Prevention

Question 1

Fluoride toothpaste ppm for low risk

Answer 1

0-3years old: at least 1000ppm, SMEAR (max 1500)

Over 3 yrs: at least 1000ppm, PEA SIZED

7+: 1350-1500ppm

Question 2

Fluoride toothpaste ppm for high risk

Answer 2

0-6 yrs: 1350-1500ppm (<3 yrs = smear, >3 yrs = pea sized)

7-10yrs: same as above

10+ : 2800ppm
16+: 5000ppm

Question 3

Describe standard prevention for caries risk (4 subsections)

Answer 3

1) OHI:
- brushing advice at least 1x year
- age appropriate toothpaste
- spit don’t rinse
- supervised brushing

2) DIET:
- advice at least 1x year
- limit food and drink containing sugar
- drink only water/milk between meals
- snacks: fresh fruit, carrot, peppers, breadsticks, oatcakes, sometimes low fat cheese
- no sugary drinks, fruit juice, sweet milk, or soy milk in feeding bottles or pacifiers
- don’t eat or drink anything except water after brushing at night
- avoid hidden sugars in food and acid in drinks

3) FISSURE SEALANT:
- place sealants in all pits and fissures of permanent molars as soon as possible after eruption
- resin based sealant = first choice of material
- ensure buccal pits of Lower 1st permanent molars & palatal fissures of upper 1st permanent molars sealed
- on fully erupted teeth + uncooperative, use GIC sealant, ensure fluoride varnish application optimal
- CHECK SEALANTS FOR WEAR AND LEAKAGE AT EVERY RECALL VISIT
- top up damaged sealant

4) FLUORIDE:
- apply sodium fluoride varnish 2x a year to kids above 2 years old
- age appropriate toothpaste

Question 4

Describe enhanced prevention for high caries risk in kids

Answer 4

1) OHI:
- same as standard except;
- every recall visit = hands on brushing advice to patient and parent

2) DIET
- keep food and drink diary, review in clinic

3) FISSURE SEALANT
CONSIDER:
- consider using glass ionomer as temporary sealant on partially erupted first and second permanent molars until tooth fully erupted
- fissure seal palatal pits on upper lateral permanent incisors, & occlusal + palatal surfaces of Ds, Es, first and second permanent molars, if assessed to be beneficial
DEFINITE;
- if unable to place fissure sealants due to cooperation/learning disability, ensure optimal fluoride varnish application and attempt again as cooperation improves

4) FLUORIDE:
- sodium fluoride varnish applied 4x a year to kids 2 years and over
- prescribe 2800ppm fluoride toothpaste for kids 10-16yrs for limited time
- recommend fluoride use 1350-1500ppm for kids up to 10years old

Question 5

Toxic dose fluoride?

Answer 5

• 5mg/kg
• 1ml fluoride varnish = 22.6mg
• weight = (age + 4) x 2

Eg
8 year old child:
8+4, x 2 = 24kg approximate

5x24 = 120mg
120/22.6 = 5.3ml approx max

Question 6

Fluoride varnish amounts per dentition

Answer 6

Primary; 0.25ml
Mixed; 0.4ml
Permanent; 0.75ml