Prevention and Management of Dental Caries in Children Flashcards
what is included in the history of a child
reason for attendance
medical history
social history
who has parental rights
caries experience in family members
toothbrushing habits
diet
dental history
difficulties in attending the dentist
what is in the dental assessment of a child
charting teeth
plaque scores
modified BPE
what techniques can be used to help examine a child
be smiley and kind
have child’s head on your lap and legs on parents lap
what is the best method for detecting caries
visual inspection on clean, dry teeth with good light
how can the extent of dentinal carious lesions be assessed
based on the appearance of the overlying enamel
why must the teeth be clean and dry for effective caries diagnosis
because if water goes into the surface enamel pores it will allow light to be transmitted as normal instead of refracted if it was carious
what would indicate that a lesion is confined to the enamel only
a stained pit or fissure without adjacent white opalescent enamel and with no radiographic sign
what would white opalescent enamel at marginal ridge indicate
proximal lesion without dentinal involvement
what would arrested enamel lesions feel like
smooth to a probe lightly drawn across the surface
what would arrested dentine lesions feel like
hard and shiny
how often are bitewings taken for high risk children
6-12 months
how often are bitewings taken for non-high risk children
2 years
what is molar incisor hypomineralisation
hypomineralisation of systemic origin of 1-4 permanent first molars frequently associated with incisors
how does MIH compromise restorations
it has an abnormal etching and bonding pattern
what factors are taken into consideration when determining whether teeth affected by hypomineralisation are of poor prognosis
enamel colour
location of defects
sensitivity
atypically shaped restorations
patient reported symptoms
what signs can be indicators of dental infection in primary teeth
TTP in non-exfoliating tooth
alveolar tenderness
non-physiological mobility
radiographic signs
what factors are considered when deciding how to manage carious lesions
extent of lesion
site of lesion
activity of lesion
time to exfoliation
number of other lesions present in dentition
childs medical status
cooperation
what lesions would be high risk of causing the child pain or infection
cavitated lesion
clinical exposure of necrotic pulp years before exfoliation
what lesions would be of low risk of causing the child pain or infection
clinical exposure of vital pulp
retained roots
arrested caries
what is plaque score 8/10
plaque line around cervical margin
what is plaque score 6/10
cervical third of crown covered
what is plaque score 4/10
middle third covered
what are the 7 factors of caries risk assessment
caries experience
diet
social history
fluoride use
plaque control
saliva
medical history
how often is the child’s caries risk re-assessed
each assessment
what is used to assess dental anxiety in children
mcdas
mcdasf
name some behaviour management strategies
communication
enhancing control
tell show do
positive reinforcement
structured time
distraction
relaxation
systematic desensitisation
what is enhancing control
stop and go signals
what is structured time
giving set times to how long you will do something (count to 5 and then i will stop)
what techniques can be used to help children relax
ask them to place a hand on their tummy and breathe in slowly and deeply to fill their tummy
what is used for systematic desensitisation
discuss with child how to recognise anxiety signs
teach how to manage with breathing
use a scale of 1-10 for anxiousness
break procedure into stages
give control
what would a general treatment plan for a child look like
manage pain
caries prevention
carious management
preventive interventions for permanent teeth first (fissure seals)
devise and agree care plan
obtain consent
who else can you get involved in your care plan
child health visitor
school nurse
childsmile support worker
if a child resists treatment what do you do
do not continue
what is the most common reason for a child’s pain
pulpal pathology as a consequence of dental caries
what are reversible pulpitis symptoms
pain provoked by stimulus and relieved when removed
difficult to localise
does not affect sleep
what are irreversible pulpitis symptoms
spontaneous pain
pain lasts hours
difficult to localise
kept awake at night
dull and throbbing
no signs and symptoms of infection yet
what are acute dental abscess/periradicular periodontitis symptoms
spontaneous pain
kept awake at night
easily localised
increased mobility
TTP
clinical evidence of sinus
what are chronic dental abscess/periradicular symptoms
infected remains of pulp cause problems unless managed
if a child with irreversible pulpitis is cooperative what treatment is considered
pulpotomy
when is a pulpotomy considered
cooperative children
when no separation on radiograph of pulp and caries
what is done when there are symptoms of pain due to food packing/pulpitis with reversible symptoms but you are uncertain
place temp dressing and review 3-7 days later
if resolves = it was reversible pulpitis and place crown/restoration
if continues = consider extraction or pulp therapy
if a child has asymptomatic dental infection but cannot cope with XLA at the moment but might with acclimatisation what do you do
allow up to 3 months for acclimatisation
if a child is pre-cooperative what do you do
consider referral to assess suitability for extraction under sedation or GA
what do you do for irreversible pulpitis for a cooperative child
XLA or pulp therapy for primary tooth
RCT or XLA for permanent tooth
what do you do for irreversible pulpitis for a pre-cooperative child
dress with lining of corticosteroid antibiotic paste, prescribe pain relief
refer for treatment - XLA with sedation/GA for primary teeth
for permanent teeth do RCT or XLA and if remains uncooperative refer to specialist
what do you do for dental abscess on pre-cooperative child
antibiotics if spreading infection
pain relief
refer for XLA with sedation or GA for primary teeth
RCT or XLA/specialist referral for permanent teeth
what do you do for a dental abscess on a cooperative child
carry out XLA or pulp therapy on primary tooth
RCT or XLA on permanent tooth
what technique is used to gain information about a patients current practice and attitudes
motivational interviewing
what are the steps of motivational interviewing
seek permission
open questions
affirmations
reflective listening
summarising
what is the general conversation like when trying to gain behaviour change
motivational interviewing
educational intervention
action planning
encourage habit formation
repeat
how do you develop an individualised action plan to encourage habit formation
identify convenient time and place for prevention
identify trigger as a reminder for child/parent
agree date to review progress
agree action plan with child and parent
what is recommended when giving toothbrushing advice
twice daily fluoride toothpaste
amount of paste
fluoride concentration
supervised brushing
spit dont rinse
what is the toothbrushing concentration for standard prevention
1000-1500ppm F
what is the toothbrushing concentration for increased risk
1350-1500ppm F for 3+
2800ppm F for 10+
what is included in standard prevention for all children
brush twice a day
1000-1500ppm F
spit dont rinse
supervise brushing
demonstration annually
action plan for brushing encouragement
brush as soon as first tooth erupts
what is enhanced prevention for high risk children
at each recall visit provide standard prevention
give hands on brushing instruction at each visit
1350-1500ppm F / 2800ppm F
utilise support workers
what is the technique for toothbrushing instruction
empathise with parent
ask if they want to brush all surfaces of mouth/each arch before moving on to next section
ask if they want to sit/stand
demonstrate on child
short scrubbing motion
use timer
30 mins after eating/drinking
assess benefits of plaque disclosing tablets
provide brush/paste
what is the standard prevention diet advice for all children
limit consumption of sugar containing foods/drinks
drink only water or milk between meals
snack in healthier foods
only water at bedtime
do not eat/drink after brushing at night
be aware of hidden sugars
be aware of acid content
what is enhanced prevention diet advice for high risk children
provide standard prevention at each recall visit
use diet diary
action planning
use health support workers
what is standard fissure sealant advice for children
place sealant in all pits and fissures ASAP after eruption
check existing sealants for wear
top up worn or damaged sealants
what is enhanced prevention for fissure sealants for children
provide standard prevention
fluoride varnish application
consider GI as temp sealant on partially erupted first and second permanent molars until fully erupted
seal palatal pits on upper laterals
what is the fissure sealant technique for resin sealants
clean tooth
isolate using cotton wool rolls
dry tooth
etch tooth
apply sealant
check sealant
how do you monitor fissure sealants
visually check
physically check with probe
top up as required
what is the GI sealant technique
place small amount of GI on finger tip and vaseline on another finger
wipe tooth surface with cotton wool roll
place GI onto tooth and keep there for 2 minutes
switch fingers with vaseline finger
what is the standard prevention for fluoride varnish
apply twice a year to children aged 2 years and over
what is enhanced prevention of fluoride varnish
apply 4 times a year to children aged 2 years and over
what is the contraindication to fluoride varnish
hospitalised due to severe asthma or colophony allergy
what is the ppm F for duraphat varnish
22,600
what is the volume for fluoride varnish used in 2-5yrs
0.25ml
what is the volume of fluoride varnish used in 5-7yrs
0.4ml
what is the technique for fluoride varnish
isolate and dry teeth
apply varnish using microbrush
what is the advise after having fluoride varnish put on
wait 30minutes until eating
wait 4 hours before brushing teeth/chewing hard food
what is taken into account when deciding how to manage a carious lesion
time to exfoliation
site and extent of lesion
risk of pain or infection
absence or presence of infection
preservation of tooth structure
number of teeth affected
avoidance of treatment induced anxiety
what are the principal strategies for managing caries in the primary dentition
no caries removal and seal with hall crown
no caries removal and fissure seal
selective caries removal and restoration
pulpotomy
if there is clear separation between carious lesion and pulp on a radiograph of a molar occlusal lesion what treatment is done
initial lesion = fissure seal/site-specific prevention
advanced lesion = selective caries removal/hall technique
if there is clear separation between carious lesion and pulp on a radiograph of an anterior tooth what treatment is done
initial lesion = site specific prevention
advanced lesion = selective caries removal, complete caries removal or non-restorative cavity control
if there is clear separation between carious lesion and pulp on a radiograph of a molar on the proximal surface what treatment is done
initial lesion = site specific prevention or sealant/infiltration
advanced lesion = hall technique or selective caries removal
what are the treatment options for a noncavitated primary molar with occlusal caries
seal by placing fissure sealant and recall at each visit
place GI sealant if cannot do resin
if cannot do sealant consider using Hall crown
what is the preferable management for noncavitated occlusal lesions
resin fissure seal
for advanced occlusal caries with cavitation and visible dentine what would the treatment options be
if only on occlusal surface do selective caries removal then restore
seal with hall crown
if proximal lesion also present seal with hall crown
what is the first treatment of choice for advanced lesions with cavitation
selective caries removal and sealing with a restoration
why should complete caries removal not be carried out on primary teeth with advanced lesions
higher risk of pulpal exposure
what indicates that a lesion has spread into dentine
cavitation or shadowing
what is the treatment for initial caries on proximal surfaces
site specific prevention and monitor
consider sealing lesion by placing sealant or resin and monitor
what is the treatment of advanced caries on proximal surfaces
do not remove caries and use hall crown
selective caries removal and restore
what is the treatment of initial caries on anterior teeth (white spot lesions)
site specific prevention
monitor at each recall
if progressing do alternative management strategy
what is the treatment for advanced caries on anterior teeth
selective caries removal and restore
complete caries removal and restore
if a tooth with caries is close to exfoliation what treatment would you do
site specific prevention or non-restorative cavity control
what is the treatment for teeth with arrested dentinal caries
site specific prevention or non-restorative cavity control
what is the treatment for unrestorable primary teeth
non-restorative cavity control or extraction
what are the principal strategies for managing caries in the permanent dentition
site specific prevention
selective caries removal
stepwise caries removal
complete caries removal
which permanent teeth are most vulnerable to decay in childhood and adolescence
permanent molars
what is the percentage of children with MIH
15%
what do you do for carious lesions which are not severe in people who have MIH
provide enhanced prevention including fissure sealants and monitor
what is the treatment for permanent teeth with initial occlusal caries
place resin fissure sealant
clinically review for wear and check integrity
radiographically review
what is used as a fissure sealant if first permanent molars are sensitive with MIH teeth
GI
what is the treatment for permanent teeth with moderate dentinal occlusal caries
selective caries removal and restoration
seal remaining fissures
what is the treatment with extensive dentinal occlusal caries
stepwise caries removal
seal remaining fissure
what is stepwise caries removal
selective caries removal initially
reactionary dentine laid down by pulp in response to irritant of caries
remove rest of decay
permanent restoration now
what can be used to help visualise proximal spaces
orthodontic separators for 5 days
what is the treatment for initial proximal caries on permanent teeth
identify and arrest early enamel only lesions
site specific prevention
alternatively seal lesion
what is the treatment for moderate dentinal caries (proximal) on permanent teeth
carry out selective caries removal and seal remaining fissures
what is the treatment for extensive dentinal proximal caries
stepwise caries removal and temporise for 6-12 months then permanent restoration
what signs deem a first permanent molar as being of poor prognosis
advanced occlusal or proximal lesions or recurrent caries
hypomineralisation causing cavitation
lingual decalcification
pulpal signs
dental infection
when would you refer to a specialist if you want to take out the first permanent molars
when any of the remaining teeth are missing with hypodontia, poorly placed or have signs of generalised developmental defects or skeletal discrepancy
what can be useful to temporise a first permanent molar with MIH
hall crown
what factors would give optimal outcome with timing the extraction of first permanent molar
bifurcation of second permanent molars
second premolars and third molars present on radiograph
mild buccal segment crowding
class 1 incisor relationship
what is the treatment for initial caries in anterior permanent teeth
site specific prevention
monitor
what is the treatment of advanced anterior caries in permanent teeth
complete removal of caries and restore
what is the treatment of reversible pulpitis in permanent teeth
carry out stepwise or complete caries removal avoiding the pulp and place restoration
what is the treatment of irreversible pulpitis in permanent teeth
RCT or XLA
what is the treatment of an unrestorable permanent tooth
extract tooth
if cannot manage the extraction temporise the tooth and continue prevention and refer to specialist
where is site specific prevention suitable for
primary tooth with initial lesion in occlusal/proximal surface, anterior tooth with initial lesion, arrested caries/when close to exfoliation
permanent teeth with initial lesion in proximal surface/anterior tooth with initial lesion
what would you do for site specific prevention
show parent and child the lesions and explain treatment
make them responsible for their role
demonstrate brushing, diet advice, fluoride varnish 4x/year
monitor site and extent of lesion
record treatment
review after 3 months
continued enhanced prevention
what is no caries removal and sealing using the hall technique suitable for
primary tooth with advanced lesion in occlusal or proximal surface
what is the procedure for the hall technique
separators
select crown size
fill crown with GI luting cement
seat over the tooth and bite down on cotton wool roll
ask child to open
remove excess cement and floss contacts
what would no caries removal and sealing using a fissure sealant be useful for
primary/permanent tooth with initial occlusal/proximal lesion
what is the technique for fissure sealing on proximal lesions
separate teeth for 2-5 days
isolate with dam
protect adjacent teeth with matrix strip
etch surface and rinse well
place fresh strip
apply sealant
check no excess
light cure and use floss through contacts
what is the aftercare for using fissure sealants on carious lesions
use radiographs to monitor
check integrity with probe at each visit
apply fresh fissure sealant if appearing worn
what is selective caries removal and restoration suitable for
primary posterior/anterior tooth with advanced lesion
permanent tooth with moderate occlusal/proximal lesion or advanced anterior lesion
what is the technique of selective caries removal
gain access with handpiece
remove superficial caries until no caries at ADJ
clear cavity walls to hard dentine
remove enough caries pulpally but avoid exposure
remove unsupported enamel
place restoration
fissure seal unprotected pits and fissures
monitor for caries progression
what is the selective caries removal technique for primary incisors
clean with prophy paste
clean margins of cavity
acid etch crown, wash and dry
composite restoration
what is atraumatic restorative technique used for
primary tooth with single surface lesion
what is the technique for atraumatic restorative
tell child it will be scratchy sound
remove caries with excavator
clean cavity with wet cotton pellet
dry with cotton pellet
ensure proper isolation
use encapsulated material - high viscosity GI
use finger press technique until set
rub vaseline and hold for 20 seconds
do not eat for hour after treatment
what is stepwise caries removal suitable for
permanent tooth with extensive lesion in occlusal or proximal surfaces
what is the stepwise caries removal procedure
LA and gain access
remove carious tissue until cavity walls are hard
pulpally remove some caries until soft dentine reached
place restoration using GI based material
wait 6-12 months
remove temp
remove any remaining carious tissue until hard dentine reached
place permanent restoration
what is non-restorative cavity control suitable for
primary tooth with arrested caries or when the tooth is unrestorable or close to exfoliation
primary tooth with advanced lesion where alternative methods not feasible
what is the aim of non-restorative cavity control
reduce cariogenic potential of the lesion by altering the environment of the plaque biofilm overlying the carious lesion
what is the non-restorative cavity control technique
show parent/carer and child the caries
make aware of responsibility
demonstrate effective brushing, diet advice, fluoride varnish
keep record of site and extent of lesion
record details of treatment in patient notes
review lesions after 3 months
continue enhanced prevention
how do you make a lesion cleansable
use high speed handpiece or hand instruments to remove undermined enamel adjacent to carious lesion making the surface of the lesion accessible to toothbrushing
what is conventional preformed metal crown preparation
remove caries
occlusal reduction
select correct size of PMC and adjust fit with crown contouring pliers
cement PMC in place with GI cement and remove excess
when would a pulpotomy be performed on a primary molar
pulpitis with irreversible symptoms
primary molar with advanced carious lesion with no clear band of dentine visible radiographically that separates the lesion and pulp
what is the technique for pulpotomy of primary molar
cut large access cavity using high speed
remove pulp chamber contents using slow speed/excavator
irrigate chamber with 3 in1 water
identify entrances to root canals
if bleeding arrest with ferric sulphate cotton wool and place another on top and bite on cotton wool roll for 2 mins
place MTA in pulp chamber and fill with ZOE cement and place crown
what is the aftercare after a primary molar pulpotomy
advise that it will be uncomfortable and they will need analgesia
conduct radiographic review
what local control of infection measures would you use for primary teeth
gentle hand excavation of carious tissue to drain infection without LA
if not able to achieve drainage place corticosteroid dressing and temp restorative material and try at another visit
when would you consider balancing extractions
when one C is to be extracted
when one C has exfoliate prematurely due to eruption of permanent lateral incisor
centre line shift developing following extraction of one D
what is a balancing extraction
extraction of contralateral tooth to minimise centre-line shift
what techniques help to reduce the chance of iatrogenic damage
prepare proximal cavity margins using gingival margin trimmers only
complete restoration using wedges and matrix bands
how do you reduce discomfort of LA
use topical
distraction
very slow injection technique
intrapapillary injections
what is the technique for the intrapapillary injection
apply topical
give buccal infiltration
advance needle 1-2mm into the interdental papilla and give 1-2 drops of LA
advance another 1-2mm and another drop of LA
continue this and observe palatal aspect to ensure blanching
what does the wand allow for
constant slow flow rate of anaesthetic solution irrespective of tissue resistance
what do you need to consider when referring a child
only after you have exhausted treatment options
be aware of the referral options
refer to service local to child
ensure you provide continued dental care for the child
what is done at each recall visit
ask about toothbrushing and diet
enquire about compliance
monitor lesions
check fissure sealants
reassess caries control and risk
what is the tiered approach to managing concerns with child protection
preventive dental team response
preventive multi-agency response
child protection referral
what questions do you consider when you are deciding if a child protection referral should be made
has there been a delay in seeking dental advice with no good explanation
does history change over time
any unexplained injuries on child
concerned with child’s behaviour/parents behaviour
what are the 5 questions that practitioners need to ask about a child’s wellfare in line with GIRFEC
what is getting in way of child wellbeing
do i have everything i need to help child
what can i do now to help child
what can my agency do to help
what additional help may be needed
