BDS IV P Prevention PDF

Prevention Dr Salwa Al-Habsi BDS MClinDent FRACDS Overview of Prevention and Dental Caries  Assessing the child and Family Parent/ Carer Motivation and Responsibility Patient History Clinical Examination Caries Risk Assessment  Assessing the child and...

Prevention Dr Salwa Al-Habsi BDS MClinDent FRACDS Overview of Prevention and Dental Caries  Assessing the child and Family Parent/ Carer Motivation and Responsibility Patient History Clinical Examination Caries Risk Assessment  Assessing the child and family Nurse will welcome the child welcoming the child or family into surgery Crouch down and make eye contact Greet child and parents Hello “ my name is …” Gain Rapport with parents and child Involve the child as much as possible with the conversation  Assessing the child and family Medical History Dental History Chief Complains Past Dental Experience If you concerned compliance of attendance contact other professionals for better health management  Clinical Assessment Extra Oral Examination Intra Oral Examination Radiographs  What is the most common dental health problem in children ? Caes  Is there a correlation between Plaque control and Dental caries? ye  Clinical Assessment Assess the Childs plaque control- who helps them brushing parents, care takers Assess the child primary and permanent teeth caries  Diagnose carious lesions Assess for pain and abscess/infection Assess the risk of pain or infection developing before exfoliation  Primary teeth Noncavitated, dentine shadow or minimal enamel cavitation Initial Radiograph: outer third dentine (Section 8.1.1) Occlusal Dentine shadow or cavitation with visible dentine Advanced Radiograph: middle or inner third dentine (Section 8.1.2) White spot lesions or shadow Initial Radiograph: lesion confined to enamel (Section 8.2.1) Proximal Enamel cavitation and dentine shadow or cavity with visible dentine Advanced Radiograph: may extend into inner third dentine (Section 8.2.2) Initial White spot lesions but no dentinal caries (Section 8.3.1) Anterior Advanced Cavitation or dentine shadow (Section 8.3.2) Pulpal Any tooth with clinical pulpal exposure or no clear separation between carious lesion and dental involvement pulp radiographically (Section 8.5) Near to Clinically mobile Special exfoliation Radiograph: root resorption (Section 8.6) Cases Arrested Any tooth with arrested caries and where aesthetics is not a priority (Section 8.7) caries Crown destroyed by caries or fractured, or pulp exposed with pulp polyp (pain/infection free) Unrestorable (Section 8.8)  Permanent Teeth Noncavitated enamel carious lesions: white spot lesions; discoloured or stained fissures Initial Radiograph: up to the enamel-dentine junction or not visible (Section 9.1.1) Enamel cavitation and dentine shadow or cavity with visible dentine Occlusal Moderate Radiograph: up to and including middle third dentine (Section 9.1.2) Cavitation with visible dentine or widespread dentine shadow Extensive Radiograph: inner third dentine (Section 9.1.3) White spot lesions or dentine shadow. Enamel intact Initial Radiograph: outer third dentine (Section 9.2.1) Enamel cavitation or dentine shadow Proximal Moderate Radiograph: outer or middle third dentine (Section 9.2.2) Cavitation with visible dentine or widespread dentine shadow Extensive Radiograph: inner third dentine (Section 9.2.3) Initial White spot lesions but no dentinal caries (Section 9.5.1) Anterior Advanced Cavitation or dentine shadow (Section 9.5.2) Pulpal Any tooth with clinical pulpal exposure or no clear separation between carious lesion and dental pulp involvement radiographically Special Cases Crown destroyed by caries or fractured, or pulp exposed with pulp polyp (pain/infection free) (Section Unrestorable 9.6) Examination of young child Assessing the dental caries Caries on the surface of enamel Intact enamel with dental caries Intact enamel with Dental caries Assessment caries lesion Activity An arrested carious lesion is one that does not progress. Assessing whether a lesion is active or arrested requires clinical and radiographic monitoring over time, and clinical photography may assist. Inform caries prevention and management choices it is often necessary to judge whether a lesion is likely to be arrested or active at a single point in time from its clinical characteristics.  Assessing Activity of the lesion over time Enamel Lesion Dentine Lesion Colour of the lesion progression over time Assessing Activity of the lesion over time Use radiographs to assess carious lesion progression over time. Film holders will improve standardisation, and therefore repeatability of radiographic views, allowing reliable comparison of lesions over time Assume that all carious lesions are active, unless there is evidence that they are arrested  Radiographs Bite wings taken after clinical examination High risk patients take radiographs every 6-12 months All other kids every 2 years Orthodontic separators useful for proximal caries  Not Caries Cusp of Carabelli Mimics caries Using age-appropriate language. For example, explain to the child how much you would “like to have the pictures to help in looking after their teeth”. - use Behavious management like rewards etc Use film/plate holders where possible. If this is not possible, consider using adhesive tabs.  Dental caries and molar incisor hypomineralisation Assess all hypomineralised molars independently to determine the extent of the disease and likely prognoses. Factors to be taken into consideration when determining whether teeth affected by hypomineralisation are of poor prognosis, include: enamel colour in order of severity and increasing likelihood of breakdown: white/cream, then yellow, then brown location of the defects in order of severity: smooth surface, then occlusal surface/incisal edge, then cuspal involvement sensitivity from brushing or to temperature atypically shaped restorations any patient reported symptoms  MIH Molar Incisor Hypomineralisation (MIH) is a common developmental condition, defined as a “hypomineralisation of systemic origin of 1-4 permanent first molars, frequently associated with affected incisors” Second primary molars can be similarly affected.Molars with hypomineralisation are prone to breakdown. The poor quality of enamel means that they are often sensitive to temperature and sometimes even painful on toothbrushing. These factors combined with increased caries susceptibility can lead to rapidly progressing caries. MIH enamel has an abnormal etching and bonding pattern that compromises restorative outcomes.  MIH There is a wide spectrum of presentation Lesions range from small, demarcated discoloured areas with no breakdown to large, dark areas that can fracture off, due to the weakness of hypomineralised enamel, exposing underlying dentine. Patient reported symptoms are variable, and may not necessarily match clinical presentation. Due to the possibility of rapid post-eruptive breakdown of the enamel, early diagnosis of MIH is key to avoid acute pain and delayed, complicated treatment. If restorations have already been placed, they will often be atypical in shape. This can aid diagnosis of MIH when the lesions are no longer visible.  Assessing pain Children are not always reliable in reporting pain, either because they have not yet developed the necessary communication skills or because they wish to avoid dental treatment. For example, an anxious child might not report an exfoliating tooth as painful, until reassured. Ask Changes in Eating, Drinking, sleeping, pain killers, Moodiness, school calls into parents child in pain etc Weight loss Assessing for dental abscess/infection in primary teeth TTP Sinus - in unattached mucosa Non Physiological Mobility- If not sure check contra lateral tooth mobility Radiographic image Assessing the risk of pain or infection developing before exfoliation 1. Extent of the lesion 2. Site of the lesion 3. Activity of the lesion 4. Time to exfoliation 5. Number of other lesions present in the dentition the child’s medical status 6. Anticipated cooperation of the child, now and in the future anticipated cooperation of the parent/carer with the preventive interventions and to attend repeat management appointments the range of clinical procedures the clinician has the skill to provide Lesions in primary teeth with high risk of causing pain or infection Lesions None in primary of the following lesions teeth at low has clinically risk evident oforcausing signs pain symptoms of orinfection, pain or infection and, although the teeth do not appear ‘healthy’, it is likely that they will proceed to exfoliation without causing further problems, provided they are closely monitored and the patient is given Enhanced Prevention  Assessing toothbrushing Gingival health is a useful indicator of tooth cleaning over time. Assessing and recording levels of visible plaque at each examination, and sharing this information with the child and their parent/carer, will help reinforce the importance of effective toothbrushing. An example of a quick method of recording plaque levels, and presenting the information in terms the child will understand, is to give marks out of 10 as follows. Disclosing Media Caries Risk Assessment High Risk Moderate Risk Low Risk  Caries Assessment and Risk Clinical evidence of previous disease Dietary habits, especially frequency of sugary food and drink consumption Social history, especially socioeconomic status Use of fluoride Plaque control Saliva Medical history Helping the Family Manage Dental Care Dental Anxiety Behaviour Management ( Pharma BM and Non Pharma BM)  Diagnosing and Managing dental pain or Infection Causes and Managing dental pain and infection ( Pulpitis -Reversible, Irreversible) Dental Abscess and periradicular periodontitis Management Strategies  Reversible Pulpitis Pain to Stimulus like cold, sweet- relieved when its removed Intermitted -Difficult to localize Not TTP Doesn’t disturb the Childs sleep  Irreversible Pulpitis Spontaneous pain Relieved by cold stimulated by hot Stays for a couple of hours Difficult for the child to localize Keeps the child awake at night Dull pain or throbbing No signs of sinuses or abscess  Dental Abscess/ Peri- radicular Periodontitis Acute Pain Spontaneous Keeps the child awake at night Can be easily localized Tooth mobility TTP Sinus, abscess or swelling/ periradicular pathology can be present Chronic - child may not report pain but other signs might be present 6.1 Management of Pain  Caries Prevention Caries Risk Assessment Standard Prevention Enhanced Prevention Caries Prevention  Standard Prevention Reminder to brush 1000-1500 ppm twice a day Spit no Rinse. Why? Brush age? Help of a child Demonstrate once every year  Enhanced Prevention Recommend higher fluoride levels for 3 plus Demonstrate tooth brushing at each visit Review often Encourage parents brush and supervise older children  Oral Hygiene Instruction Provide Information- Photos of parents brushing and child brushing himself Modelling Rehearsal Reinforcement Increasing control to build confidence and motivate Prompts, cues and incentives  Dietary Advice Sugar drinks should be avoided Can only consumed with meals Between meals child should drink water or milk only Breast feeding is recommended for babies up to 2 yea, only breast milk up to 6 months and beyond breast milk with supplementary food Snacks - Fruits, carrots, bread sticks, oatcakes and cheese If a child is having a bottle at bed time this should only contain water  Fissure Sealants Fissure sealants all pits and fissures on permanent teeth Resin Fissure sealants are the first choice Fissure seal with GIC partially erupted teeth Technique AE Sealants Glass Ionomer Sealants Indicated Pre-cooperative Age When moisture control is not possible Partially erupted teeth Use “ press finger “ technique in child who is uncooperative  SIGN Guidelines Scottish Intercollegiate Guidlines Network Systematic Review Fluoride varnish SIGN guidelines is the most effective method for reducing dental caries in primary dentition Fluoride varnish 5% 2-4 times a year in children 2 years and above Duraphat contain “colophony” Note patient not allergic , use colophony free Varnish  Technique Isolate if possible Wipe teeth with wet gauze if child uncooperative If cooperative brush with Prophy brush without pumice and  SDF What is it ? Silver Diamine Fluoride Used to prevent cavities from growing  SDF Silver: Helps kill bacteria Water: Provides a liquid base for mixture Fluoride: Helps your teeth rebuild the materials they’re made of (Known as demineralization) Ammonia : helps the solution remain concentrated so that its maximally effective against cavity resonance  Cases it used for High risk caries cases Early childhood caries Cavitated and uncavitated teeth Research shows that SDF is more effective in reducing cavity growth than varnish SDF can be applied once per year compared to Fluoride varnish How does SDF benefit your oral hygiene Effective to help stop cavity development after a cavity formed Kills bacteria that breaks tooth surfaces while keeping them from spreading to other teeth Comfortable alternative to drilling cavities Helpful for overly sensitive teeth Prevents cavity forming and keeping cavity to minimal  How is it used? Consent is needed Isolate Apply Leave for 30 sec to 1 min to dry  Review the patient in 7 days May repeat this after 1 year