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YR 3 - CCD > Treatment Planning > Flashcards

Treatment Planning Flashcards

1
Q

link of disease and deprived areas

A

positive correlation

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2
Q

what are the high risk groups for dental caries?

A

low socioeconomic groups
medical conditional
clinical - enamel defects

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3
Q

what are the 3 independent factors for caries.

A

diet
fluoride
oral hygiene

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4
Q

how many dental disease affect children

A
  • pain and infection - difficulties eating, sleeping, concentration at school
  • miss school
  • carers take time off work
  • extractions affect alignment of permanent teeth
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5
Q

what are the 5 steps of the Dental Care Philosophy

A
  1. gain trust and co-operation
  2. accurate diagnosis and appropriate treatment plan
  3. comprehensive preventative care
  4. deliver in a way the child finds acceptable
  5. techniques for effective and long-lasting result
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6
Q

what comes under history taking?

A

reason for attendance
any complains
past MH
past DH
SH

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7
Q

what comes under examination

A

extra oral

intra oral
- soft tissues
- gingivae
- dental charting
- occlusion

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8
Q

how many primary teeth are there?

A

20

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9
Q

when do the primary teeth erupt (in months)

A

maxillary
- central incisor = 7 month
- lateral incisor = 8 month
- canine = 18 month
- first molar = 14 month
- second molar = 24 month

7,8,18,14,24

mandibular
- central incisor = 6 month
- lateral incisor = 7 month
- canine = 16 month
- first molar = 12 month
- second molar = 20 month

6,7,16,12,20

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10
Q

when do the permanent teeth erupt (in years)

A

maxillary
- central incisor = 7-8
- lateral incisor = 8-9
- canine = 11-12
- first premolar = 10-11
- second premolar = 10-12
- first molar = 6-7
- second molar = 12-13
- third molar = 17-21

mandibular
- central incisor = 6-7
- lateral incisor = 7-8
- canine = 9-10
- first premolar = 10-12
- second premolar = 11-12
- first molar = 6-7
- second molar = 12-13
- third molar = 17-21

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11
Q

give 6 key things to look for in a developing dentition.

A
  • any delayed eruptions
  • abnormal eruptions
  • premature loss of primary canines
  • crossbites
  • prognosis of first permanent molars
  • palpate for permanent canines at 9 years old
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12
Q

what is a cross bite?

A

when teeth don’t line up properly when mouth is closed

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13
Q

what special tests can kids have?

A

radiographs
palpations
percussions
mobility tests

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14
Q

how often do children have radiographs and what type?

A

12-24 months
- frequency dictated by risks

  • every 6 month for high caries risk
  • routine bitewings
  • OPT only when clinically necessary
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15
Q

which special tests are not performed on children? why?

A

vitality tests
- ethyl chloride or EPT

they are not reliable

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16
Q

What should the diagnosis include? (7)

A
  • patients cooperation ability
  • dentition stage
  • oral hygiene and gingival status
  • dental caries
  • pulpal/perio pathology
  • developing dentition
  • any other defects
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17
Q

what are the 3 principle strategies for restorations

A
  1. prevention approach
  2. biological
  3. conventional
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18
Q

describe the preventative approach.

A

aim is to reduce the cariogenic potential of a lesion
- altering environment
- through OHI

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19
Q

what 4 tools are there for the preventative approach?

A

OHI
fluoride varnish
diet
fissure sealants

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20
Q

what case selections are ideal for the preventative approach?

A
  • asymptomatic - no pain
  • no evidence of sepsis
  • parental motivation and consent
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21
Q

for prevention, how often should fluoride varnish be applied to high caries risk children?

A

2 times a year

22
Q

generally, how much fluoride should 3-6 years be using?

A

more than 1000ppm

23
Q

how much fluoride should a child above 6 be using or if they are below this age and high caries risk?

A

1350-1500ppm

24
Q

for prevention, how much fluoride for 10+ years with active caries?

A

2800ppm

25
Q

for prevention, how much fluoride for 16+ with active caries?

A

either 2800ppm or 5000ppm

26
Q

how much does fluoride intervention reduce caries by in primary and permanent teeth?

A

primary - 37%
permanent - 43%

27
Q

what does diet advice communication need to be like? (3)

A

easy to deliver, retain and follow

28
Q

what does diet advice entail? (7)

A
  • restrict food and drink w/ sugar to 4 occasions in one day max
  • drink water or milk between meals
  • sugar-free snacks
  • no sweetened drinks in feeding bottles
  • no eat or drink after brushing at night
  • foods have hidden sugars
  • restrict fizzy, acidic drinks
29
Q

what age should a child be supervised when brushing?

A

until at least 7 years old

30
Q

by what percent do fissure sealants reduce the incidence of occlusal caries over 4 years?

A

50% reduction

31
Q

what’s the recall intervention for a child with high caries risk?

A

every 3 months until they move to a low caries risk

32
Q

what discussions can you have with the parent?

A
  • explain preventative approach - can delay decay progression
  • reasons why treatment is appropriate for child
  • importance of home care
33
Q

what must be documented?

A
  • discussions with the parents, including reasons for choosing approach
  • parental consent
  • parent understanding treamtne may be required in future
  • DNA’s and cancellations
34
Q

in which 2 cases would a preventative approach be successful?

A
  • child with early lesions
  • older child with asymptomatic dental caries who can’t cope with LA/conventional approach
35
Q

describe the biological approach.

A

the aim is to completely seal a carious lesion from the oral environment
- to slow or arrest caries progression

36
Q

why may the biological approach be more suitable?

A
  • if child struggles with LA
  • if it is possible to arrest the caries
37
Q

what does the Hall Technique state?

A
  • evidence for prevention approach = limited
  • evidence for biological approach = more robust
  • crowns are more effective than fillings for managing decay
38
Q

what are the 3 advantages and 2 disadvantages of the biological approach?

A

pros
- can be effective and is preferred to complete caries removal by all members
- avoid use of LA and tooth prep
- no iatrogenic damage risk

cons
- quality of seal must be good, otherwise caries persists
- evidence needs to be more solid

39
Q

what case selections are ideal for the biological approach?

A
  • asymptomatic - no pain
  • no evidence of sepsis
  • child can sit in chair and follow instruction
  • parental consent
40
Q

what are the steps in the biological approach?

A

assessment
good OHI
fissure sealant or hall technique crown

41
Q

if you are to place a hall technique crown on a child, what is the criteria?

A
  • must be able to manage bitewings
  • need to have a clear band of healthy dentine between caries and pulp
  • no history of nocturnal pain or infection
  • bitewings post-op to ensure full seating
42
Q

what is the ‘technique’ of a hall technique crown lol

A
  1. assess tooth shape, contact points and occlusion
  2. protect airway
    - sit at 45 and gauze for the throat
  3. size the crown
  4. load with cement
  5. fit the crown
  6. remove excess cement, check fit
  7. check occlusion
43
Q

with the biological approach, when would you use fissure sealants?

A
  • no cavitations
  • no radiolucency
44
Q

describe the steps of applying fissure sealant.

A
  • clean pits and fissure
  • isolate the tooth for moisture control
  • etch, wash and dry
  • bond and cure
  • sealant and cure
  • evaluate
45
Q

with the biological approach, what must be discussed with parents?

A
  • its is a new technique, with evidence to work
  • need good homecare for succession
  • need regular review and recall
  • future intervention may be required
46
Q

when do you stop recall interventions with children?

A
  • move to low caries risk
  • no new lesions on BWs
  • good plaque control
  • low cariogenic diet
47
Q

describe the conventional approach.

A

the gold standard
managing all caries and restore oral health
- LA, RD, complete caries removal, restorations, extractions
- GA/RA if required
- lots of evidence for success

48
Q

with the conventional approach, how is the treatment plan set out?

A

formulate the plan visit by visit
- order will be simple to complex
- preventative care runs parallel to restorative
- behaviour management is integral

49
Q

with the conventional approach, what is the order of care with the teeth? aka quadrant dentistry.

A

order of care:
- upper posterior (2 visits)
- lower posterior (2 visits)
- upper anterior
- lower anterior

  • prioritise the key teeth- permanent, Es, Ds
50
Q

how can child behaviour be considered?

A
  • go at a pace they can tolerate
  • set realistic goals
51
Q

what material is used for occlusal cavities?

A

composite

52
Q

what is the next option if LA is not possible?

A

general anaesthesia
inhalation sedation - 5+yrs

YR 3 - CCD (16 decks)

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