Paeds Clinic Flashcards
List and describe the factors in caries risk assessment (7)
Medical history
- disabled
- immunocompromised
- medications
social history
- single parent
- deprivation
- siblings have caries
fluoride
saliva
clinical evidence
- caries in 6’s
- 3 carious lesions in 3 years
- DMFT/dmft > or equal to 5
- fixed appliances
diet
> 4 sugary intakes per day
plaque control
- unassisted
- irregular brushing
What are the ingredients for caries? (3)
Tooth
Substrate and bacteria
time
Provide Oral Hygiene instruction. (7)
brush teeth as soon as they erupt
Brush teeth 2x per day - morning and night
- Don’t eat/drink for 30 mins after morning brush or at all after night brush
Brush for 2 mins
spit out toothpaste, don’t swallow
Don’t rinse mouth after brushing
Use a fluoridated toothpaste
brushing should be assisted until 7 and supervised until confident
Fluoride concentrations for High risk 0-3 years.
1350-1500 ppm
Fluoride concentrations for High risk 3-9 years.
1350-1500 ppm
Fluoride concentrations for High risk > 10 y/o
2800ppm
Fluoride concentrations for low risk 0-3 years.
1000ppm or above
Fluoride concentrations for low risk 3-9 years.
1350-1500ppm
how much toothpaste should we use for 0-3 years?
smear
how much toothpaste should we use for > 3 years?
pea size
describe the modified bass technique. (5)
assistance = stand behind or in front
work systematically - give examples
start from back and work your way forward
toothbrush contacting both gum and tooth surface (45 degree angle)
forward and back motion - sh sh sound - and flick downwards to the biting surface
Describe when interdental cleaning aids are useful in children.
between D, E or 6’s
- use 2/3x per week
List additional methods for improving toothbrushing in high risk children. (4)
Toothbrushing chart
disclosing tablets (@ home and @ visit)
free toothbrush and toothpaste
encourage flossing
What questions should we ask when taking a diet history?
Age appropriate - do they use a bottle? what’s in it?
Age appropriate - do they go to bed with a bottle? what’s in it?
What snacks do you take in nursery/school?
What do you drink between meals?
Do you like fruit and vegetables? what are your favourites?
Provide diet advice. (7)
try to have sugary intakes < 4x per day
Base meals around starchy foods - potatoes/pasta
eat lots of fruit and vegetables
water and milk as a drink between meals
- save sugary drinks for meal times
don’t give sugary drinks in bottles
snacks - vegetables, cheese, breadsticks
remember:
flavoured water/milk has hidden sugars
fruit juices have lots of sugar and are acidic
what are the advantages of using a diet diary? (2)
allows you to provide personalised/tailored advice
highlights areas of sugars that may be unknown to the patient
what must be included in a radiographic report? (7)
Justification
grade
teeth present/missing
caries
health of apices, middle and crown
any pathology
any abnormality
What material do we use for conventional fissure sealants?
Bis-GMA resin
what areas should we seal when applying conventional fissure sealants?
All fissure patterns on occlusal surface of molars/premolars
cusp of carabeli on U6
Buccal fissure L6
cingulum pits
Describe how we carry out a conventional fissure sealant. (7)
isolate the tooth using cotton rolls
use pumice and water to clean the occlusal surface
apply etch for 20 secs and wash off directly into aspirator
change cotton rolls
apply Bis-GMA to fissure pattern
- ensure spidery
- no air bubbles
- remove excess with microbrush
light cure
assess by;
running probe across margins and try to dislodge
look for air bubbles
how do we assess the quality of a conventional fissure sealant?
assess by;
running probe across margins and try to dislodge
look for air bubbles
how often are fissure sealants reviewed?
every 4-6 months
when would we use a GIC fissure sealant instead? (4)
Non-AGP
partially erupted
can’t achieve moisture control
- disability
- poor cooperation
sensitive teeth
describe how to carry out a GIC fissure sealant. (4)
Dry the tooth with air or cotton wool
- don’t use air if teeth sensitive
Apply GI from the applicator straight to tooth
Smooth into fissures using a gloved finger
Keep finger over GI until it sets, or place petroleum jelly over it (to decrease moisture contamination)
What concentration of fluoride varnish do we use? (percentage and ppm)
5% sodium fluoride duraphat
22,600ppm
How much fluoride varnish do we use per mouth?
0.25-0.5ml
how many times a year is fluoride varnish applied for high risk kids?
4x
how many times a year is fluoride varnish applied for low risk kids?
2x
when is fluoride varnish contraindicated? (4)
Allergy to colophony - Elastoplast
Severe asthma (hospitalised in past year or had to take oral steroid)
severe allergy (hospitalised in last year)
ulcerative gingivitis
what advice is given after fluoride application? (4)
avoid eating/drinking for an hour after
stick to soft foods that day
avoid brushing that night but brush as normal starting from the next day - not recommended in practice
don’t take any further fluoride supplements for 2 days after.
Describe the method for applying fluoride varnish . (5)
Isolate the tooth using cotton rolls
remove gross plaque
dry the tooth
apply varnish to lower arch first, then upper with a microbrush
floss varnish through the contacts
What do you do if you accidentally put FV on a child who is allergic?
inform the patient and apologise
brush off the varnish with a toothbrush
have emergency first aid kit nearby
if no reaction;
- observe child in practice for a few hours and then send home with instructions that if symptoms start go to A&E.
- get in next day for a follow up
If signs of a reaction;
phone 999/send to A&E
At what age can a fluoride mouthwash be given?
What is the concentration?
> 6 years old
225ppm
What dose of fluoride supplement tablets can be given to 6months - 3 year olds?
0.25mg per day
What dose of fluoride supplement tablets can be given to 3 - 6 year olds?
0.5mg oer day
What dose of fluoride supplement tablets can be given to > 6 year olds?
1mg per day
What questions should we ask in a paediatric trauma case? (6)
When
How - child protection case?
where - child may need antibiotics and check tetanus.
any other injuries
witnesses
Loss of consciousness
At what age should we investigate the presence of canines in the jaw and how do we do this?
9 years old
- palpate and inspect labial mucosa for bulges
- inspect palate for bulges
- radiograph if no bulges present
At what age do we assess BPE at in children?
7 - 17
what teeth do we assess using BPE?
16, 11, 26, 36, 31, 46
What probe do we use for BPE in kids - describe.
WHO 621
Black band from 3.5-5.5mm
Black band at 8.5mm
Black band at 11.5mm
what BPE scores do we give 7-11 year olds?
0-2
what BPE scores do we give 12-17 year olds?
full range
