer 41

• Allow for more patient participation in appointments • Ask parent to remain in reception area • Consider challenged of mixed dentition • Assess periodontium • Increase patient responsibility with home care habits • Ensure the patient can brush and floss properly • tell/show/do • Less parental supervision with decision making (food, safety, habits) - provide nutritional, safety and OHI guidance • Positive communication - highlight successes

Question 42

Adolescents (11-18) management

Answer 42

• Permanent dentition - help patient understand that oral health habits affect teeth throughout lifetime • Lots of physical & psychological changes are taking place • Appearance is important - use it as a motivator for increased home care • Assess periodontium • Address tobacco & other substance use • Vaping is widely used; marketed to teens; falsely believed to be safe • Anxiety - family, school, peer pressure, may lead to violence and/or substance use/abuse • Intimate partner violence is a consideration - look for signs (physical & emotional)

Question 43

Periodontal risk assessment for children and adolescents

Answer 43

• Childhood inflammation may advance to periodontal disease resulting in tooth loss • Early identification and prevention strategies should be central to the dental hygiene visit • Change in periodontium with shedding/eruption should be considered • Assess clinically and use radiographs to determine periodontal status • PSR may be used to screen for disease • Adolescents have increased risk for periodontal infections due to hormonal changes/more independence/less supervision • Emphasize prevention during assessment and use motivational language to encourage compliance • Biofilm-induced gingivitis is most common among children and appears to be more severe in adolescence due to hormonal changes

Question 44

Documentation after a pediatric appt

Answer 44

Make sure documentation includes assessment info including risk assessments, any pathologies, OH status, remember this is pediatric so anticipatory guidance is necessary and needs to be documented, completed interventions, child’s behavior or temperament during appt, next appt Interval and rationale

Question 45

Documentation after a pediatric appt

Answer 45

Referral, Planning, & Documentation • Provide referral for conditions requiring intervention by other providers • Care plan is based on dental hygiene diagnosis, risk factors present, and patient concerns-inform parent and patient; obtain consent after asking questions • Documentation: • Overall appraisal • Pathology • OH status and risk assessment (caries/perio) • Anticipatory guidance provided • Interventions completed • Behavior/temperament • Next visit interval and rationale

Question 46

What ASA patients are safe treat in general practice with minor or no modifications?

Answer 46

ASA 1 and 2

Question 47

What ASA patients require more substantial changes to their management and potentially referral to a hospital setting?

Answer 47

ASA 3 and 4

Question 48

Elective treatment should be avoided on ASA___ patients.

Answer 48

ASA 4

Question 49

Two main types of cariogenic bacteria

Answer 49

streptococcus mutans and lactobacillus

Question 50

Cariogenic bacteria can be transferred in what two ways

Answer 50

• Vertical transmission from the primary caregiver, most often the mother, via saliva contact • Horizontal transmission from family members and care providers, such as in school and daycare settings

Question 51

What ensures that cariogenic bacteria is spread from caregiver to child?

Answer 51

The higher the bacteria level in the caregiver's mouth, the more likely the child will become colonized with mutans streptococci

Question 52

Caregivers with high bacteria levels usually have:

Answer 52

• High frequency of sugar intake • Poor oral hygiene • High levels of dental caries

Question 53

Evidence supports that caregivers can decrease their risk of passing on cariogenic bacteria to their children by

Answer 53

decreasing their own caries levels

Question 54

Caregivers can optimize their oral health and that of their children by:

Answer 54

• Receiving regular comprehensive dental care • Limiting frequency of sugar in the diet • Maintaining excellent oral hygiene and using fluoride toothpaste • Using preventive agents such as: Topical fluorides, Antibacterial mouth rinses, Xylitol containing gums

Question 55

How do systemic insults produce teeth with developmental defects?

Answer 55

The cells that manufacture enamel are very sensitive to systemic insults. So when systemic insults happen it causes the ameloblasts to halt enamel production . This will result in a microscopic or macroscopic defects.

Question 56

___percent of children have developmental defects of enamel

Answer 56

20-40%

Question 57

Enamel Defects may appear as changes in

Answer 57

translucency, color, or texture

Question 58

In children, Enamel defects are associated with substantially increased risk of__

Answer 58

ECC

Question 59

Signs of abuse in children and adolescents

Answer 59

**Dental neglect** • A specific form of maltreatment, involves the willful failure of a parent or guardian to seek or follow through with necessary dental care for a child **Physical abuse** • Craniofacial, head, face, and neck injuries occur in more than half of child abuse cases • Recognition of these injuries is critical in preventing further harm **Sexual abuse** • Oral manifestations of STIs • Unexplained petechiae on hard palate can be a sign of sexual abuse **Psychological/Emotional abuse** • Extreme lack of self-esteem • Significant, unexplained delays in development • Inappropriate or underdeveloped social skills and poor personal boundaries

Question 60

Treatment for children and adolescents

Answer 60

• Remove deposits and stain • Educate parent/patient about biofilm control, caries prevention, nutrition, relationship between biofilm control and oral disease • Use disclosing agent as a good visual to show the patient and/or parent location of biofilm and how it is removed • Cautioned use of power scalers (remember that newly erupted teeth and primary teeth in general are less mineralized) • Primary teeth may be hypersensitive • Professional topical fluoride application - moderate caries risk • Supplementation- if the patient has sub-optimal fluoride exposure, consider: • Rinse • Rx dentifrice • Custom tray