Tucker

Question 1

How should a infant oral healthcare vist be viewed

Answer 1

• foundation for a lifetime of preventative education and dental care can be built to assure optimal oral health in childhood

Question 2

Early Intervention: Recommendatoins

Answer 2

• Advise parents on their own oral health and transmission of cariogenic bacteria from caregiver to infant
• Dental home
• Provide caries prevention info
• assess caries risk
• provide information to parents regarding oral conditions to infants:
  
  • pacifiers
  • teething
  • trauma
  • growth and developement
• Ankyloglossia ifnromaton
• Natal and neonatal teeth

Question 3

When should the Child’s First dental exam occur?

Answer 3

• at the tie of reuption of first tooth or no later than 12 months

Question 4

Informed consent for exam

Answer 4

• Only legal guardian can give consent for an exam or tx

Question 5

Normal Behavior

Answer 5

• Pre-cooperative
  
  • 3 y.o. or less
  • No psychosocial developement to understand the need to cooperate and interact positively
  • Self-centered/ego-centric perception
  • interact and listen to parent/caregiver exclusively
  • Expected to cry=Normal
    
    • ​upsets parents
    • try to minimize, but can’t eliminate

Question 6

Knee-to-Knee Exam

Answer 6

• Parent sits upright in normal chair
  
  • face dentist
• Parent holds the child in their lab w/child facing the parent
  
  • child’s leg straddling parents waist
• Dentist sits in chair with knees touchng parents knees
• Parents and Dentists thighs form the table
• Child lies on back with head in dentists lab
• Dentisst supports back, controls head, and assists mouth opening if necessary
• Parent supports child, holds and controls childs hands with their own hands, and limits leg movement with elbows

Question 7

Benefits of Knee-to Knee Exam

Answer 7

• allows child to remain in parents lab and their control
• helps reduce anxiety in the child and patient
• Establish roles before start of exam bc parents want to help verbally and physically
  
  • parent=silent observer

Question 8

Communication with parents

Answer 8

• initiate before first dental appointment
• can be do through
  
  • Front desk staff
  • Pre-appointment letter/packet
• can include health history that the parent can fill out before appointment
• don’t want to overwhelm parent with to much information

Question 9

What you should communicate to parent before first appointment

Answer 9

• At time of the appointment their child will be the focus of communication
  
  • Parents want to talk to you and this will prevent you from focusing on their child/patient
• Explain importance of allowing Direct communication b/w the child and dentist
  
  • direct communication is necessary
  • not communication when the parent repeats questions/instructions
• Let parents know up front that you will talk to them at length after the exam
  
  • if they are insistent on talking before exam, have staff occupy child while you step away to talk
  • have staff available for child after appointment also so the parent can pay attention

Question 10

Topics to review with parents

Answer 10

• Always address their chief concern
• oral hygiene instruction
• feeding habits
  
  • especially night-time
  • limit sippy-cup/bottle use
• Etiology of caries
• Expectations for future
  
  • eruption pattern for primary teeth
  • exfoliation pattern
  • normal situations that may cause concern
• Importance of routine recall
• Expectations for future dental visits

Question 11

Addressing chief concern

Answer 11

• Parents w/no concern and know the need to establish a dental home
  
  • so only present to have the initial exam
• Parents w/a concern
  
  • usually very anxious about any perceived problem in a child at this age
  • address with patient first
  • don’t let it keep you from addressing other areas of communication that are important to first exam
• May present w/a child w/ECC or S-ECC and they think that you are going to resolve at initial appointment
• let the patients know what to expect for this appointment and future appointments

Question 12

Oral Hygiene Instruction

Answer 12

• Frequency
  
  • at least twice a day
• Duration
  
  • 2 minutes
    
    • adequate
    • perception of brushing longer than actual time involved
• Technique
  
  • horizontal scrub technique-most effective
  • Floss interproximal contacts if present
• Guidance
  
  • parents brushing their theeth very important for children at young ages

Question 13

Feeding habits

Answer 13

• Sippy-cup (no-spill cups)
  
  • used primarily to prevent spills
  • Bad for them to constantly use and why
  • no bottles or sippy-cups at night in crib/bed
• Once child is past nursing, only water at night if thirsty
• If child has unlimited access to the Sippy Cup
  
  • should only contain water b/w meals

Question 14

Caries Etiology Explanation

Answer 14

• Caries formation requires 4 things
  
  • Time
    
    • brushing frequency important
  • Tooth/Host
    
    • biofilm formation
  • Bacteria
    
    • thorough cleaning
  • Fermentable carbohydrates
    
    • affects oral pH
• If we can control and remove any of these, we can prevent cariest formation

Question 15

Behavioral Expectations for future dental visits

Answer 15

• Discuss appropriate behavior expectations for differrent age groups

Question 16

Procedural expectations for future dental visits

Answer 16

• Let parents know what to expect for their child
• helps communicate that we are tailoring the care to be sensitive to their child needs
• General indications and expectations for radiographic examination
• integral part of gaining informed consent

Question 17

Child Friendly Office Design

Answer 17

• Office design will form first impression of child and parent
• Front Desk staff will be first point of contact with most parents and patients as they enter
• Make the child feel comfortable and “at home”
• Reduce anxiety associated w/the visit
• Increase the child’s willingness to listen and communicate

Question 18

Communication with Young Children

Answer 18

• White Coat Syndrome
• How to approach a child on first encounter
  
  • getting down on their level
  • physically lower yourself so not to be imposing
  • friendly demeaner
  • speak in child friendly terms/language
• Behavior Guidance techniques:
  
  • Tell, Show, Do
  • Reinforcement
  • Behavior Modeling
  • Voice control

Question 19

White Coat Syndrome

Answer 19

• Clinically observaed elevation of BP in patients when dealing with medical or dental procedures or personnel
• Used generally to refer to anxiety/fear that is often the cause of the elevated BP
  
  • especially in pediatric populations
• Due to previous trips, children associate the white coat with pain/injections

Question 20

Anticipatory Guidance

Answer 20

• way of conveying information to the patient that helps them undertand what should be expect
• age 0-3
• categories of information required:
  
  • oral and dental development
  • fluorides
  • Non-nutritive habits
  • Diet and Nutrition
  • Oral Hygiene
  • Injury Prevention

Question 21

Prevention of Caries

Answer 21

• Easier to prevent caries than to treat after the carious lesion has developed
• Cheaper from a family/individual and societal standpoint to prevent oral disease vs treat

Question 22

Expectations for normal dental developement

Answer 22

• Many 1 y.o. presents to establish dental home but have not teeth
  
  • important to know the average age of eruption for primary teeth
    
    • there are normal variations form this average
• When to expect primary teeth to exfoliate and when to expect permanent teeth eruption
• Common patterns of eruptions
  
  • permanent mandibular central incisors erupt lingual to primary mandibular central incisors and before exfoliation

Question 23

Anticipatory guidance for primary dentition: Eruption and Exfoliation

Answer 23

Question 24

Anticipatory Guidance for Permanent Dentition: Eruption and Exfoliation

Answer 24

Question 25

Importance of Periodic Exam

Answer 25

• Important in prevention of dental caries and early detection of other oral pathology
• allows caries and pathology to be cauht earlier
• allows for more conservative treatment
• Tailored recall interval
  
  • to the needs of the patient is vital to maintaining the dental home conept
  • requires patients caries risk assessment

Question 26

Cariest Risk Assessment

Answer 26

• essential element of contemporary clinical care for infants, children, and adolescents
• Framework for classifying caries risk based on a set of physical, enviromental, and general health factors

Question 27

Caries Risk Assessment Tool (CAT)

Answer 27

• dynamic instrument
• will be evaluated and revised as new evidence arises
• is qualitative instead of quantitative

Question 28

When using CAT, clinicians should:

Answer 28

• be able to visualize a childs teeth and mouth
  
  • have access to reliable historian for nonclinical date
• assess all 3 components of careis risk
  
  • clinical conditions
  • enviromental characteristics
  • general health conditions
• be familiar with footnotes that clarify use of individual factors
• a child’s ultimate risk classification is determined by the highest risk category where they have a risk indicator
  
  • changed for the current tool

Question 29

Caries-risk assessment form for 0-5 year olds

Answer 29

• intended for phsicians and other non-dental healthcare provider
• different b/w current form and previous form
  
  • caries risk is judged based on majority of factors rather than category of highest risk

Question 30

Caries-risk assessment form for >6 year olds

Answer 30

• intended for dental providers
• Evaluation of data and risk is determined by dental provider
• intended for the majority of evidence be used, but one item can be weighed more heavilty based upon judgement

Question 31

Clinical Management protocols

Answer 31

• documents designed to assist in clinical decision making
• criteria on diagnosis and treatment for recommended course of action