Developing the Personal Care Plan

Question 1

What elements are required for a care plan to be successful?

Answer 1

• tailored to a realistic assessment of childs ability to accept treatment
• aim to increase likelihood of behavioural change to improve oral health
• gain parent/carers support in bringing child for care and in supervising preventive interventions

Question 2

What are the priorities of a paediatric personal care plan (start with the most important)?

Answer 2

1. manage pain if present
2. caries prevention
3. managing caries (asymptomatic sepsis), if present

Question 3

What must be included in ALL childrens personal care plan?

Answer 3

caries prevention

Question 4

List some approaches for caries prevention

Answer 4

• toothbrush instruction
• diet advice
• fluoride application

Question 5

What are the factors that complicate caries management in children?

Answer 5

• children can finde operative treatment unpleasant (white coat syndrome)
• clinicians can find operative treatment on children difficult to provide
• children with decay tend to have multiple teeth affected?

Question 6

How would you possibly go about treating a child with caries lesions on multiple teeth?

Answer 6

GA to take all carious teeth out

Question 7

Primary teeth have a limited life span, how does this simplify the treatment we are able to provide?

Answer 7

• as opposed to a restoration or extraction, slowing caries progression may be sufficient before subsequent exfoliation ot the tooth

Question 8

Early childhood caries is also known as …

Answer 8

bottle caries

Question 9

What is the aetiology of ECC?

Answer 9

• on demand night time feeding >1 years
• breast milk, formula
• juice or sweet drinks befoe nap/bed time (slow saliva production)
• dipping pacifiers in sweet drinks

Question 10

How can ECC be prevented?

Answer 10

• only water at night time
• fluoride application
• changing bottle to cup (training cup) - children tend to fall asleep with their bottles

Question 11

What is the first priority of a personal care plan in a child if no pain is present?

Answer 11

*[caries prevention]
keeping the 6s and the 7s free from both occlusal and approximal caries

Question 12

What is the second priority of the personal care plan for children?

Answer 12

reduce the risk of caries in primary dentition resulting in pain and sepsis before it exfoliates

Question 13

What should come first, preventive interventions for permanent teeth or treatment of primary teeth?

Answer 13

preventive interventions for permanent teeth should come before treatment for primary teeth

e.g. fissure seal permanent teeth before restoring permanent teeth

Question 14

In the initial care plan, you should inform parent/carer of the expected number and duration of appointments. What should you keep in mind to maintain cooperation of the child?

Answer 14

splitting them into manageable bite sized chunks - dividing treatment into stages

predict more appointments than you think you will need

Question 15

What was the relevance of the Law Reform Act 1969 in healthcare?

Answer 15

• permits a patient of 16, of sound mind to legally give valid consent
• does no preclude (prevent) children under 16 from giving consent

if <16 can understand proposed treatment proposed and they can come to an informed decision

Question 16

A child under 16 is considered to be Gillick competent if…

Answer 16

• they are able to understand the nature of the treatment and purpose
• understand risks + limitations
• compare alternative, including no treatment

Question 17

It is prudent to get a gillick competent child to discuss with their parent. True or false

Answer 17

True

Question 18

In a case where the parent is unavailable for a gillick competent child, how should you treat this patient?

Answer 18

• childs best interest should be put first
• do the minimum treatment possible- the main priority should be resolving the pain

Question 19

Parental responsibility is defined by …

Answer 19

the Children Act 1989

Question 20

Parents are unable to delegate parental responsibility. True or false

Answer 20

false

Question 21

In what instance to both parents have automatic parental responsibility of a child/.

Answer 21

if they are married at the time of conception

Question 22

What is an easy opening question to ask fathers to detemine parental responsibility?

Answer 22

“Are you married dad or partner dad”?

Question 23

In what instances does an unmarried father have parental responsibility?

Answer 23

• father has acquired PR via court order or PR agreement
• couple subsequently marry
• named on birth certificate

Question 24

A legally appointed guadian has parental responsibility. How is a legal guardian appointed?

Answer 24

• court
• parent with PR in the event of their own death

Question 25

Does a foster parent have parental responsibility?

Answer 25

they would not usually have responsibility but will know who has

Question 26

Give examples of other situations where parental responsibility lie outside of the parents

Answer 26

* Court Residence Order concerning a child * Local Authority designated in care order (but not when the child is beein looked after under section 20 of the Children Act- accomodated or in voluntary care * Local authority or other authorised person holding an Emergency Protective Order (ususally not the foster parent) - so investigate

Question 27

If a father is a "partner dad", what further questions should you ask?

Answer 27

* are they named on birth certificate? * do they have PR?

Question 28

A 5 year old boy has attended with his child minder afer falling in the garden, loose teeth, child is very distressed. How would you go about providing care to this child?

Answer 28

1. if mother or person with PR is contactable 2. act in childs best interest - limit treatment to what is required to get child out of pain 3. exam/emergency treatment only 4. get second opinion from colleague (dual consent)

Question 29

An 11 year old girl, attended with her father. Father divorced after he was married to the mother for 2 years following the child birth. Child lives with father, mother lives in the city. How would you go about checking parental responsibility for this child?

Answer 29

father has PR as he was married to the mother at conception PR is not lost following a divorce so do not need to contact mum

Question 30

A 15 year old boy attended unaccompanied with toothache. He described his compliants, able to give dental history and medical history. Lives with mum who is not well and has 4 other young kids so cannot make the surgery. How would you go about giving treatment to this child?

Answer 30

* assess whether he is gillick competent? * if they are, then they can give consent * limit to emergency treatment only * contact mother for full course of treatment

Question 31

What is the ideal sequence of treatment if a patient is not presenting with pain but has multiple carious lesions?

Answer 31

1. prevention 2. fissure sealant 3. preventive restorations 4. simple fillings 5. fillings requiring LA but do not involve pulp 6. more extensive restorative work 7. extractions

Question 32

What is a preventive resin restoration (PRR)?

Answer 32

A small cavity created (enamel biopsy) and restored; then fissure sealed

Question 33

What is the better alternative option to a PRR if in doubt?

Answer 33

a high quality sealant review reinforce preventive advice

Question 34

What is the choice of restoration for early caries (<1/3 into dentine) ?

Answer 34

fissure sealants

Question 35

What is the general rule of thumb for delivering LA in children requiring work in both upper and lower arches?

Answer 35

Do the upper arch before the lower arch as LA easier to deliver

Question 36

By appointments, how would you treatment plan the following patient: * 8 years old * MH clear * irregular attender * previous dental visits XGA of all Ds * small cavity in LRE requiring restoration * large cavities in all other Es requiring XLA

Answer 36

* visit 1: clinical assessment, care plan, diet sheet, TBI, plaque disclosure * visit 2: collect diet sheet, plaque disclosure to assess TB, fissure sealant (one tooth), flouride varinsh * visit 3: discuss diet sheet, make recommendations, fissure seal other teeth * visit 4: restore LRE without LA, hall crown, repeat TBI * visit 5: XLA URE with LA infiltration, discuss diet progress * visit 6: XLA ULE and LLE LA, repeat TBI