module 3 Flashcards

1
Q

what is the best method for assessing dental caries

A
  • visual inspection on clean, dry teeth with good light
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2
Q

what percentage is normal health enamel mineralised

A
  • 98%

- almost transparent

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3
Q

what colour is caries affected enamel

A
  • white appearance
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4
Q

how is the white appearance of carious enamel created

A
  • acidic solutions preferentially dissolve prism sheaths in enamel, creating pores
  • these pores refract light, reflecting it back, instead of letting it pass through
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5
Q

when viewing anterior lesions using transmitted light what colour will lesions appear

A
  • dark

- due to light being blocked

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6
Q

how can you identify dentinal carious lesions

A
  • opalescent white
  • central cavitation is directly visible as dark, carious dentine
  • surrounded by opalescent white halo wherever enamel is partially demineralised
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7
Q

why must teeth be dry to inspect for caries

A
  • 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
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8
Q

what does opalescent enamel adjacent to stained fissure indicate

A
  • dentinal involvement
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9
Q

what is an arrested carious lesion

A
  • one that does not progress
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10
Q

what does active caries feel like

A
  • rough to a probe dragged across surface

- arrested caries is smooth

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11
Q

how hard is arrested caries

A
  • softer the lesion, the more active it is likely to be

- softer lesions are also more shiny

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12
Q

why is colour not a good indicator of caries activity

A
  • colour can vary
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13
Q

why are radiographs useful

A
  • diagnosing presence of caries
  • diagnosing extent of carious lesion
  • assessing caries progression
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14
Q

why is it difficult to assess caries proximally in primary dentition visually

A
  • they have broad contact points
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15
Q

what age can bitewings be done

A
  • 4+
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16
Q

what does frequency of radiographs depend on

A
  • child’s risk assessment
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17
Q

why is it important to see a clear band of healthy dentine separating caries and pulp

A
  • if there isn’t one, then more invasive techniques will be needed
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18
Q

what is a bitewing radiographs radiation dose equivalent to

A
  • a few days worth of background radiation
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19
Q

how often should children at increased caries risk have bitewings taken

A
  • 6-12 months
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20
Q

how often should children at lower risk of caries have bitewings taken

A
  • 2 years
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21
Q

what is a triangle shaped radiolucency on mesial surface of maxillary second primary molars and maxillary permanent molars be

A
  • cusp of carabelli

- could be mistaken for proximal caries

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22
Q

what kind of prevention must all children receive

A
  • standard
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23
Q

what prevention must a child at increased risk of caries receive

A
  • enhanced prevention
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24
Q

how do you develop and individualised action plan

A
  • 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
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25
Q

how much tooth paste do children under 3 get

A
  • a smear of toothpaste
26
Q

how much tooth paste do children over 3 get

A
  • pea-sized amount
27
Q

what strength of toothpaste is standard risk

A
  • 1000-1500ppm
28
Q

what strength of toothpaste is for increased risk

A
  • 1350-1500ppm

- for 10+ then consider 2800ppm

29
Q

how often is standard prevention done

A
  • at least once a year
30
Q

what is included in standard prevention advice

A
  • 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
31
Q

how often is enhanced prevention done

A
  • at each recall visit
32
Q

what is included in enhanced prevention advice

A
  • 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
33
Q

how long should patients wait after eating to brush teeth

A
  • 30 minutes
34
Q

how can you help patients see plaque levels in mouth

A
  • disclosing tablets
35
Q

what diet advice is given for standard prevention

A
  • 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
36
Q

what additional advice can be given for diet for enhanced prevention

A
  • more in-depth advice

- food and drink diary

37
Q

what clinical work should be done for standard prevention

A
  • 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
38
Q

what additional clinical work should be done for enhanced prevention

A
  • fissure seal palatal pits on upper lateral permanent incisors and occlusal and palatal surface of D, E, 1st and 2nd permanent molars
39
Q

how can you clean tooth of debris

A
  • wipe tooth with cotton wool pledget
  • clean with toothbrush
  • bristle brush with prophy paste
  • gently pull a probe through fissures
40
Q

how to do a sealant

A
  • 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
41
Q

how can you tell a clear sealant is damaged

A
  • opalescence visible at sealant/tooth interface
42
Q

when can a GI sealant be used

A
  • when on a partially erupted tooth
  • un/non co-operative child
  • concern over moisture control
43
Q

how does GI compare to resin sealant

A
  • retention rates are less
44
Q

what technique is used to place GI sealant

A
  • press finger technique
45
Q

how is the ‘press-finger’ technique done for GI sealants

A
  • 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
46
Q

how often is varnish applied for standard prevention

A
  • twice a year
47
Q

how often is varnish applied for enhanced prevention

A
  • 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

48
Q

how is fluoride varnish applied

A
  • isolate and dry teeth

- apply a small amount of fluoride using small brush

49
Q

what advice is given after fluoride varnish applied

A
  • soft foods and liquids may be consumed 30 minutes after

- don’t brush teeth or have chewing food for at least a few hours

50
Q

what can a recall visit be assigned based on

A
  • clincians knowledge of the chid
  • assessment of disease levels
  • overall risk
  • Childs occlusal development
  • need to provide further care
51
Q

what is the recommenced interval for recall

A
  • 3-12 months

- 3 for higher risk

52
Q

what is done at each recall visit

A
  • 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
53
Q

when reading clinical guidelines what does the strength of a strong key recommendation convey

A
  • based on available information, weighing up balance of benefit versus risk, almost all individuals would choose this option
54
Q

what is one aim when providing dental care for children

A
  • reduce the risk of the child experiencing pain, infection or treatment induced anxiety
55
Q

what does a comprehensive assessment of the child not include

A
  • carer motivation and responsibility only
56
Q

an assessment of lesion activity is essential for providing the appropriate level of caries prevention this includes

A

progression over time using clinical photographs

57
Q

when assessing toothbrushing and recording plaque levels at each examination, a score of 8 out of 10 means

A
  • plaque line around the cervical margin
58
Q

motivational interviewing is used to translate knowledge into behaviour change, it involves

A
  • toothbrushing demonstration on child and age appropriate toothpaste advice
59
Q

enhanced prevention should include what at each recall visit

A
  • standard prevention and hands on toothbrushing to child and parent/carer at each recall visit
60
Q

what percentage is sodium fluoride varnish used

A
  • 5%