Week 4- Prevention in Child Pt Flashcards
When should you educate patient on oral health associated with pregnancy?
Before 6 months of pregnancy
What are things you should teach patient regarding oral health and pregnancy?
- Pregnancy gingivitis and epulis
- Morning sickness – nausea, erosion
- Periodontal disease link to pre-term low, weight babies
- Caries, a transmissible disease
- Oral health and diet – cravings and snacking
Why do pregnant patients get pregnancy gingivitis and epulis?
Hormones (progesterone) activates immune response to bacteria/plaque.
What is the management for pregnancy epulis?
Usually goes away on its own, but needs surgical intervention if not
How can you prevent pregnancy gingivitis and epulis?
Good OH and pt education
What are the effects of morning sickness on teeth?
Chronic and prolonged morning sickness will lead to acid erosion on teeth
What should you advise patient if they have morning sickness?
Don’t brush teeth after morning sickness. Wait at least 30 minutes.
What is the link with perio and pre-term birth?
Women who have bad OH and perio during pregnancy are more prone to pre-term, low weight babies.
Endotoxins can enter circulatory system and then enter fetal placental unit.
Describe caries transmission between parents and baby?
Strep mutans pass from parent to child. Usually happens in first years of life. Sucrose facilitates adhesion of SM to tooth surface.
What are preventative strategies for pregnant patients?
- Dietary advice
- Rinse with water after exposure
- Xylitol products
- CHX varnish
- Topical F- for high risk pts
- Regular brushing and flossing
- Recalls
Why is caries risk increased during pregnancy?
- Sucking sweets to reduce nausea
- Cravings and extra snacking
- Morning sickness and erosion
What is early childhood caries?
Caries present 0-3 years of age
What is ECC caused by?
Frequent, prolonged exposure to sucrose containing liquids (milk, juice, soft drink)
What is the caries pattern of ECC?
Usually primary mx incisors and all molars
What is the aetiology of ECC?
- Pooling of sugary fluid around mx anteriors causing demin. Md anteriors more protected than mx anteriors due to fresh saliva pooling under tongue.
- Decreased saliva flow during sleep
What are the EEC manifestations?
- White areas of demineralization
- Cavitation
- Loss of crown due to caries
- Need for extraction
What are long term effects of ECC?
- Pain
- Premature tooth loss (malocclusion, poor self esteem)
- Chewing difficulty (nutrition)
- Speech problems
- Growth and sleep disturbances
- Risk or need for tx under GA
- Financial burden
How can ECC be prevented?
- Early intervention/education (esp if mother high caries risk)
- Train dental team to identify pt at risk
- Lifestyle change (OH, diet, F-)
- Apply Fl varnish from 1 yr old
- Recall
- Wean infants off bottle by 12 months.
When can you start applying Fl varnish?
From 1 year old
When should infants be weaned off bottle?
12 months
What is some advice for parents to prevent ECC?
- Limit bottle feeding to water, milk formula
- Bottle is not pacifier
- Wean infants by 12 months
- Avoid on demand feeding
- Less frequent and low cariogenic snacks.
When should child have their first dental visit?
6 months ideal
How should parent clean babies teeth once erupted?
Once first tooth erupts, use washcloth, gauze or soft small brush.
When should F- toothpaste be introduced?
18 months
How much and ppm F- toothpaste should be used in patients 18months-6years?
Smear to pea sized, 500-550ppm
What are some strategies for reinforcing toothbrushing for children?
- Have routine
- Make song
- Praise or gold star
What ppm F- toothpaste should be used in patients over 6 years?
1000-1500ppm
What children can use adult F- toothpaste?
High risk children in non-fluoridated areas
What are the ppm F- for Jack n Jill, Colgate childrens, Macleans little teeth and Macleans milk teeth tooth paste?
- Jack n Jill TP = No Fl
- Colgate’s children’s = 500ppm Fl
- MacClean’s Little Teeth – 1000ppm Fl
- MacClean’s Milk Teeth = 500ppm Fl
How should we teach children to floss?
- Watch parents brush & floss (imitation)
- Floss sticks (easier)
- Start with primary molars (broad contact)
When should children start flossing themselves?
10 years
What is the protocol for high risk primary school aged children (5+)?
- 3-6 month recalls
- F- TP
- Diet assessment, new meds, new hobbies
- F- varnish
- Tooth mousse
- Fissure seal molars and premolars on eruption
When can F- tooth mousse start being used?
8 years old.
How can you describe bacteria in children’s mouth to them?
Bugs in your mouth
What habits should be watched for in children?
- Tongue position
- Lingual frenum for tongue tie
- Speech & language development
- Lip competency
- Mouth breathing
- Pacifier use, thumb or digit sucking
What can happen if patient continues thumb sucking habit?
Altered occlusion and facial development
What age is thumb sucking and tongue thrusting normal until?
Thumb sucking, tongue thrusting until 2-3 years is acceptable and won’t have effect. Habit beyond this stage is a concern. Need to identify these habits early on.
What are early interventions to prevent thumb sucking?
- Positive reinforcement, identify trigger, reminders
- Bitter fingernail polish
- I/O appliances if habit continues
What patients are more prone to trauma to central incisors?
Patients with Class 2 Div 1
How can older primary school aged children be managed (11+)?
- Plaque disclosing gel
- Explain diet, snacking, brushing and flossing
- Posters and brochures
What do the 3 colours for GC tri-plaque ID gel indicate?
- Pink: recently cleaned surfaces with immature biofilm
- Blue-Purple: Undisturbed biofilm for 48hours+
- Blue: Acid production from plaque bacteria
How should adolescent patients be managed?
- Respect them & avoid judgement
- Discuss impact of social media and unrealistic expectations
- Introduce tongue brushing
- Advice on OH, diet, smoking, alcohol and drug use.
- Explain impact of poor oral health (aesthetics of caries, halitosis)
How should you manage patients with braces?
- Demonstrate OH technique
- F- varnish
- Tooth mousse
- If necessary, high F- TP or mouthwash
What are common sources of acid erosion in patients?
- Acid drinks
- Citrus
- Vinegar
What are some tips to prevent erosion?
- Avoid swishing
- Straws
- Rinse with water after
- Chew gum to increase saliva flow
What are signs of acid erosion?
- Cupping
- Vertical loss
- Palatal erosion
What are characteristics of early onset periodontitis?
- Rare, can occur in young with family susceptibility
- Onset – puberty targeting first molars and incisor, but can be generalised
- Rapid progression
- Episodic – intermittent attachment destruction
- Signs – pocket depth and bone loss inconsistent with plaque levels
How long should parents supervise thier child brushing thier teeth?
- Brush children’s teeth until 6 years.
- Supervision until 6-8 years
