When should the first dental assessment of a child be carried out and why
before the child is six month old - encourages parents to adopt optimum caries preventive practices early
What questions would you ask a parent during the dental history of an exam
- Toothbrushing habits - who brushes Childs teeth? how often do they brush? for how long? what toothpaste do they use? doe child spit after brushing?
- Dietary habits - do they take drinks to bed with them at night? what is in drinks? how often do they have sugary snacks? do they add sugar to hot drinks? does child take regular sugar containing medication? what does child eat between meals? how much fruit and vegetables does child have during day?
- Previous dental experiences - what tx has been carried out previously? does child have experience of local anaesthetic? is child anxious about visiting dentist?
what questions would you ask a parent during the social history of an exam?
- Which adults provide care for child and need to be included in prevention programmes (regular overnights with grandparents, childminders etc)
- Which days and times suit for dental appointments
- Name of nursery/ school
- Name of GP
- Caries experience in parent and siblings (has siblings required GA/teeth out/fillings)
- Ask parent if there will be any difficulties in bringing child for visit
what radiographs are recommended for low/standard caries risk
bitewing radiographs at 2 year intervals
what radiographs are recommended for high caries risk
bitewing radiographs every 6-12 months
How do you assess toothbrushing (include scores)
Taking a plaque score - split mouth into sections like a BPE
10/10 - clean tooth
8/10 - plaque around cervical margin
6/10 - plaque around cervical third of crown
4/10 - plaque around middle third of crown
what are the 7 factors of caries risk assessment
- Clinical evidence of previous disease (missing due to caries, decayed or filled)
- Dietary habits
- Social history
- Medical history
- Fluoride use
- Saliva
- Plaque control
what would make a child high risk
SDCEP says
- any child living in SIMD number 1-3
- any child with missing teeth due to caries, decay or previously filled
- subjective based on other risk factors and history/clinical assessment of clinician
What are the evidence based caries prevention factors
- OHI and toothbrushing
- Dietary advice
- Fluoride varnish
- Fissure sealants
- Fluoride toothpaste
- Fluoride supplements
- Radiographs
- Sugar free medication
What is the standard prevention recommendations for fluoride toothpaste for children under 3 and over 3
- under 3: smear of 1000-1500ppm
- over 3: pea sized amount of 1000-1500ppm
what is the enhanced prevention recommendations for fluoride toothpaste in high caries risk children under 3 and over 3
- under 3: smear of 1350-1500ppm
- over 3: pea sized of 1350-1500ppm
- over 10: 2800ppm
what standard prevention advice should you offer to children of low caries risk and how often (toothbrushing)
At least once per year;
- brush teeth twice daily, including last thing at night (do not eat or drink after brushing at night before bed unless it is water)
- use age-appropriate fluoride toothpaste depending on caries risk
- spit don’t rinse
- supervise child until they can brush their own teeth effectively
- demonstrate brushing on the child for roughly 3 minutes annually
- advise parent to brush as soon as first primary tooth erupts
- advise parent to not allow child to eat toothpaste
what enhanced prevention advice should you offer to children of high caries risk and how often (toothbrushing)
- same as standard risk but at every visit
- use fluoride conc for high risk
- utilise child smile/school nurse
- 3 minutes OHI at every visit
what standard prevention advice should you offer to children of low caries risk and how often (Diet)
Advise child and parent once per year
- limit sugary foods and drinks (meal times only)
- drink water or milk between meals
- snack on healthier foods low in sugar
- do not place sugary drinks, fruit juices or sweetened milk in feeding bottles
- after brushing, only drink water
- be aware of hidden sugars and acid content of drinks
what enhanced prevention advice should you offer to children of high caries risk and how often (Diet)
same as standard but at every visit
- also complete a diet diary 3-5 days, one day being weekend
what standard prevention advice should you offer to children of low caries risk and how often (Fluoride varnish)
- apply fluoride varnish twice a year to children 2 years and above
what enhanced prevention advice should you offer to children of high caries risk and how often (Fluoride varnish)
- apply fluoride varnish 4 times a year to children 2 years and above
what are contraindications to fluoride varnish?
- colophony allergy
- children who have been hospitalised due to severe asthma or allergy in past 12 months
- children who are allergic to sticking plaster
what is the fluoride content of duraphat fluoride varnish
22,600ppm
what volume of fluoride varnish is safe to give to children
nursery and primary 1 (age 2-5): 0.25ml
primary 2 and above (>6): 0.4ml
what are the steps of applying fluoride varnish
- check MH and ensure no colophony allergy
- isolate and thoroughly dry teeth a quadrant at a time
- apply fluoride varnish using small brush, ensuring inter proximal and occlusal application
- advise that soft foods and liquid may be consumed 30 minutes after fluoride varnish is applied, child should wait 4 Horus before brushing teeth or chewing hard food
What is the standard prevention for low caries risk in fissure sealants
- place sealants in pits and fissures of permanent molars as soon as possible after eruption
- check existing sealants for wear and integrity at each visit
- top up damaged sealants
- child uncooperative - use GI
what is enhanced prevention for high caries risk in fissure sealants
- same as standard,
- consider GI in partially erupted first molars
- fissure seal palatal pits on upper lateral incisors and occlusal and palatal surfaced of D’s E’s first & second permanent molars
what should you use for isolation during fissure sealant placement
- cotton wool roll
- dry guard
- saliva ejector
- mouth mirror for tissue retraction
