Paeds- prevention Flashcards
Including fluoride use and fissure sealants
What are the arrows pointing to?
The Dentine layer showing through non-carious enamel
The bluish- grey colour due to dentine thinning towards the incisal edge. This colour is due to the shadow at the back of the mouth.
Where does the colour of the tooth come from?
dentine
Compare the appearance of the enamel lesion on the surface and in transmitted light.
Enamel lesion on the surface will appear matte/ opaque and chawky white.
In transmitted light- the lesion will appear darker than healthy enamel.
Why does a caries cause the tooth to appear more matte?
Caries dissolves the prisms sheaths, creating pores- these pores refract light back instead of letting it through.
What clinical feature indicates dentinal involvement?
Opalescent enamel beside stained fissures.
What are we looking for in a radiograph ?
If the carious lesion extends into the dentine and if so, what part of the dentine (outer/ middle/ inner)
How do we prevent via recall appointments?
Provide oral hygiene advice
Provide diet advice
Closely monitor any lesions you are treating with prevention.
Check fissure sealants are still intact
Your patient is deemed normal caries risk, How often should you book a checkup?
Every 6 months
Your patient is deemed high caries risk, How often should you book a checkup?
Every 3 months
Your patient is deemed normal caries risk, How often should take radiographs?
Every 2 years
Your patient is deemed high caries risk, How often should take radiographs?
Every 6-12 months
Your patient is deemed normal caries risk, How often should you provide toothbrushing instruction.
Every year
Your patient is deemed high caries risk, How often should you provide toothbrushing instruction.
At every recall appointment
Your patient is deemed normal caries risk, what strength of toothpaste should you advise?
1350-1500ppm
Your patient is deemed high caries risk and aged >10 what strength of toothpaste should you advise?
2800ppm
Your patient is deemed normal caries risk, how often should you apply fluoride varnish?
Twice a year
Your patient is deemed high caries risk, how often should you apply fluoride varnish?
4 times a year
What fluoride supplements would you give high risk patients?
Alcohol free fluoride mouthwash.
(for patients over the age of 7)
Your patient is deemed normal caries risk, how often should you provide diet advice?
Once a year
Your patient is deemed high caries risk, how often should you provide diet advice?
At every recall visit.
Use food and drink diaries
Your patient is deemed normal caries risk, which teeth should you fissure sealant
1st permanent molars after eruption.
Buccal pits of lower 1st permanent molars
Palatal fissures of upper 1st permanent molars
Your patient is deemed high caries risk, which teeth should you fissure seal.
All permanent molars and premolars sealed on eruption.
palatal pits on upper lateral incisiors
Occlusal and palatal surfaces of the D/E.
What does the fluoride varnish consist of?
5% sodium fluoride.
What children are at risk of an allergy to duraphat and why?
Those who :
- have recently been hospitalised due to asthma or an allergy
- are allergic to sticking plaster.
Because duraphat contains colophony.
Discuss the cocentration of duraphat varnish and the volume used.
22,600 ppm.
We use 0.25ml on children aged 2-5 (nursery & P1)
We use 0.4ml on primary 2 and above
How much fluoride needs to be ingested to cause toxicity and what factors impact this?
5mg/kg for toxicity.
The concentration of the toothpaste and the weight of the child affect this
How do you manage a child who has swallowed <5mg/kg of toothpaste?
Give them milk and monitor them for a few hours.
How do you manage a child who has swallowed 5-15mg/ kg of toothpaste?
Give them calcium orally and take them to hospital.
How do you manage a child who has swallowed >15mg/ kg.
Admit them to hopsital immediately
For: cardiac monitoring
Life support
Intravenous Calcium glucon
What is a fissure sealant?
It is a protective plastic coating that is used to seal fissures and pits of a tooth to prevent food or bacteria getting stuck.
Why are fissures more vulnerable to caries?
- They are less protected by fluoride than other tooth surfaces.
- A toothbrush cannot reach the whole way into a fissure.
What material is a fissure sealant made of?
Normally BIS gma resin
sometimes RMGIC
What teeth do we fissure seal for children with disabilities,
All teeth.
What teeth do we fissure seal for high risk children with learning difficulties
all teeth
What teeth do we fissure seal for high risk children who are medically compromised.
All teeth
What preventative action should you take if a child presents with caries in 1 permanent molar?
Fissure seal the other 3 1st permanent molars.
If the caries is occlusal- seal the 2nd permanent molars on erruption.
What are the SDCEP guidelines for all children no matter their risk.
All permanent molars should be sealed as soon as possible after eruption.
What surfaces should you ensure to seal on upper molars?
Occlusal surface and palatal pits.
What surfaces should you ensure to seal on lower molars?
Occlusal surface and buccal pits.
What surfaces should you ensure to fissure seal on the upper incisors.
Cingulum pits.
Why do we not want to overfill the fissure sealant?
overfilling decreases long term retention.
How should you check a fissure sealant after application?
Check for:
- adhesion
- air bubbles
- Material interproximally
- Excess material distal to the tooth.
- for opaqueness.
How often do we review fissure sealants?
Every 4-6 months.
What should we look for when checking the fissure sealant at recall meetings?
Visual check- Is there opalescence visible- this indicates leaking and demineralisation.
Physical check- use a probe to try and lift away the fissure sealant.
When do we chose a glass ionomer fissure sealant?
When good moisture control cannot be achieved.
If the patient has very sensitive teeth (so drying would be painful)
As a temporary sealant on primary and secondary molars until they fully erupt.
Covid- this doesn’t require an AGP.
Discuss glass ionomer cement as a fissure sealant.
adv- they release fluoride
Disadv- they are poorly retained
they require regular re-application.
