Prevention Flashcards
Define GRADE
Grading of Recommendations, Assessment, Development and Evaluations.
It reflects the extent to which the relevant disease-based Guideline Development Group (GDG) is confident that desirable effects of an intervention outweigh undesirable effects across the range of patients for whom the recommendation is intended.
What does it mean if the GDG makes a strong recommendation?
The GDG is highly confident that desirable consequences outweigh undesirable or undesirable consequences outweigh desirable, typically based on high or moderate certainty evidence.
What does it mean if GDG makes condtional recommendation?
Conditional recommendations – the GDG is less confident of the effectiveness of an intervention (low or very low certainty evidence) or the balance between benefits and harms is unclear.
What does the GDG mean by ‘Good Practice’?
Clinical opinion suggests this advice is well established or supported.
No robust underpinning research evidence exists.
Good practice points are primarily based on extrapolation from research on related topics and/or clinical consensus, expert opinion and precedent, and not on research appropriate for rating the certainty or quality of the evidence
All children aged up to 3 years
Advice:
For parents or carers feeding babies by bottle:
• only breastmilk, infant formula or cooled boiled water should be given in a bottle
• babies should be introduced to drinking from a free-flow cup from the age of 6 months
• feeding from a bottle should be discouraged from the age of 1 year
Strength of recommendation?
Strong
All children aged up to 3 years
Advice:
For parents or carers feeding babies by bottle:
• only breastmilk, infant formula or cooled boiled water should be given in a bottle
• babies should be introduced to drinking from a free-flow cup from the age of 6 months
• feeding from a bottle should be discouraged from the age of 1 year
Strength of recommendation?
Good practice
All children aged up to 3 years
Advice
Gradually introduce a wide variety of solid foods (of different textures and flavours) from around the age of 6 months. Sugar should not be added to food or drinks given to babies and toddlers
Strength of recommendation?
Good practice
All children aged up to 3 years
Advice:
Parents or carers should brush their children’s teeth:
• as soon as they erupt
• twice a day
• last thing at night (or before bedtime) and on one other occasion
• with a toothpaste containing at least 1000 ppm fluoride
• using only a smear of toothpaste
Strength of recommendation?
Strong
All children aged up to 3 years
Advice:
Minimise consumption of sugar-containing foods and drinks
Strength of recommendation?
Strong
All children aged up to 3 years
Advice:
Use sugar-free versions of medicines if possible
Strength of recommendation?
Good practice
All children aged up to 3 years
Advice:
Avoid sugar-containing foods and drinks at bedtime when saliva flow is reduced and buffering capacity is lost
Strength of recommendation?
Good practice
All children aged up to 3 years
Professional intervention:
Assign a recall interval ranging from 3 to 12 months based on oral health needs and disease risk
Strength of recommendation?
Conditional
All children aged 3 to 6 years
Advice:
Teeth should be brushed by a parent or carer. As the child gets older, a parent or carer should assist them to brush their own teeth:
• on all tooth surfaces
• at least twice a day
• last thing at night (or before bedtime) and on at least one other occasion
• with toothpaste containing at least 1,000 ppm fluoride
• using a pea-sized amount of the toothpaste
• spitting out after brushing rather than rinsing, to avoid diluting the fluoride concentration
Strength of recommendation?
Strong
All children aged 3 to 6 years
Advice:
Minimise amount and frequency of consumption of sugar-containing food and drinks
Strength of recommendation?
Strong
All children aged 3 to 6 years
Advice:
Use sugar-free versions of medicines if possible
Strength of recommendation?
Good practice
All children aged 3 to 6 years
Professional intervention:
Apply fluoride varnish (2.26% NaF) to teeth 2 times a year
Strength of recommendation?
Strong
All children aged 3 to 6 years
Professional intervention:
Assign a recall interval ranging from 3 to 12 months based on oral health needs and disease risk
Strength of recommendation?
Conditional
Children aged 0 to 6 years giving concern because of dental caries risk
Advice:
Use toothpaste containing 1,350 to 1,500 ppm fluoride
Strength of recommendation?
Strong
Children aged 0 to 6 years giving concern because of dental caries risk
Advice:
For children taking medication frequently or long term, choose or request sugar-free medicines if possible
Strength of recommendation?
Good practice
Children aged 0 to 6 years giving concern because of dental caries risk
Proessional intervention:
Where the child is prescribed medication frequently or long term, liaise with medical practitioner to request that it is sugar free
Strength of recommendation?
Good practice
Children aged 0 to 6 years giving concern because of dental caries risk
Proessional intervention:
Investigate diet and assist adoption of good dietary practice in line with the Eatwell Guide
Strength of recommendation?
Good practice
Children aged 0 to 6 years giving concern because of dental caries risk
Proessional intervention:
Assign a shortened recall interval based on dental caries risk
Strength of recommendation?
Conditional
All children from 7 years and young people up to 18 years
Advice:
Brush teeth at least twice daily (with assistance from parent or carer if required):
• last thing at night (or before bedtime) and on at least one other occasion
• with toothpaste containing 1,350 to 1,500 ppm fluoride
• spitting out after brushing rather than rinsing with water, to avoid diluting the fluoride concentration
Strength of recommendation?
Strong
All children from 7 years and young people up to 18 years
Advice:
Minimise amount and frequency of consumption of sugar-containing food and drinks
Strength of recommendation?
Strong
All children from 7 years and young people up to 18 years
Advice:
Avoid sugar-containing foods and drinks at bedtime when saliva flow is reduced and buffering capacity is lost
Strength of recommendation?
Conditional
All children from 7 years and young people up to 18 years
Professional intervention:
Apply fluoride varnish to teeth 2 times a year (2.26% NaF)
Strength of recommendation?
Strong
All children from 7 years and young people up to 18 years
Professional intervention:
Assign a recall interval within the range of 3 to 12 months based on oral health needs and disease risk
Strength of recommendation?
Conditional
Children from 7 years and young people up to 18 years giving concern because of dental caries risk
Advice:
Parent or carer to assist and supervise toothbrushing if required
Strength of recommendation?
Good practice
Children from 7 years and young people up to 18 years giving concern because of dental caries risk
Advice:
Use a fluoride mouth rinse daily (0.05% NaF; 230 ppmF) at a different time to brushing
Strength of recommendation?
Conditional
Children from 7 years and young people up to 18 years giving concern because of dental caries risk
Professional intervention:
Apply resin sealant to permanent teeth on eruption
Strength of recommendation?
Strong
Children from 7 years and young people up to 18 years giving concern because of dental caries risk
Professional intervention:
Apply fluoride varnish to teeth 2 or more times a year (2.26% NaF)
Strength of recommendation?
Strong
Children from 7 years and young people up to 18 years giving concern because of dental caries risk
Professional intervention:
For those 8 years and above with active dental caries, consider recommending or prescribing daily fluoride mouth rinse (0.05% NaF; 230ppm F), to be used at a different time from brushing, until dental caries risk is reduced
Strength of recommendation?
Conditional
Children from 7 years and young people up to 18 years giving concern because of dental caries risk
Professional intervention:
For those 10 years and above with active dental caries, consider prescribing 2,800ppm fluoride toothpaste until dental caries risk is reduced
Strength of recommendation?
Conditional
Children from 7 years and young people up to 18 years giving concern because of dental caries risk
Professional intervention:
For those 16 years and above with active dental caries, consider prescribing either 2,800ppm or 5,000ppm fluoride toothpaste until dental caries risk is reduced
Strength of recommendation?
Conditional
Children from 7 years and young people up to 18 years giving concern because of dental caries risk
Professional intervention:
Where a child or young person is prescribed medication frequently or long term, liaise with medical practitioner to request that it is sugar free
Strength of recommendation?
Good practice
Children from 7 years and young people up to 18 years giving concern because of dental caries risk
Professional intervention:
Investigate diet and assist adoption of good dietary practice in line with the Eatwell Guide
Strength of recommendation?
Good practice