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SDCEP Guidance Documents > Prevention and Management of Dental Caries in Children > Flashcards

Prevention and Management of Dental Caries in Children Flashcards

1
Q

what is included in the history of a child

A

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

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2
Q

what is in the dental assessment of a child

A

charting teeth
plaque scores
modified BPE

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3
Q

what techniques can be used to help examine a child

A

be smiley and kind
have child’s head on your lap and legs on parents lap

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4
Q

what is the best method for detecting caries

A

visual inspection on clean, dry teeth with good light

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5
Q

how can the extent of dentinal carious lesions be assessed

A

based on the appearance of the overlying enamel

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6
Q

why must the teeth be clean and dry for effective caries diagnosis

A

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

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7
Q

what would indicate that a lesion is confined to the enamel only

A

a stained pit or fissure without adjacent white opalescent enamel and with no radiographic sign

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8
Q

what would white opalescent enamel at marginal ridge indicate

A

proximal lesion without dentinal involvement

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9
Q

what would arrested enamel lesions feel like

A

smooth to a probe lightly drawn across the surface

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10
Q

what would arrested dentine lesions feel like

A

hard and shiny

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11
Q

how often are bitewings taken for high risk children

A

6-12 months

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12
Q

how often are bitewings taken for non-high risk children

A

2 years

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13
Q

what is molar incisor hypomineralisation

A

hypomineralisation of systemic origin of 1-4 permanent first molars frequently associated with incisors

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14
Q

how does MIH compromise restorations

A

it has an abnormal etching and bonding pattern

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15
Q

what factors are taken into consideration when determining whether teeth affected by hypomineralisation are of poor prognosis

A

enamel colour
location of defects
sensitivity
atypically shaped restorations
patient reported symptoms

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16
Q

what signs can be indicators of dental infection in primary teeth

A

TTP in non-exfoliating tooth
alveolar tenderness
non-physiological mobility
radiographic signs

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17
Q

what factors are considered when deciding how to manage carious lesions

A

extent of lesion
site of lesion
activity of lesion
time to exfoliation
number of other lesions present in dentition
childs medical status
cooperation

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18
Q

what lesions would be high risk of causing the child pain or infection

A

cavitated lesion
clinical exposure of necrotic pulp years before exfoliation

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19
Q

what lesions would be of low risk of causing the child pain or infection

A

clinical exposure of vital pulp
retained roots
arrested caries

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20
Q

what is plaque score 8/10

A

plaque line around cervical margin

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21
Q

what is plaque score 6/10

A

cervical third of crown covered

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22
Q

what is plaque score 4/10

A

middle third covered

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23
Q

what are the 7 factors of caries risk assessment

A

caries experience
diet
social history
fluoride use
plaque control
saliva
medical history

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24
Q

how often is the child’s caries risk re-assessed

A

each assessment

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25
Q

what is used to assess dental anxiety in children

A

mcdas
mcdasf

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26
Q

name some behaviour management strategies

A

communication
enhancing control
tell show do
positive reinforcement
structured time
distraction
relaxation
systematic desensitisation

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27
Q

what is enhancing control

A

stop and go signals

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28
Q

what is structured time

A

giving set times to how long you will do something (count to 5 and then i will stop)

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29
Q

what techniques can be used to help children relax

A

ask them to place a hand on their tummy and breathe in slowly and deeply to fill their tummy

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30
Q

what is used for systematic desensitisation

A

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

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31
Q

what would a general treatment plan for a child look like

A

manage pain
caries prevention
carious management
preventive interventions for permanent teeth first (fissure seals)
devise and agree care plan
obtain consent

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32
Q

who else can you get involved in your care plan

A

child health visitor
school nurse
childsmile support worker

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33
Q

if a child resists treatment what do you do

A

do not continue

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34
Q

what is the most common reason for a child’s pain

A

pulpal pathology as a consequence of dental caries

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35
Q

what are reversible pulpitis symptoms

A

pain provoked by stimulus and relieved when removed
difficult to localise
does not affect sleep

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36
Q

what are irreversible pulpitis symptoms

A

spontaneous pain
pain lasts hours
difficult to localise
kept awake at night
dull and throbbing
no signs and symptoms of infection yet

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37
Q

what are acute dental abscess/periradicular periodontitis symptoms

A

spontaneous pain
kept awake at night
easily localised
increased mobility
TTP
clinical evidence of sinus

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38
Q

what are chronic dental abscess/periradicular symptoms

A

infected remains of pulp cause problems unless managed

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39
Q

if a child with irreversible pulpitis is cooperative what treatment is considered

A

pulpotomy

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40
Q

when is a pulpotomy considered

A

cooperative children
when no separation on radiograph of pulp and caries

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41
Q

what is done when there are symptoms of pain due to food packing/pulpitis with reversible symptoms but you are uncertain

A

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

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42
Q

if a child has asymptomatic dental infection but cannot cope with XLA at the moment but might with acclimatisation what do you do

A

allow up to 3 months for acclimatisation

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43
Q

if a child is pre-cooperative what do you do

A

consider referral to assess suitability for extraction under sedation or GA

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44
Q

what do you do for irreversible pulpitis for a cooperative child

A

XLA or pulp therapy for primary tooth
RCT or XLA for permanent tooth

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45
Q

what do you do for irreversible pulpitis for a pre-cooperative child

A

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

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46
Q

what do you do for dental abscess on pre-cooperative child

A

antibiotics if spreading infection
pain relief
refer for XLA with sedation or GA for primary teeth

RCT or XLA/specialist referral for permanent teeth

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47
Q

what do you do for a dental abscess on a cooperative child

A

carry out XLA or pulp therapy on primary tooth

RCT or XLA on permanent tooth

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48
Q

what technique is used to gain information about a patients current practice and attitudes

A

motivational interviewing

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49
Q

what are the steps of motivational interviewing

A

seek permission
open questions
affirmations
reflective listening
summarising

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50
Q

what is the general conversation like when trying to gain behaviour change

A

motivational interviewing
educational intervention
action planning
encourage habit formation
repeat

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51
Q

how do you develop an individualised action plan to encourage habit formation

A

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

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52
Q

what is recommended when giving toothbrushing advice

A

twice daily fluoride toothpaste
amount of paste
fluoride concentration
supervised brushing
spit dont rinse

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53
Q

what is the toothbrushing concentration for standard prevention

A

1000-1500ppm F

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54
Q

what is the toothbrushing concentration for increased risk

A

1350-1500ppm F for 3+
2800ppm F for 10+

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55
Q

what is included in standard prevention for all children

A

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

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56
Q

what is enhanced prevention for high risk children

A

at each recall visit provide standard prevention
give hands on brushing instruction at each visit
1350-1500ppm F / 2800ppm F
utilise support workers

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57
Q

what is the technique for toothbrushing instruction

A

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

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58
Q

what is the standard prevention diet advice for all children

A

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

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59
Q

what is enhanced prevention diet advice for high risk children

A

provide standard prevention at each recall visit
use diet diary
action planning
use health support workers

60
Q

what is standard fissure sealant advice for children

A

place sealant in all pits and fissures ASAP after eruption
check existing sealants for wear
top up worn or damaged sealants

61
Q

what is enhanced prevention for fissure sealants for children

A

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

62
Q

what is the fissure sealant technique for resin sealants

A

clean tooth
isolate using cotton wool rolls
dry tooth
etch tooth
apply sealant
check sealant

63
Q

how do you monitor fissure sealants

A

visually check
physically check with probe
top up as required

64
Q

what is the GI sealant technique

A

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

65
Q

what is the standard prevention for fluoride varnish

A

apply twice a year to children aged 2 years and over

66
Q

what is enhanced prevention of fluoride varnish

A

apply 4 times a year to children aged 2 years and over

67
Q

what is the contraindication to fluoride varnish

A

hospitalised due to severe asthma or colophony allergy

68
Q

what is the ppm F for duraphat varnish

A

22,600

69
Q

what is the volume for fluoride varnish used in 2-5yrs

A

0.25ml

70
Q

what is the volume of fluoride varnish used in 5-7yrs

A

0.4ml

71
Q

what is the technique for fluoride varnish

A

isolate and dry teeth
apply varnish using microbrush

72
Q

what is the advise after having fluoride varnish put on

A

wait 30minutes until eating
wait 4 hours before brushing teeth/chewing hard food

73
Q

what is taken into account when deciding how to manage a carious lesion

A

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

74
Q

what are the principal strategies for managing caries in the primary dentition

A

no caries removal and seal with hall crown
no caries removal and fissure seal
selective caries removal and restoration
pulpotomy

75
Q

if there is clear separation between carious lesion and pulp on a radiograph of a molar occlusal lesion what treatment is done

A

initial lesion = fissure seal/site-specific prevention
advanced lesion = selective caries removal/hall technique

76
Q

if there is clear separation between carious lesion and pulp on a radiograph of an anterior tooth what treatment is done

A

initial lesion = site specific prevention
advanced lesion = selective caries removal, complete caries removal or non-restorative cavity control

77
Q

if there is clear separation between carious lesion and pulp on a radiograph of a molar on the proximal surface what treatment is done

A

initial lesion = site specific prevention or sealant/infiltration
advanced lesion = hall technique or selective caries removal

78
Q

what are the treatment options for a noncavitated primary molar with occlusal caries

A

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

79
Q

what is the preferable management for noncavitated occlusal lesions

A

resin fissure seal

80
Q

for advanced occlusal caries with cavitation and visible dentine what would the treatment options be

A

if only on occlusal surface do selective caries removal then restore
seal with hall crown
if proximal lesion also present seal with hall crown

81
Q

what is the first treatment of choice for advanced lesions with cavitation

A

selective caries removal and sealing with a restoration

82
Q

why should complete caries removal not be carried out on primary teeth with advanced lesions

A

higher risk of pulpal exposure

83
Q

what indicates that a lesion has spread into dentine

A

cavitation or shadowing

84
Q

what is the treatment for initial caries on proximal surfaces

A

site specific prevention and monitor
consider sealing lesion by placing sealant or resin and monitor

85
Q

what is the treatment of advanced caries on proximal surfaces

A

do not remove caries and use hall crown
selective caries removal and restore

86
Q

what is the treatment of initial caries on anterior teeth (white spot lesions)

A

site specific prevention
monitor at each recall
if progressing do alternative management strategy

87
Q

what is the treatment for advanced caries on anterior teeth

A

selective caries removal and restore
complete caries removal and restore

88
Q

if a tooth with caries is close to exfoliation what treatment would you do

A

site specific prevention or non-restorative cavity control

89
Q

what is the treatment for teeth with arrested dentinal caries

A

site specific prevention or non-restorative cavity control

90
Q

what is the treatment for unrestorable primary teeth

A

non-restorative cavity control or extraction

91
Q

what are the principal strategies for managing caries in the permanent dentition

A

site specific prevention
selective caries removal
stepwise caries removal
complete caries removal

92
Q

which permanent teeth are most vulnerable to decay in childhood and adolescence

A

permanent molars

93
Q

what is the percentage of children with MIH

A

15%

94
Q

what do you do for carious lesions which are not severe in people who have MIH

A

provide enhanced prevention including fissure sealants and monitor

95
Q

what is the treatment for permanent teeth with initial occlusal caries

A

place resin fissure sealant
clinically review for wear and check integrity
radiographically review

95
Q

what is used as a fissure sealant if first permanent molars are sensitive with MIH teeth

A

GI

96
Q

what is the treatment for permanent teeth with moderate dentinal occlusal caries

A

selective caries removal and restoration
seal remaining fissures

97
Q

what is the treatment with extensive dentinal occlusal caries

A

stepwise caries removal
seal remaining fissure

98
Q

what is stepwise caries removal

A

selective caries removal initially
reactionary dentine laid down by pulp in response to irritant of caries
remove rest of decay
permanent restoration now

99
Q

what can be used to help visualise proximal spaces

A

orthodontic separators for 5 days

100
Q

what is the treatment for initial proximal caries on permanent teeth

A

identify and arrest early enamel only lesions
site specific prevention
alternatively seal lesion

101
Q

what is the treatment for moderate dentinal caries (proximal) on permanent teeth

A

carry out selective caries removal and seal remaining fissures

102
Q

what is the treatment for extensive dentinal proximal caries

A

stepwise caries removal and temporise for 6-12 months then permanent restoration

103
Q

what signs deem a first permanent molar as being of poor prognosis

A

advanced occlusal or proximal lesions or recurrent caries
hypomineralisation causing cavitation
lingual decalcification
pulpal signs
dental infection

104
Q

when would you refer to a specialist if you want to take out the first permanent molars

A

when any of the remaining teeth are missing with hypodontia, poorly placed or have signs of generalised developmental defects or skeletal discrepancy

105
Q

what can be useful to temporise a first permanent molar with MIH

A

hall crown

106
Q

what factors would give optimal outcome with timing the extraction of first permanent molar

A

bifurcation of second permanent molars
second premolars and third molars present on radiograph
mild buccal segment crowding
class 1 incisor relationship

107
Q

what is the treatment for initial caries in anterior permanent teeth

A

site specific prevention
monitor

108
Q

what is the treatment of advanced anterior caries in permanent teeth

A

complete removal of caries and restore

109
Q

what is the treatment of reversible pulpitis in permanent teeth

A

carry out stepwise or complete caries removal avoiding the pulp and place restoration

110
Q

what is the treatment of irreversible pulpitis in permanent teeth

A

RCT or XLA

111
Q

what is the treatment of an unrestorable permanent tooth

A

extract tooth
if cannot manage the extraction temporise the tooth and continue prevention and refer to specialist

112
Q

where is site specific prevention suitable for

A

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

113
Q

what would you do for site specific prevention

A

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

114
Q

what is no caries removal and sealing using the hall technique suitable for

A

primary tooth with advanced lesion in occlusal or proximal surface

115
Q

what is the procedure for the hall technique

A

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

116
Q

what would no caries removal and sealing using a fissure sealant be useful for

A

primary/permanent tooth with initial occlusal/proximal lesion

117
Q

what is the technique for fissure sealing on proximal lesions

A

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

118
Q

what is the aftercare for using fissure sealants on carious lesions

A

use radiographs to monitor
check integrity with probe at each visit
apply fresh fissure sealant if appearing worn

119
Q

what is selective caries removal and restoration suitable for

A

primary posterior/anterior tooth with advanced lesion
permanent tooth with moderate occlusal/proximal lesion or advanced anterior lesion

120
Q

what is the technique of selective caries removal

A

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

121
Q

what is the selective caries removal technique for primary incisors

A

clean with prophy paste
clean margins of cavity
acid etch crown, wash and dry
composite restoration

122
Q

what is atraumatic restorative technique used for

A

primary tooth with single surface lesion

123
Q

what is the technique for atraumatic restorative

A

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

124
Q

what is stepwise caries removal suitable for

A

permanent tooth with extensive lesion in occlusal or proximal surfaces

125
Q

what is the stepwise caries removal procedure

A

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

126
Q

what is non-restorative cavity control suitable for

A

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

127
Q

what is the aim of non-restorative cavity control

A

reduce cariogenic potential of the lesion by altering the environment of the plaque biofilm overlying the carious lesion

128
Q

what is the non-restorative cavity control technique

A

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

129
Q

how do you make a lesion cleansable

A

use high speed handpiece or hand instruments to remove undermined enamel adjacent to carious lesion making the surface of the lesion accessible to toothbrushing

130
Q

what is conventional preformed metal crown preparation

A

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

131
Q

when would a pulpotomy be performed on a primary molar

A

pulpitis with irreversible symptoms
primary molar with advanced carious lesion with no clear band of dentine visible radiographically that separates the lesion and pulp

132
Q

what is the technique for pulpotomy of primary molar

A

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

133
Q

what is the aftercare after a primary molar pulpotomy

A

advise that it will be uncomfortable and they will need analgesia
conduct radiographic review

134
Q

what local control of infection measures would you use for primary teeth

A

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

135
Q

when would you consider balancing extractions

A

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

136
Q

what is a balancing extraction

A

extraction of contralateral tooth to minimise centre-line shift

137
Q

what techniques help to reduce the chance of iatrogenic damage

A

prepare proximal cavity margins using gingival margin trimmers only
complete restoration using wedges and matrix bands

138
Q

how do you reduce discomfort of LA

A

use topical
distraction
very slow injection technique
intrapapillary injections

139
Q

what is the technique for the intrapapillary injection

A

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

140
Q

what does the wand allow for

A

constant slow flow rate of anaesthetic solution irrespective of tissue resistance

141
Q

what do you need to consider when referring a child

A

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

142
Q

what is done at each recall visit

A

ask about toothbrushing and diet
enquire about compliance
monitor lesions
check fissure sealants
reassess caries control and risk

143
Q

what is the tiered approach to managing concerns with child protection

A

preventive dental team response
preventive multi-agency response
child protection referral

144
Q

what questions do you consider when you are deciding if a child protection referral should be made

A

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

145
Q

what are the 5 questions that practitioners need to ask about a child’s wellfare in line with GIRFEC

A

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

146
Q
A

SDCEP Guidance Documents (11 decks)

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