Prevention and caries risk assessment in paediatric dentistry

Study Notes

Microorganisms, Time, Fermentable Carbohydrates, and Tooth are key factors in caries risk.
Caries risk assessment (DBOH) considers previous caries within 12 months.
Amelogenesis imperfecta without post-eruptive breakdown is a standard caries risk.
Standard caries risk includes no active caries, no new caries in 12 months, and no developmental defects with no enamel breakdown. Recall is 6 months.
Increased caries risk includes active caries, caries within 12 months, poor oral hygiene/diet, and 4+ sugar attacks and developmental defects with enamel breakdown. Recall is 4 months.

Primary: Oral hygiene instruction (OHI), fluoride, and fissure sealants for sound teeth.
Secondary: Addressing existing dental conditions (restorations).
Tertiary: Addressing missing teeth (dentures, implants, bridges).

High fluoridated toothpaste recommendations vary by age and caries risk (0-6, 10-16, 16+).
Dosage: 0.5 F mouthwash for patients 7+ years old who can spit.

Fissure sealants are indicated for patients with both standard and increased caries risk, for both permanent and primary teeth (especially first molars and premolars).
Application often includes upper central and lateral incisors if cingulum pits are prominent.

Under 3 years: Breastfeeding is best; introduce free-flow cups from 6 months; discourage bottles after 1 year. ECC (nursing caries) is a historical term.
3-6 years: Twice-daily brushing, smear of toothpaste with 1000 ppm F-, spit after brushing, 6-month recall.
7+ years: Twice-daily brushing, pea-sized fluoride toothpaste (1350-1500 ppm F-), spit after brushing, 2.26% NaF varnish twice yearly, 6-month recall.
Increased Risk: Diet monitoring targeting <4 sugary intakes daily. Use of fluoride mouth rinse (0.05% NaF, 230 ppm F) at a different time to brushing. Increased NaF concentration recommendations exist for those 10+ and 16+ with active cavities.