Paeds Clinic Flashcards by Abby Lindsay

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

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What are the ingredients for caries? (3)

Tooth

Substrate and bacteria

time

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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

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Fluoride concentrations for High risk 0-3 years.

1350-1500 ppm

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Fluoride concentrations for High risk 3-9 years.

1350-1500 ppm

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Fluoride concentrations for High risk > 10 y/o

2800ppm

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Fluoride concentrations for low risk 0-3 years.

1000ppm or above

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Fluoride concentrations for low risk 3-9 years.

1350-1500ppm

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how much toothpaste should we use for 0-3 years?

smear

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how much toothpaste should we use for > 3 years?

pea size

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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

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Describe when interdental cleaning aids are useful in children.

between D, E or 6’s

use 2/3x per week

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List additional methods for improving toothbrushing in high risk children. (4)

Toothbrushing chart

disclosing tablets (@ home and @ visit)

free toothbrush and toothpaste

encourage flossing

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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?

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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

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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

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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

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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?

how many times a year is fluoride varnish applied for low risk kids?

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