Module 4 Flashcards
what should oral health promotion strategies include
○ Facilitate daily toothbrushing with fluoride toothpaste
○ Be based on recognised oral health behaviour theory and models such as motivational interviewing
○ Be specific to individuals, and tailored to their particular needs and circumstances
what does the social history give an understanding of
The social history gathered during the assessment gives an understanding of the child’s current oral health practice, the parent / carer’s ability and attitude towards maintaining oral health and their motivation to take responsibility for it
what is the route map of health behaviour change using motivational interviewing
step 1: explore current practice and attitudes using a motivational interviewing approach - gain empathy > Seek permission > Open questions > Affirmations > Reflective listening > Summarising - develop discrepancy, roll with resistance - elicit change talk [the situation as it is now]
step 2:
educational intervention
- improve knowledge and skills
[the situation we would like it to be]
step 3:
action planning
- set time, date and place to start
[making it happen]
step 4:
encouraging habit formation
- achieve sufficient repetititon
[keeping it that way]
step 5:
repeat at each recall visit
what is SOARS
> Seek permission > Open questions > Affirmations > Reflective listening > Summarising
How would you develop an individualised action plan to encourage the child’s habit formation
• Identify a convenient time and place for the preventive behaviour to occur
○ Eg toothbrushing after breakfast and last thing at night
○ A date for when the task is to be started (ideally from the day of the appointment) and who is to carry it out
○ If difficulties are reported, alternatives may be necessary
○ For example, if the child is often too tired for toothbrushing last thing at night, agree an earlier time
• Identify a trigger as a reminder for the child or parent / carer to carry out the preventive behaviour (eg when the child gets ready for bed)
• Agree a date to review progress
○ Eg assess oral hygiene at the next visit
- Agree the action plan with the child and parent / carer and write this down for them if necessary, possibly on a copy of a food and drink diary or toothbrushing chart
- Record the action plan in the child’s notes so that it can be referenced at subsequent visits
- At subsequent visits, encourage, give further support and review the action plan and revise it, if necessary
• While discussing the action plan, assess the parent / carer or child’s ability and motivation to comply and if there is doubt about this, discuss collaboration with other healthcare professionals as a source of community / home support for the child and include this in the action plan
○ Eg health visitor, school nurse, Childsmile dental health support worker
what is one of the most effective methods for preventing caries
toothbrushing with fluoride toothpaste
what should be recommended to encourage and support all children to brush their teeth or have their guardian brush their teeth twice every day
○ The use of both an amount of toothpaste and a fluoride concentration appropriate for the child’s age and caries risk level;
○ Supervised brushing until the child can brush his / her teeth effectively
○ That children do not rinse their mouths after toothbrushing (‘spit, don’t rinse’)
what amount of toothpaste should a child under the age of 3 have
smear
what amount of toothpaste should a child over the age of 3 have
pea sized amount
what concentration of toothpaste should a child at standard risk use
1000-1500ppmF
what concentration of toothpaste should a child at enhanced risk use
under 10: 1350-1500ppmF
over 10: 2800ppmF
for standard prevention for all children: what brushing advice should be given to the child and their parents and how often
at least once a year, advise or remind them
- to brush thoroughly twice daily, including last thing at night
- brushing is best done in the morning and last thing at night before bed with nothing to eat or drink after brushing at night, apart from water
- brushing last thing at night is particularly effective due to retention of fluoride in the mouth
for standard prevention for all children: how often should brushing be demonstrated on the child
demonstrate brushing on the child for around 3 minutes annually
by modelling the desired behaviour, facilitating practice of the desired behaviour and giving reassurance that the behaviour is being done correctly, you can increase the child or parent’s confidence and so the likelihood that the toothbrushing behaviour will be done at home
for standard prevention for all children: what should be done to encourage tooth brushing
use action planning to encourage tooth brushing
- ask what routine habits exist each day (eg getting changed in the morning or at night) to be used as a reminder to brush teeth
- being very specific about when, what and where something is done
- best way to establish a new habit is to add it to something that is already a habit
for standard prevention for all children: when should you advise the parent to start brushing the child’s teeth
as soon as the first primary tooth erupts
for enhanced prevention for children at an increased caries risk: when should standard prevention toothbrushing advice be provide
at each recall visit
for enhanced prevention for children at an increased caries risk: when should hands-on brushing instruction be given to the child and parent
at each recall visit for around 3 minutes
for enhanced prevention for children at an increased caries risk: what additional preventive interventions should be provided
- recommend the use of 1350-1500ppmF toothpaste for children up to the age of 10
- prescribe 2800ppmF toothpaste for children aged 10-16 years for a limited period [regular review is required]
for enhanced prevention for children at an increased caries risk: wha other community / home support for toothbrushing might be utilised for these children
- health visitor
- school nurse
- childsmile dental health support worker
why do primary teeth matter if they are just going to fall out anyway
Baby teeth hold space for adult teeth
They allow the child to eat, talk and smile
A part of being a healthy child
what is the role of the parent / carer in looking after their child’s dental health
The role of the parent / carer is the brush the child’s teeth at least twice a day with a fluoride toothpaste to minimise sugary food / drink as part of a healthy diet
why should children be encourage to spit not rinse
Rinsing gets rid of the fluoride which makes it stop working
why should sugary foods be minimised and kept to meal tiimes
Every time we eat sugary foods the bacteria in our mouths turns the sugar in the food into acid and this acid attacks our teeth and causes decay
Avoid sugary foods as much as possible
how long should children be supervised whilst brushing their teeth
Children should be supervised until they are at least 7 years old
To make sure they are brushing correctly and that they are using the right amount of toothpaste
which method of fluoride delivery does the patient not administer themselves
fluoride varnish
what are the methods of fluoride delivery that a patient can use themselves
- fluoride toothpaste
- fluoride supplements
- fluoride mouthrinse
what is not suitable for the use of any 10 year old child
5000 ppmF toothpaste
what are some take home messages from the marimho 2008 review of the evidence for topical fluoride
- additional topical fluorides (eg motuhwash, varnish, tablets) used as well as toothpaste further reduce the occurence of caries
- the higher the caries rate, the greater the preventive effect of topical fluorides
- fluoride toothpaste prevents dental caries
what is the least amount of fluoride in toothpaste that should be recommended for a 2 year old child
1000ppmF
what is the strength of fluoride in duraphat varnish
22,600ppmF
when should topical fluorides (other than toothpaste) be taken
at a different time from toothbrushing
what is the correct drug prescription that should be written on a prescription to allow a tube of duraphat 2,8000ppmF toothpaste to be dispensed
sodium fluoride 0.619% toothpaste
when should a parent start using a toothbrush for their child
when their first tooth erupts
for a 6 month old child at low risk of caries, what brushing regime would you recommend
smear of 1000ppmF toothpaste for twice daily brushing
what essential questions should you ask a parent who calls your surgery to advise that their child has ingested some toothpaste
- amount of toothpaste
- strength of toothpaste
- age / weight of child
what is the minimum fluoride concentration that would provide a probably toxic dose
5mg / Kg body weight
the actual amount of toothpaste that needs to be ingested to reach the toxic dose for any child depends on 2 variables
- the weight of the child
2. the strength of the toothpaste
how many mgF is present in a 90g tube of 1000ppmF
90mg F
how many mgF is present in a 75g tube of 2800ppmF
210mg F
if a child has ingested <5mg / Kg how is this managed
give calcium orally (milk) and observe for a few hours
if a child has ingested 5-15mg / Kg how is this managed
give calcium orally (milk, calcium gluconate, calcium lactate) and admit to hospital
if a child has ingested >15mg / Kg how is this managed
admit to hospital immediately
cardiac monitoring and like support
intravenous calcium gluconate
