module 3 Flashcards
what is the best method for assessing dental caries
- visual inspection on clean, dry teeth with good light
what percentage is normal health enamel mineralised
- 98%
- almost transparent
what colour is caries affected enamel
- white appearance
how is the white appearance of carious enamel created
- acidic solutions preferentially dissolve prism sheaths in enamel, creating pores
- these pores refract light, reflecting it back, instead of letting it pass through
when viewing anterior lesions using transmitted light what colour will lesions appear
- dark
- due to light being blocked
how can you identify dentinal carious lesions
- opalescent white
- central cavitation is directly visible as dark, carious dentine
- surrounded by opalescent white halo wherever enamel is partially demineralised
why must teeth be dry to inspect for caries
- if surface enamel pores fill with water which has similar optical properties to enamel, then the pores allow light to be transmitted through enamel
- would hide caries
what does opalescent enamel adjacent to stained fissure indicate
- dentinal involvement
what is an arrested carious lesion
- one that does not progress
what does active caries feel like
- rough to a probe dragged across surface
- arrested caries is smooth
how hard is arrested caries
- softer the lesion, the more active it is likely to be
- softer lesions are also more shiny
why is colour not a good indicator of caries activity
- colour can vary
why are radiographs useful
- diagnosing presence of caries
- diagnosing extent of carious lesion
- assessing caries progression
why is it difficult to assess caries proximally in primary dentition visually
- they have broad contact points
what age can bitewings be done
- 4+
what does frequency of radiographs depend on
- child’s risk assessment
why is it important to see a clear band of healthy dentine separating caries and pulp
- if there isn’t one, then more invasive techniques will be needed
what is a bitewing radiographs radiation dose equivalent to
- a few days worth of background radiation
how often should children at increased caries risk have bitewings taken
- 6-12 months
how often should children at lower risk of caries have bitewings taken
- 2 years
what is a triangle shaped radiolucency on mesial surface of maxillary second primary molars and maxillary permanent molars be
- cusp of carabelli
- could be mistaken for proximal caries
what kind of prevention must all children receive
- standard
what prevention must a child at increased risk of caries receive
- enhanced prevention
how do you develop and individualised action plan
- identify convenient time and place for preventive behaviour and who is to carry it out
- identify a trigger as a reminder for the child or parent/carer to carry out preventive behaviour
- agree a date to review progress
- agree action plan with child and parent/carer and write this down for them
- record action plan in child’s notes
- revise plan if needed at future visits
how much tooth paste do children under 3 get
- a smear of toothpaste
how much tooth paste do children over 3 get
- pea-sized amount
what strength of toothpaste is standard risk
- 1000-1500ppm
what strength of toothpaste is for increased risk
- 1350-1500ppm
- for 10+ then consider 2800ppm
how often is standard prevention done
- at least once a year
what is included in standard prevention advice
- brush thoroughly twice daily, including last thing at night
- use age-appropriate amount of toothpaste
- spit don’t rinse
- supervise children until they can brush their teeth effectively
- demonstrate bushing on child
- use action planning
- advise parent to start brushing as soon s first primary tooth erupts
- advise parent not to let child eat toothpaste
how often is enhanced prevention done
- at each recall visit
what is included in enhanced prevention advice
- same as standard plus…
- give hands on instructions at each visit
- possibly prescribing stronger strength toothpaste
- utilise any community/home support for tooth brushing that is available locally
how long should patients wait after eating to brush teeth
- 30 minutes
how can you help patients see plaque levels in mouth
- disclosing tablets
what diet advice is given for standard prevention
- limit consumption of food and drinks containing sugar
- drink only water or milk between meals
- snack on healthier foods such as carrot, breadsticks, peppers, oatcakes
- do not place sugary drinks, fruit juices, sweetened milk or soy formula milk in feeding bottles
- don’t eat or drink after brushing teeth at night unless water
- be aware of hidden sugars in food
- be aware of acid content of drinks and restrict carbonated drinks to mealtimes
what additional advice can be given for diet for enhanced prevention
- more in-depth advice
- food and drink diary
what clinical work should be done for standard prevention
- place sealants in all pits and fissures of permanent molars as soon as possible after
- ensure buccal pits pf lower first molars and palatal pits of upper first are sealed
- if child un-cooperative, and can’t do resin sealant, do GI
- make sure fluoride varnish application is optimal
what additional clinical work should be done for enhanced prevention
- fissure seal palatal pits on upper lateral permanent incisors and occlusal and palatal surface of D, E, 1st and 2nd permanent molars
how can you clean tooth of debris
- wipe tooth with cotton wool pledget
- clean with toothbrush
- bristle brush with prophy paste
- gently pull a probe through fissures
how to do a sealant
- dry tooth to avoid diluting etch
- apply phosphoric acid etch for 30 seconds
- wash etch
- dry tooth
- apply resin to etched enamel ensuring it flow with no air blows
- light cure sealant
- check sealant with a probe - if can be clicked off then it needs removed and re done
how can you tell a clear sealant is damaged
- opalescence visible at sealant/tooth interface
when can a GI sealant be used
- when on a partially erupted tooth
- un/non co-operative child
- concern over moisture control
how does GI compare to resin sealant
- retention rates are less
what technique is used to place GI sealant
- press finger technique
how is the ‘press-finger’ technique done for GI sealants
- place a small amount of GI on one finger tip, and petroleum jelly on the adjacent finger
- wipe tooth surface with a cotton wool roll
- firmly apply finger tip with GI to tooth surface to be sealed
- keep finger in place for 2 mins if possible
- place second finger in mouth, switch fingers and cover tooth in petroleum jelly before moisture contamination
how often is varnish applied for standard prevention
- twice a year
how often is varnish applied for enhanced prevention
- 4 times a year
- also use alcohol free sodium-fluoride mouth wash for children over 7 as well at a different time to tooth brushing
how is fluoride varnish applied
- isolate and dry teeth
- apply a small amount of fluoride using small brush
what advice is given after fluoride varnish applied
- soft foods and liquids may be consumed 30 minutes after
- don’t brush teeth or have chewing food for at least a few hours
what can a recall visit be assigned based on
- clincians knowledge of the chid
- assessment of disease levels
- overall risk
- Childs occlusal development
- need to provide further care
what is the recommenced interval for recall
- 3-12 months
- 3 for higher risk
what is done at each recall visit
- carry out focused oral health review
- enquire about compliance with agreed action plans
- closely monitor lesions managed with prevention alone
- check condition of fissure sealants
- reassessment Childs caries control and risk
when reading clinical guidelines what does the strength of a strong key recommendation convey
- based on available information, weighing up balance of benefit versus risk, almost all individuals would choose this option
what is one aim when providing dental care for children
- reduce the risk of the child experiencing pain, infection or treatment induced anxiety
what does a comprehensive assessment of the child not include
- carer motivation and responsibility only
an assessment of lesion activity is essential for providing the appropriate level of caries prevention this includes
progression over time using clinical photographs
when assessing toothbrushing and recording plaque levels at each examination, a score of 8 out of 10 means
- plaque line around the cervical margin
motivational interviewing is used to translate knowledge into behaviour change, it involves
- toothbrushing demonstration on child and age appropriate toothpaste advice
enhanced prevention should include what at each recall visit
- standard prevention and hands on toothbrushing to child and parent/carer at each recall visit
what percentage is sodium fluoride varnish used
- 5%
