Weak 10: Acute pain in peds, Teething, Oral care & hygiene

Question 1

How to assess pain in kids less than 3?

Answer 1

FLACC scale Face, legs, activity, cry, consolability

Question 2

How to assess pain in children 4-8?

Answer 2

• Face pain scales
• Visual analog scales
• Verbal Numeric scale 6+ (rate pain 1-10)

Question 3

How to assess pain in children 8-11?
11+ (adolescents)?

Answer 3

• Visual analog that rate pain based on a numeric scale
• Numeric rating scale without accessory tool

Question 4

What are some non-pharm strategies for pain?

Answer 4

Physical (massage, heat or cold)
Behavioural (relaxation, exercise)
Cognitive (distraction, imagery)

Question 5

What is the max days for analgesics for pain? for fever?

Answer 5

3 days for pain
5 days for fever

Question 6

Explain teething.
What point in your life do you have teeth and when do they switch?

Answer 6

Teething: Eruption of deciduous “milk” teeth through gingival tissues

• 6 months first teeth (bottom 2 then top 2)
• 20 teeth for a full set of primary teeth by 3 years
• Lose primary teeth by 5-6 years

Question 7

What is the golden rule for tooth eruption?
When should you refer if the child hasn’t had their first teeth?

Answer 7

7+4 rule
7 months: first teeth
11 months: 4 teeth etc..

Refer if child has no teeth by 1 year

Question 8

What vitamins should mother take for good development of child’s teeth?

Answer 8

Calcium, phosphorous, vitamin C, D

Question 9

What are the associated signs and symptoms of teething?
What are NOT associated?

Answer 9

Associated
- Gum redness, swelling
- Gum rubbing, biting
- Drooling –> facial irritation
- Crying, insomnia
- decrease in appetite, increased thirst

NOT associated
- vomiting
- diarrhea
- malaise
- Fever
- Rashes

Question 10

Explain what to do if eruption cysts occur in a child’s mouth

Answer 10

Not associated with infection, can disappear if left alone

Question 11

What are red flags for teething? dental, urgent, medical consult
What is pericoronitis

Answer 11

Dental consult
- Pericoronitis
- Delays of 6+ months in a tooth eruption
- Delays of 12+ months in a permanent tooth eruption
- Eruption cysts if causing discomfort/ interfering with feeding

URGENT
- Pericoronal abscess

Medical consult
- suspected systemic illness in a young child

Question 12

What is the first line therapy for teething? Describe what you can do

Answer 12

Nonpharm
- rub gums
- offer rings
- cold toys or foods

Question 13

What are pharmacological treatments for teething you can give?
What can’t you give?

Answer 13

Oral analgesics (same dose as headache + fever)
- Do not use topical anesthetics like benzocaine
- BELLADONNA IS VERY TOXIC TO CHILDREN

Question 14

Define the following terms:

Plaque/biofilm
Oral candidiasis/thrush
Periodontium
Pericoronitis
Eruption cyst
Dental carries

Answer 14

Plaque/biofilm
- deposit made of bacteria, saliva, and dextran

Oral candidiasis/thrush
- infection caused by candida species

Periodontium
- the tissues supporting teeth (GUMS)
Pericoronitis
- swelling of the gums

Eruption cyst
- tooth wants to erupt but is blocked by cyst filled with blood and fluid (self-limiting)

Dental carries
- tooth decay or cavities

Question 15

What is a good oral health indicative of?
What is the pathway that links them both

Answer 15

Good systemic health
- Dental plaque can accumulate in arteries

Inflammation

Question 16

How does biofilm/dental plaque cause oral disease

Answer 16

• Accumulation on tooth surfaces –> caries
• Accumulation along & under the gums –> gingivitis
• chronic gingivitis –> periodontitis

Question 17

What is considered a keystone pathogen in many systemic diseases?

Answer 17

P. gingivalis

Question 18

Explain dental fluorosis.
When can you give fluoride for kids?

Answer 18

• High intake of fluoride during permanent tooth formation
• 0-6 years but most susceptibility 15-30 months
• Mild: chalk-like lacy marking
• Severe: brown pitted brittle enamel
• Can give fluoride to kids when they can spit (usually until 3-4 years)

Question 19

What is the purpose of fluoride?

Answer 19

• Safe & effective for prevention and control of carries
• Makes enamel harder and more resistant to decay

Question 20

What is the optimal concentration of fluoride in drinking water.
What should the max total intake be?

Answer 20

Optimal is 0.7 ppm
Max daily intake: 0.05-0.07mg/kg body weight

Question 21

When should fluoride be administered?

Answer 21

Only 6+ months and only if:
- fluoride in drinking water is less than 0.3ppm
- Child does not brush teeth at least BID
- Child is susceptible to high caries

Question 22

What is the recommendation of supplemental fluoride for age of child:

0-6 months
6 months - 3 years
3-6 years
6+ years

Answer 22

All have to be less than 0.3ppm
0-6 months
- none

6 months - 3 years
- 0.25mg/day

3-6 years
- 0.5mg/day

6+ years
- 1mg/day

Question 23

When does flossing give best result. What else can you use

Answer 23

Before brushing teeth

Mouthwashes

Question 24

Describe the role of each ingredient in toothpastes

Abrasive agents
Fluorides, arginine, xylitol, hydroxyapatite
Humectants
Thickening agents
Whiteners
Detergents
Desensitizers
Triclosan, zinc citrate, stannous fluoride

Answer 24

Abrasive agents (calcium carbonate/phosphate)
- remove debris, whiten teeth

Fluorides, arginine, xylitol, hydroxyapatite
- strengthens tooth enamel

Humectants (glycerol)
- Prevent toothpaste from drying out

Thickening agents
- stabilize the product

Whiteners (peroxides)
- break down pigments on teeth

Detergents (sodium lauryl sulfate)
- cause foaming

Desensitizers (arginine, stannous flouride)
- reduce hypersensitivity

Triclosan, zinc citrate, stannous fluoride
- prevent gingival inflammation

Question 25

What should you not have in your toothpaste if you are on chlorohexidine?

Answer 25

Stannous flouride (desensitizer)

Question 26

What is the gold standard for plaque reduction? What are its downsides?

Answer 26

Chlorhexidine

• not for long term use since it can cause tooth staining and discolouration

Question 27

What is the best type of mouthwash for daily use

Answer 27

Essential oil rinse (listerine)