What are the four evidence based interventions?
- OHI with fluoride toothpaste
- Dietary advice
- Topical fluoride
- Fissure sealants
Define standard care/standard prevention ?
Preventative intervention that should be given to all children
What is enhanced care/enhanced prevention?
Preventative intervention required for those at an increased risk of caries
List enhanced prevention for children 0-6 yo
- Standard care PLUS
- 1350-1500ppm Fluoride
- F- varnish 2x annually
- Diet and OH advice
- Sugar free medications
- Shorter recall interval
List enhanced prevention for children 7+
- Fissure sealants
- Diet and OH advice
- Fluoride -
- -> daily mouth wash
- -> high conc toothpaste (2800 if 10+ or 5000 if 16+)
- -> F varnish 2x year
List general toothbrushing advice
- Brush teeth as soon as they erupt 2x day with fluoride TP
- Spit dont rinse
- Supervise brushing
How much ppm fluoride should be in toothpaste for the following - 0-3 low risk 3-6 low risk 0-6 high risk 7+ low risk 10+ active caries 16+ active caries
0-3 = 1000ppm 3-6 - >1000ppm 0-6 HIGH RISK = 1350-1500 7+ - 1350-1500 10+ active caries - 2800 16+ active caries - 5000
When should fluoride mouthwash be prescribed
7+ high risk patients can be prescribed a daily mouthwash
What conc fluoride is the daily mouthwash? How much fluoride is this?
0.05%
225ppm
When to apply fluoride varnish according to standard and enhanced care?
- Standard - 2x year aged 3+
- Enhanced - 2 or more times a year aged 0+
What conc fluoride is in fluoride varnish? How much fluoride is this?
2.2%
22,600ppm
Dose of fluoride varnish for:
- Primary dentition
- Mixed dentition
- Permanent dentition
- Primary - 0.25ml
- Mixed - 0.4ml
- Permanent - 0.75ml
Contraindications for fluoride varnish
- Hypersensitivity to constituents
- Bronchial asthma
- Ulcerative gingivitis
- Allergic to or unable to take alcohol for cultural reasons
List general diet advice
- Avoid frequent snacks between meals
- Avoid drinking juices, fizzy drinks between meals
- Be aware of sugar content and hidden sugars
- Parents should not put sugary drinks in bottles at night (e.g. sweetened milk)
What are good alternatives to high sugar snacks?
- Fresh fruit and veg
- Breadsticks
- Small amount of cheese
What is a diet diary
Child or parent/carer records all food and drink consumed over a 3 day period (with one day being a weekend)
Drinks between meals
- Water
- Cows milk
What are fissure sealants?
Material placed in susceptible areas on teeth to prevent the development of caries
What sites in the mouth are susceptible to caries
Fissures Grooves Cingulum pits Dens in dente pits Anywhere food collects
Types of material used for fissure sealants
Flowable resin composite
GIC as a temporary sealant (high wear)
Indications for fissure sealant
- High risk children >7yo
When may a gic sealant be placed?
Partially erupted teeth
Uncooperative patient
How to monitor already placed fissure sealants
Assess wear, leakage or loss of integrity
What is the radiographic recall period for low and high risk children?
Low risk - 12-18 months for primary teeth and 2 years for permanent
High risk - 6-12 months
