Weak 10: Acute pain in peds, Teething, Oral care & hygiene Flashcards
How to assess pain in kids less than 3?
FLACC scale Face, legs, activity, cry, consolability
How to assess pain in children 4-8?
- Face pain scales
- Visual analog scales
- Verbal Numeric scale 6+ (rate pain 1-10)
How to assess pain in children 8-11?
11+ (adolescents)?
- Visual analog that rate pain based on a numeric scale
- Numeric rating scale without accessory tool
What are some non-pharm strategies for pain?
Physical (massage, heat or cold)
Behavioural (relaxation, exercise)
Cognitive (distraction, imagery)
What is the max days for analgesics for pain? for fever?
3 days for pain
5 days for fever
Explain teething.
What point in your life do you have teeth and when do they switch?
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
What is the golden rule for tooth eruption?
When should you refer if the child hasn’t had their first teeth?
7+4 rule
7 months: first teeth
11 months: 4 teeth etc..
Refer if child has no teeth by 1 year
What vitamins should mother take for good development of child’s teeth?
Calcium, phosphorous, vitamin C, D
What are the associated signs and symptoms of teething?
What are NOT associated?
Associated
- Gum redness, swelling
- Gum rubbing, biting
- Drooling –> facial irritation
- Crying, insomnia
- decrease in appetite, increased thirst
NOT associated
- vomiting
- diarrhea
- malaise
- Fever
- Rashes
Explain what to do if eruption cysts occur in a child’s mouth
Not associated with infection, can disappear if left alone
What are red flags for teething? dental, urgent, medical consult
What is pericoronitis
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
What is the first line therapy for teething? Describe what you can do
Nonpharm
- rub gums
- offer rings
- cold toys or foods
What are pharmacological treatments for teething you can give?
What can’t you give?
Oral analgesics (same dose as headache + fever)
- Do not use topical anesthetics like benzocaine
- BELLADONNA IS VERY TOXIC TO CHILDREN
Define the following terms:
Plaque/biofilm
Oral candidiasis/thrush
Periodontium
Pericoronitis
Eruption cyst
Dental carries
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
What is a good oral health indicative of?
What is the pathway that links them both
Good systemic health
- Dental plaque can accumulate in arteries
Inflammation
How does biofilm/dental plaque cause oral disease
- Accumulation on tooth surfaces –> caries
- Accumulation along & under the gums –> gingivitis
- chronic gingivitis –> periodontitis
What is considered a keystone pathogen in many systemic diseases?
P. gingivalis
Explain dental fluorosis.
When can you give fluoride for kids?
- 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)
What is the purpose of fluoride?
- Safe & effective for prevention and control of carries
- Makes enamel harder and more resistant to decay
What is the optimal concentration of fluoride in drinking water.
What should the max total intake be?
Optimal is 0.7 ppm
Max daily intake: 0.05-0.07mg/kg body weight
When should fluoride be administered?
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
What is the recommendation of supplemental fluoride for age of child:
0-6 months
6 months - 3 years
3-6 years
6+ years
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
When does flossing give best result. What else can you use
Before brushing teeth
Mouthwashes
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
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
What should you not have in your toothpaste if you are on chlorohexidine?
Stannous flouride (desensitizer)
What is the gold standard for plaque reduction? What are its downsides?
Chlorhexidine
- not for long term use since it can cause tooth staining and discolouration
What is the best type of mouthwash for daily use
Essential oil rinse (listerine)
