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BDS3 - Paediatrics > Module 1 > Flashcards

Module 1 Flashcards

1
Q

what are the aims of providing dental care for children

A

Prevent disease

Reduce risk of child experiencing pain or infection or needing treatment-induced dental anxiety if caries does occur

Got child to grow up feeling positive about their oral health and with skills and motivation to maintain it

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2
Q

what are the priorities for the dental team

A

Involve both the child and their parent in decisions regarding the child’s oral health care

Encourage the child’s parent to take responsibility for the child’s oral health
○ Implement advice given on prevention
○ Bring their child for dental care

Ensure valid consent is obtained

Relieve pain or infection

Apply preventative measures to the highest standard possible based on an assessment of the child’s caries risk

Focus on prevention of caries in permanent dentition

Diagnose caries early and manage appropriately - permanent dentition

Manage caries in primary dentition using an appropriate technique
○ Maximise chance of tooth exfoliating without causing pain or infection
○ Minimise the risk of treatment-induced anxiety

Identify where there is a concern about a parent’s ability to comply with dental health preventative advice, support or treatment uptake, and to contact and work collaboratively with other professionals

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3
Q

what is involved in clinical assessment

A

Assess child’s plaque levels

Assess child / parents toothbrushing skills and knowledge - discuss

Assess dentition
○ Including visual examination for the presence of caries on clean and dry teeth using a tooth by tooth approach

Consider taking bitewing radiographs to accurately diagnose the extent of any caries, including proximity to the pulp

Assess activity of each lesion
○ Use radiographs to assess progression over time
○ Assume that all caries are active unless there is evidence that they have arrested

Primary dentition: assess risk of carious lesions causing pain / infection prior to exfoliation to inform a suitable management strategy

Assess any hypomineralised molars independently to determine the extent of disease and likely prognosis

Discuss findings with child and parent

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4
Q

classify initial and advanced carious lesions on occlusal surfaces (primary teeth)

A

initial = Non-cavitated, dentine shadow or minimal enamel cavitation
Radiograph: outer 1/3 dentine

advanced = Dentine shadow or cavitation with visible dentine
Radiograph: middle or inner 1/3 dentine

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5
Q

classify initial and advanced carious lesions on proximal surfaces (primary teeth)

A

initial = White spot lesions or shadow
Radiograph: lesion only in enamel

advanced = Enamel cavitation and dentine shadow or cavity with visible dentine
Radiograph: may extend into inner 1/3

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6
Q

classify initial and advanced carious lesions on anterior surfaces (primary teeth)

A

initial = White spot lesions but not dentinal caries

advanced = Cavitation or dentine shadow

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7
Q

explain pulpal involvement in carious primary teeth

A

Any tooth with clinical pulpal exposure or no clear separation between carious lesion and dental pulp radiographically

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8
Q

explain near to exfoliation in primary teeth

A

Clinically mobile

Radiograph: root resorption

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9
Q

explain arrested caries i

A

Any tooth with arrested caries and where aesthetics is not a priorit

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10
Q

explain unrestorable primary teeth

A

Crown destroyed by caries or fractured, or pulp exposed with pulp polyp (pain / infection free)

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11
Q

classify initial, moderate and extensive caries on occlusal surfaces (permanent teeth)

A

initial =

moderate =

extensive =

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12
Q

classify initial, moderate and extensive caries on occlusal surfaces (permanent teeth)

A

initial = Non-cavitated enamel carious lesions
White spot lesions
Discoloured or stained fissures
Radiographs: up to the EDJ or not visible

moderate = Enamel cavitation and dentine shadow or cavity with visible dentine
Radiograph: up to and including middle 1/3 dentine

extensive = Cavitation with visible dentine or widespread dentine shadow
Radiograph: inner 1/3 dentine

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13
Q

classify initial, moderate and extensive caries on proximal surfaces (permanent teeth)

A

initial = White spot lesions or dentine shadow
Enamel intact
Radiograph: outer 1/3 dentine

moderate = Enamel cavitation or dentine shadow
Radiograph: outer or middle 1/3 dentine

extensive = Cavitation with visible dentine or widespread dentine shadow
Radiograph: inner 1/3 dentine

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14
Q

classify initial, moderate and extensive caries on anterior surfaces (permanent teeth)

A

initial = White spot lesions
No dentinal caries

moderate =

extensive = Cavitation or dentine shadow

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15
Q

explain pulpal involvement permanent teeth

A

Any tooth with clinical pulpal exposure or no clear separation between carious lesion and dental pulp radiographically

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16
Q

explain unrestorable permanent teeth

A

Crown destroyed by caries or fractured, or pulp exposed with pulp polyp (pain / infection free)

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17
Q

what is caries risk assessment

A

= assess whether or not the child is at an increased risk of developing caries

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18
Q

how do you carrying out a CRA

A
  • Patient history
  • Resident in an area of relative disadvantage
  • DMF / dmf (missing due to caries)

Use this CRA to inform the frequency of review radiographs

Reassess the child’s risk at each assessment

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19
Q

How can you manage a child’s anxiety level with the use of BMT

A 
○ Communication
○ Enhanced control
○ Tell, show, do
○ Behaviour shaping and positive reinforcement 
○ Structured time
○ Distraction
○ Relaxation
○ Systematic desensitisation
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20
Q

what factor is most likely to improve the oral health of all pre-school children?

A

Water fluoridation

Ideally if all children used 1450ppm toothpaste it would be the most efficient way to ensure their teeth received the fluoride they need
Unfortunately those who most need it do not use it, they may not even brush their teeth at all

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21
Q

which treatment is of the highest priority in the following plan?

A

relief of pain

This comes as a higher priority than OHI, restoration of pain free permanent teeth and restoration of pain free primary teeth

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22
Q

when planning treatment which of the following should be carried out first?

A

simple restoration requiring LA in the upper jaw

This should be the first choice over pulpotomy in the upper jaw, anterior tooth restoration needing LA or simple restoration requiring LA in lower jaw

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23
Q

which of the following would not alter your treatment plan?

A

need for prevention

Need for GA, child with congenital cardiac disease and allergy to latex would alter your treatment plan

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24
Q

what factor does not need to be considered in the mixed dentition phase?

A

size of maxillary sinuses
In the mixed dentition stage we should consider development of all permanent teeth, developing malocclusion and the growth of the child

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25
Q

what is the first component of any treatment plan?

A

relief of pain

This comes before restorative treatment, diet advice and OHI and prevention

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26
Q

which of the following is not a major factor in a preventive treatment plan for a child?

A

water fluoridation

OHI, fissure sealing and fluoride therapy are major factors in a preventive treatment plan for a child

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27
Q

in what order should care be provided

A

○ Manage pain (if present)
○ Provide caries prevention
○ Manage caries / asymptomatic infection (if present)

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28
Q

what should be obtained after explaining the child’s oral health needs and any proposed treatment options

A

obtain valid consent for the agreed care plan from the child where possible and / or the parent / care

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29
Q

when should a child be referred to be assess for suitability for treatment under sedation or GA

A

If a child is pre-cooperative, unable to cooperate or has multiple affected teeth, consider referral to assess suitability for treatment under sedation or GA

30
Q

What are reversible symptoms of pulpitis

A
  • pain to cold / sweet
  • tooth not tender to percussion
  • resolves on removal of stimulus
  • tooth difficult to localise
31
Q

what is the treatment of reversible pulpitis

A

restore

or place a dressing and restore later

32
Q

what are irreversible symptoms of pulpitis

A
  • spontaneous pain wakens child at night
  • does not resolve on removal of stimulus
  • pain to hot / cold
  • does not resolve with placement of a temporary dressing
33
Q

what are the symptoms of dental abscess / periradicular periodontitis

A
  • spontaneous pain wakens child at night
  • tooth mobile and tender to percussion
  • swelling
  • malaise
34
Q

how should a pre-cooperative child with irreversible pulpitis be treated

A

try to dress with sub-lining of corticosteroid-antibiotic paste
prescribe pain relief

primary teeth: refer for treatment / extraction with sedation or GA

permanent teeth: carry out root canal therapy or extraction. if the child remains uncooperative refer for specialist care

35
Q

when should antibiotics be prescribed

A

Antibiotics should only be prescribed if there is evidence

  • of spreading infection (swelling, cellulitis, lymph node involvement)
  • or systemic involvement (fever, malaise)
36
Q

when should fissure sealants be placed

A

For all children, place fissure sealants on the permanent molars as early as possible after eruption

37
Q

when should sodium fluoride varnish be applied

A

For all children, aged 2 or older, apply sodium fluoride varnish at least twice per year

38
Q

if the child is at an increased risk of developing caries, what sort of prevention should they receive

A

If the child is at increased risk of developing caries , in addition to standard prevention, ensure they receive enhanced prevention, unless there is a valid reason not to
In this case, ensure this is documented in the patient’s notes

39
Q

what amount of toothpaste should be recommended for a child under the age of 3

A

use a smear

40
Q

what amount of toothpaste should be recommended for a child over the age of 3

A

use a pea-sized amount

41
Q

what concentration of fluoride toothpaste is recommended in standard prevention

A

1000-1500ppmF

1450ppmF

42
Q

what concentration of fluoride toothpaste is recommended in enhanced prevention

A

under 10s: 1350-1500ppmF

over 10s: consider 2800ppmF

43
Q

what advice is included in standard prevention for all children

A

• Give toothbrushing advice at least once a year
○ Brush thoroughly twice daily, including last thing at night
○ Use age-appropriate amount of toothpaste
○ Fluoride concentration: 1000-1500ppm F
○ Spit don’t rinse
○ Supervise children until they can brush effective

• Demonstrate brushing on the child for around 3 minutes annually

• Give dietary advice at least once a year, advise or remind the child and parent about how a health diet can help prevent caries, including
○ Limit consumption of food and drinks containing sugar
○ Drink only water or milk between meals
○ Snack on healthier foods, which are low in sugar
○ Do not place sugary drinks, fruit juices, sweetened milk or soy formula milk in feeding bottles or pacifiers
○ Do not eat or drink, apart from tap water, after brushing at night
○ Be aware of hidden sugars in food and the acid content of drinks

• Place sealants in all pits and fissures of permanent molars as soon as possible after eruption
○ Resin-based sealants are the first choice of material
○ Ensure the buccal pits of lower first permanent molars and the palatal fissures of upper first permanent molars are sealed
○ On fully erupted teeth where the child is uncooperative, use glass ionomer fissure sealants and ensure that fluoride varnish application is optimal

  • Check existing sealants for wear and integrity / leakage at every recall visit
  • Top up worn or damaged sealants
  • Apply sodium fluoride varnish (5%) twice a year to children aged 2 years and over
44
Q

list healthier snacks which are low in sugar

A 
§ Fresh fruit
§ Carrots, peppers
§ Breadsticks
§ Oatcakes
§ Occasionally a small amount of lower far cheese
45
Q

what advice is included in enhanced prevention for children at an increased caries risk

A

In addition to standard prevention
• At each recall visit, give hands on brushing instructions for around 3 minutes to the child and parent

• At each recall visit, give dietary advice as described for standard prevention

• Consider providing additional preventive interventions depending on the child’s circumstances, for example:
○ Recommending the use of 1350-1500ppm F toothpaste for children up to the age of 10 years old
○ Prescribing 2800ppm F toothpaste for children aged 10-16 years for a limited period [Regular review needed]
○ Keeping a food and drink diary, which is reviewed in practice and advice offered
○ Keeping a toothbrushing chart to record each time teeth are brushed as a reminder
○ Action planning to encourage change

  • Consider using GI as a temporary sealant on partially erupted first and second permanent molars until the tooth is fully erupted
    • Fissure seal palatal pits on upper lateral permanent incisors, and the occlusal and palatal surfaces of Ds, Es and first and second permanent molars, if assessed as likely to be beneficial

• If unable to give fissure sealants (eg due to the child being pre-cooperative or having a learning disability) then ensure that fluoride varnish application is optimal and attempt again as cooperative improves

• Ensure that sodium fluoride varnish is applied 4 times per year to children aged 2 years and older
○ Some applications may be provided through Childsmile

• Utilise any community / home support for preventive interventions that is available locally
○ Eg health visitor
○ School nurse
○ Childsmile dental health support worker

46
Q

what is the potential problem with using duraphat

A

most varnishes contain colophony eg Duraphat
A child who has been hospitalised due to severe asthma or allergy in the last 12 months or who is allergic to sticking plaster may be at risk of an allergic reaction to colophony
In these cases, consider using colophony-free varnish (licensed for caries prevention in the UK) or suggest the use of alternative age-appropriate fluoride preparations (eg fluoride mouthwash or higher concentration fluoride toothpaste)

47
Q

what should be done for For a child with a carious lesion in a primary tooth

A 
choose the least invasive, feasible caries management strategy, taking into account: 
○ the time to exfoliation, 
○ the site and extent of the lesion, 
○ the risk of pain or infection, 
○ the absence or presence of infection, 
○ preservation of tooth structure, 
○ the number of teeth affected, 
○ avoidance of treatment-induced anxiety
48
Q

what should be done for a child in pain due to pulpitis in vital primary tooth with irreversible symptoms and no evidence of dental abscess

A

consider carrying out a pulpotomy to preserve tooth and to avoid the need for an extraction

49
Q

what indicates infection

A

signs or symptoms of abscess, sinus, inter-radicular radiolucency, non-physiological mobility

50
Q

how can a primary tooth associated with infection be managed

A

either by extraction, or in certain circumstances consider referral for pulpectomy
In some cases local measure to bring the infection under control may be appropriate

51
Q

what does arrested caries look like

A

enamel: smooth
dentine: hard, lesion likely to be dark in colour

52
Q

management for carious primary teeth when there are no clinical or radiographic signs of pulpal involvement:
what is the technique used when the tooth is near to exfoliation

A
  • site specific prevention

- non-restorative cavity control

53
Q

management for carious primary teeth when there are no clinical or radiographic signs of pulpal involvement:
what is the technique used for any tooth with arrested caries (aesthetics is not a priority)

A
  • site specific prevention

- non-restorative cavity control

54
Q

management for carious primary teeth when there are no clinical or radiographic signs of pulpal involvement:
what is the technique used on initial and advanced occlusal lesions

A

initial:

  • site specific prevention
  • no caries removal and seal using the hall technique (but other options would be considered preferable)
  • no caries removal and seal with fissure sealant (or infiltration)

advanced:

  • no caries removal and seal using the hall technique (but other options would be considered preferable)
  • selective caries removal and restoration
  • non-restorative cavity control (due to a lack of supporting evidence, this approach is only appropriate for these types of lesions if no alternative is feasible. document the use of this approach and rationale in the patient’s record)
55
Q

management for carious primary teeth when there are no clinical or radiographic signs of pulpal involvement:
what is the technique used on initial and advanced proximal lesions

A

initial:

  • site specific prevention
  • non caries removal and seal with fissure sealant (or infiltration) (an emerging technique with a developing supporting evidence base)

advanced:

  • no caries removal and seal using the hall technique
  • selective caries removal and restoration (due to a lack of supporting evidence, this approach is only appropriate for these types of lesions if no alternative is feasible. document the use of this approach and rationale in the patient’s record)
  • non-restorative cavity control (due to a lack of supporting evidence, this approach is only appropriate for these types of lesions if no alternative is feasible. document the use of this approach and rationale in the patient’s record)
56
Q

management for carious primary teeth when there are no clinical or radiographic signs of pulpal involvement:
what is the technique used on initial and advanced anterior lesions

A

initial:
- site specific prevention

advanced:

  • selective caries removal and restoration
  • non-restorative cavity control (due to a lack of supporting evidence, this approach is only appropriate for these types of lesions if no alternative is feasible. document the use of this approach and rationale in the patient’s record)
  • complete caries removal and restoration
57
Q

management for carious primary teeth when there are no clinical or radiographic signs of pulpal involvement:
what technique is used for an unrestorable tooth (pain/infection free)

A
  • non-restorative cavity control

- extraction

58
Q

when is caries considered to have arrested

A

when there is demonstrable evidence of non-progression of lesions over several months using a recording system, such as photographs or ICDAS codes

59
Q

how should caries be managed in permanent teeth

A 
For a child with carious lesion in a permanent tooth, choose the least invasive, feasible caries management strategy taking into account:
○ The site and extent of lesion
○ The risk of pain or infection
○ Preservation of tooth structure
○ The health of the dental pulp
○ Avoidance of treatment induced anxiety
○ Life time prognosis of tooth
○ Orthodontic considerations
○ Occlusal development
60
Q

what teeth are most vulnerable to decay in the permanent dentition in children and teenagers

A

The permanent molars are the most vulnerable to decay in childhood and adolescence

○ Caries most commonly develop at just 2 sites on the permanent molars
§ Base of pits and fissures
§ Proximal surfaces, just below the contact point

Both these sites present challenges to the clinician in terms of diagnosis and caries management

61
Q

what might be done if the first permanent molar is assessed as having a poor life time prognosis

A

If a FPM is assessed as having a poor life time prognosis (whether from caries or MIH) and the second permanent molar is not yet erupted, then it may be in the child’s best long term interests to extract the FPM to allow the second permanent molar to erupt in its place

62
Q

can dental amalgam be used in all permanent teeth

A

Dental amalgam should not be used in the permanent teeth of a child or young person under 15 years of age unless exceptional circumstances can be justified

63
Q

what needs to be considered for first permanent molars with molar-incisor hypomineralisation

A

If there are carious lesions which are
§ Not severe
§ Not sensitive
§ Do not need restoration, and are unlikely to in the future
Then provide enhanced prevention, including fissure sealants and monitor

If there is good quality enamel with small defects that require restoration, use adhesive restorative materials
§ Indirect restorations extending onto sound enamel have better longevity, and it may be necessary to modify the cavity shape to achieve this

If the molars are sensitive then use GIC as a fissure sealant

64
Q

Management options for carious permanent teeth where there are no clinical or radiographic signs of pulpal involvement:
what technique should be used for initial, moderate and extensive occlusal lesions

A

initial:
- no caries removal and seal with fissure sealant (or infiltration)

moderate:

  • selective caries removal and restoration
  • complete caries removal and restoration

extensive:
- stepwise caries removal and restoration

65
Q

Management options for carious permanent teeth where there are no clinical or radiographic signs of pulpal involvement:
what technique should be used for initial, moderate and extensive proximal lesions

A

initial:

  • site specific prevention
  • no caries removal and seal with fissure sealant (or infiltration)

moderate:

  • selective caries removal and restoration
  • complete caries removal and restoration

extensive:
- stepwise caries removal and restoration

66
Q

Management options for carious permanent teeth where there are no clinical or radiographic signs of pulpal involvement:
what technique should be used for initial and advanced anterior lesions

A

initial:
- site specific prevention

advanced:

  • complete caries removal and restoration
  • selective caries removal and restoration (may be appropriate in some circumstances for anterior teeth, although evidence derived from studies on posterior teeth)
67
Q

Management options for carious permanent teeth where there are no clinical or radiographic signs of pulpal involvement:
what technique should be used on unrestorable teeth

A
  • extraction
68
Q

what should be done before referring a child for treatment

A

First relieve pain

Provide prevention

Attempt caries treatment using BMT and LA

consider the need for temporary dressings to reduce the chance of further pain

69
Q

what should be considered when referring a child for treatment

A

• For children who live in a different locality to your practice, be aware that you should refer to the service local to the child
○ This may be different to the service you routinely refer to

• Ensure all the relevant information is included in the referral communication (either electronic or letter)
○ A checklist provided in full guidance

• If referring a child for sedation or GA, follow your local protocol if there is one in place
○ Diagram below is helpful is deciding whether or not to refer a child for treatment under sedation or LA

• If a child is referred for care, ensure that you provide their continued dental care

70
Q

what should be done at each recall visit

A

At each recall visit:

• Carry out a focused oral health review, including
○ Asking again about toothbrushing practice and diet
○ Asking about compliance with any agreed action plans
○ Checking the condition of fissure sealants
○ Monitoring any lesions managed with prevention alone
○ Reassessing the child’s caries control and caries risk

  • Provide standard prevention to all children and additionally enhanced prevention if the child is assessed as at increased risk of developing caries
  • If caries is not being effectively controlled, consider alternative management options and the need for additional community / home support
  • Create a new personal care plan as required and maintain comprehensive records

BDS3 - Paediatrics (20 decks)

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