Paedodontics: Treating Children in Primary Care Flashcards
What is the first point of contact for NHS dental care?
General Dental Service (GDS)
Who can get free dental care in Scotland?
< age of 26
How much does plastic restoration of a primary tooth cost?
£10.15
How much does a preformed metal crown cost?
£26.60
What are the roles of the GDP for children? [contractually]
- Capitation = check ups, scaling, prevention
- Childsmile = food & drink advice, fluoride varnish
- Emergency dental care
- Management of dental caries
- Molar incisor hypomineralisation management
- Simple ortho treatment
What symptoms associated with molar incisor hypomineralisation may require management?
- hypersensitivity
- crumbling back teeth
- aesthetic concerns regarding incisors
What management options are available for symptomatic molar incisor hypomineralisation?
- seal
- restore with plastic restoration
- PMC
- extraction and timing of this
- aesthetic management of incisors
What simple orthodontic treatment may GDPs be required to carry out in children?
- removable appliances
- fixed appliances
What factors are involved in caries development?
- personal factors = eg poverty, toothbrush habits
- oral environment factors = eg saliva
- time, tooth, bacteria, dietary carbohydrate
What should be looked at when deciding a child’s caries risk assessment?
- clinical evidence of previous disease
- dietary habits
- oral hygiene habits
- exposure to fluoride
- social history / socioeconomic status
- saliva
- medical history
What can affect the makeup of saliva, leading to increased caries risk?
- diabetes [high blood sugar levels]
- asthma inhaler users [beta 2 agonists & corticosteroids]
- anticonvulsants
- antihistamines
What are the 3 key elements of prevention in paediatric primary dental care?
- caries risk assessment
- behaviour modification
- tooth protection
Behaviour modification is the 2nd element of prevention, what does it consist of?
- attendance patterns
- tooth brushing habits
- use of home fluoride
- drinking and dietary habits
- acclimitisation
Give an example of a behaviour modifcation technique:
Motivation interviewing
Tooth protection plays a role in paediatric prevention, what may be involved?
- application of 5% sodium fluoride varnish
- placement of fissure sealants
- prescription of 2800ppmF toothpaste
- SDF
What is the fluoride content of SDF?
44800ppmF
How does SDF work?
Synergistic effects
- occludes dentinal tubules
- silver is antibacterial
- fluoride encourages remineralisation
Discuss the advantages of using SDF:
- safe
- simple easy quick
- non AGP
- non invasive
- evidence based
Discuss the disadvantages of using SDF:
- stains caries black
- can cause temp tattoo
- relatively expensive
- metallic taste
Why is caries progression faster in primary molars?
- wider contact points [more food trapping]
- larger pulps close to occlusal surface therefor faster spread
From what age should dental bitewings be taken?
consider BWs from age 4
What are examples of non invasive caries interventions?
- biofilm control
- remineralisation
- dietary control
What are examples of micro-invasive caries interventions?
- sealing
- resin infiltrations
What are examples of minimally invasive caries interventions?
ART [atraumatic restorative treatment]
- cleaning out decay using hand instruments
What are examples of important variables that affect caries intervention in children?
- caries risk
- age of child & ability to cope
- length of time until tooth exfoliates vs survival rates
- choice of material
Why might a child be referred to PDS?
- anxiety & phobia
- GA extractions
- sedation
- special needs
- vulnerable groups
Why might a child be referred to HDS?
- management of severe caries
- medical conditions
- trauma
- dental defects
- multidisciplinary care
What non dental services may you occasionally have to refer child patients to?
- child protection
- social services
What is the most common type of sedation used in child patients?
Inhalation sedation
What are some indications for use of conscious sedation in paediatric patients?
- child is anxious but co-operative
- treatment is straight forward
- treatment is not likely to damage childs attitude to treatment in future
What are some contra-indications for use of conscious sedation in paediatric patients?
- severe dental anxiety where child cannot cooperate at all
- treatment required too extensive or complex
- child too young to understand how to use IS
- child cannot breathe through their nose
What considerations decide if a child requires conscious sedation or GA?
- cooperation of child
- degree of anxiety
- degree of surgical trauma anticipated
- complexity of operative procedure
- medical status of child
What are some negative impacts on paediatric dentistry of the COVID-19 pandemic?
- longer waiting times for GA
- smaller number of pts on GA list
