Treatment planning Flashcards
On average how many 5 year old have decay
1/4 Have tooth decay on average in 3-4 teeth
What is the average cost of a tooth extraction in a hospital for a children less than 6
£836
List some high risk groups for dental caries
- Social- low socioeconomic status
- Children with medical conditions
- Clinical - those with enamel defects
- Poor diet
- Lack of fluoride in water
- Poor oral hygiene
What are the effects of dental disease
- Pain and infection
- Difficulty eating, speaking, concentrating in school
- Growth can be effected
- Children may miss school
- Children with childhood caries may have increased risk of further caries in primary and permanent teeth
- Dental extraction may lead to orthodontic problems
- Preventable burden on NHS
List the 5 key points of the dental care philosophy
- Gain trust and co operation of child and patient
- Make an accurate diagnosis and devise a treatment plan
- Comprehensive preventative care
- Deliver care in a manner the child finds acceptable
- Use treatment and restorative techniques which produce an effective long lasting result
List the steps we ned to carry out before forming a treatment plan
- History
- Examination
- Special test
- Diagnosis
- Treatment
When taking a history of a child what do you need to find out
- Reason for attendance
- Complaints
- Past medical history
- Past dental history
- Social history
What do you need to record when finding out the reason for attendance for a paediatric patient
Is this appointment:
- A referral? If so by who
- An emergency appointment?
- A recall appointment?
What do we look at during an intra oral exam on a child
Look at:
- Soft tissues
- Gingivae- modified BPE for over 7s
- Dental charting
- Occlusion
What things should you look out for when looking at the developing dentition
- Delayed eruption
- Extopic eruption of first permanent molars
- Premature unilateral loss of primary canines
- Abnormal or asymmetrical eruption patter/order
- Cross bites
- Prognosis of first permanent molars
- Palpate for permanent canines at age of 9
Name some special tests we can carry out on paediatric patients
- Radiographs
- Palpation
- Percussion
- Mobility
When coming to a diagnosis what should we include?
- Comment on ability of patient to co operate
- Dentition stage (mixed, primary, permanent)
- Comment on oral hygiene and gingival status
- Dental caries listing teeth involved
- Pulpal/ periodontal pathology
- Developing dentition/ occlusion
- Any other issues
How might we describe a patients ability to co operate when writing up our diagnosis
- Pre co operative
- Potentially co operative
- Anxious
- Un cooperative
How might we describe a patients pulpal/ periodontal pathology when writing up our diagnosis
- Presence of sinus or swelling
- Intra radicular pathology
How might we describe a patients dentition/ occlusion when writing up our diagnosis
- Molar incisor relationship
- Overjet
- overbite
- Crowding
- Crossbite
Name the 3 approaches/strategies of paediatric dentistry
- Prevention only approach
- Biological
- Conventional
How do we decide which paediatric dentistry strategy we will adopt
Depends entirely on the patient and can be affected by factors such as:
- Age
- Signs and symptoms
- Level of cooperation
- Medical history
- Parental motivation and wishes
- Access to treatment
What is the aim of the preventative approach
To reduce cariogenic potential of the lesion by altering the environment of the plaque biofilm overlying the carious lesions through brushing and dietary advice
What does the prevention approach include
- Looking at diet and giving diet advice
- Fissure sealants
- Oral hygiene advice
- Fluoride use eg fluoride varnish
Describe a case where we could adopt the preventative approach
- Asymptomatic
- No evidence of sepsis
- Parental motivation and consent evident
Give examples of diet advice we might want to give parents and children
- Drink only water and milk between meals
- Snack on sugar free snacks
- Do not eat or drink after brushing at night
- Be aware of hidden sugars
- Try to limit acidic and sugary drinks to meal times
Give examples of oral hygiene advice we might want to give parents and children
- Brush twice a day
- Use correct amount of fluoride toothpaste based on age
- Spit dont rinse
- Help children with brushing until at least the age of
What is essential if you have decided to adopt a preventative only approach?
- Appointments every 3 months
- Serial plaque scores
- Fluoride varnish application
- Clinical photographs
What documentation should we obtain before starting our preventative treatment?
- Record you have discussed with the parents
- Parental consent
- Parental understanding that treatment may be required in the future
- Close follow ups- DNAs and cancellations
What is the aim of the biological approach
To completely seal a carious lesion from the oral environment so that the environment of the plaque biofilm is altered sufficiently to slow or even arrest caries
What is the rationale for the biological approach
- Some children struggle with LA
- If teeth are asymptomatic should children be prescribed general anaesthetic
- We know it is possible to arrest caries
What techniques can we carry oit if we adopt the biological approach
- Hall technique
- Fissure sealants
What is the hall technique
Placing no prep performed metal crowns in primary molars
What is the probability of the tooth surviving following the hall technique without extraction or loss of crown
3 years: 73.4%
5 years: 67.6%
What are some ion the advantages of the biological approach?
- Can be effective and is preferred to complete caries removal techniques by children, their carers and dentists
- Avoids need for LA and tooth preparation
- No risk of iatrogenic damage to adjacent teeth
What are some of the disadvantages to the biological approach
- Dependent on the quality of the seal for success- if seal fails caries will progress
- Further clinical trials in primary care needed to consolidate evidence base
Describe a patient in whom you may decide to adopt a biological approach
- Asymptomatic
- No evidence of sepsis
- Child can sit in the chair and follow instructions and is wiling to take radiographs
- Parents are on board
How is a hall technique crown placed?
- Odontogenic bands are placed between teeth at least 3-5 days before crown placement to separate them slightly
- Assess the tooth shape, contact points and occlusion
- Protect the airway
- Size a crown (usually start with size 4)
- Load the crown with cement
- Fill the crown and first stage setting
- Remove excess cement, check fit and second stage setting
- Final clearance of cement
- check occlusion
What do fissure sealants do?
They inhibit the progression of non cavitated carious lesions
What are fissure sealants known as?
Secondary prevention
What requirements must be fulfilled for us to consider placing fissure sealants
- No cavitations
- No radiolucencies on a bitewing radiogrpahs
Name the different types of fissure sealants
- Resin based sealants
- GI sealants (fuji triage)
- Polyacid modified resin sealant
- Resin modified GI sealant
Talk through the steps of fissure sealant placement
- Clean the pits and fissures
- Isolate the tooth
- Etch, wash and dry
- Apply bonding agent, cure
- Apply sealant
- Evaluate
What hold you discuss with parents before placing fissure sealants
- It is a reasonably new technique
- Excellent homecare is required for into succeed
- Regular review and recall is imperative- further intervention may be required in the future
After placing fissure sealants when should you follow up with the patient
Every three months until the Childs caries status moves to low caries risk
What is considered a low caries risk
- No new lesions on 6s monthly bitewings
- Good plaque control
- Low cariogenic diet
What is the aim of the conventional approach
Managing all caries and restoring oral health
this often reused full caries removal and restorations or extractions
Out of the 3 paediatric approaches which is the gold standard
The conventional approach
Describe a patient in whom you many adopt a conventional approach
- Potentially co operative/ co operative patients that can manage bitewings and LA
- Motivated patietns
List the principles for treatmetn planning when you decide to asopt the conventioanl approach
- Formulate treatment plan visit by visit
- order of care: simple to complex
- Preventative care running parallel to restorative care
- Behaviour management integral to treatment plan
Which primary teeth do we aim to treat first if they all have caries
- Upper posteriors
- Lower posteriors
- Upper anteriors
- Lower anterior
but of course whichever is causing pain is treated fi
What do you need to consider when planning your treatment if you adopt the conventional approach
Behavioural considerations:
1. Carry out tx at a pace the child can tolerate
2. Set realistic goals
3. Consider LA, sedation or GA
Which teeth should we prioritise in the conventional approach
- Permanent teeth
- Es and Ds
What is the restorative material of choice for paediatric patients
Composite
If a tooth required pulp therpary what will you need to do
Carry out pulpal therpay then restore with an SSC
If treatment under LA is not possible what should you consider
- Inhalation sedation
- GA
