Caries Prevention

• What are the four pillars of prevention?

  • Oral hygiene
  • Diet advice
  • Fluoride availability
  • Fissure sealants Should be in every treatment plan
• What are some statistics about dental decay in children?

  
• What is the GA data for England in 2021/2022?

  Episodes of GA for dental extraction2021/22 = 42,180 Remains the commonest reason for hospital admission in 6-10 yr olds Approx 140 children per day (1 child every10 mins) Cost to the NHS = £81million
• What are the effects on the quality of life for children with dental decay?

  May lead to pain, infection Affects child's ability to speak, eat, play, learn, socialise, sleep Affects confidence Time away from school, fall behind in their learning Parents / carers time away from work / financial impact Impact is seen to be greater amongst those who are socially / economically disadvantaged
• How can prevention be encouraged?

  Encourage regular attendance from an early age
• Does early prevention reduce dental anxiety?

  yes
• The carious process factors

  
• What is the key message for preventing caries?

  A reduction in free sugar intake but diet advice should take a holistic approach to general healthy eating
• What are free sugars

  Sugars added to foods / drinks by manufacturers, cooks or consumers along with those found naturally in honey, syrups and fruit juice
• What is the recommended sugar allowance?

  • WHO and SACN recommends average intake should not exceed 5% of total dietary energy intake from 1yrs+
  • 4-6 yrs = 19g/day = five sugar cubes
  • 7-10 yrs = 24g/day = six sugar cubes
  • 11 yrs+ = 30g/day = seven sugar cubes
  • No specific guideline for under 4's but should avoid added sugar
• What are some complications to consider when assessing diet?

  parents may be separated grandparents may be involved in care (esp. for working parents) packed lunch or school dinners
• What are some sugar free snacks?

  fruit, vegetable sticks, humous, pitta bread, cheese
• What is advice relating to sugar in drinks?

  • Water and milk are only safe options - limit all others to mealtimes only• Dilute fruit juices with 50% water• Add squash only to colour the water• Avoid fizzy drinks - limit to special occasions, drink through a straw• Over 12 yrs, unsweetened tea / coffee - but limit due to caffeine (no more than 3mg/kg body weight per day)
• What do we need it know about infant feeding

  • BSPD position statement on infant feeding (2018)• WHO + DoH - exclusive breastfeeding until 6months of age, on demand• Do not add sugar to any infant drinks• Only allow milk / cooled boiled water in bottles• Do not leave bottles to be sucked overnight• Introduce a free-flowing cup as soon after 6 months as possible and discourage bottles after 1 yr• Don't dip teats / dummies in sugar / jam / honey..
• How do medications affect children?

  • Chronically ill children may be on long-term liquid medications• Liquid medications may also be taken frequently for analgesia, coughs, colds etc...• Parents / carers should request sugar-free preparations where possible• Where there is no sugar-free alternative advise to take at mealtimes if possible
• What are the general principles of oral hygiene?

  General principles: As soon as first tooth erupts Under supervision until at least age 7 Every night and at one other time in the day Fluoridated toothpaste no less than 1000ppm Appropriately sized toothbrush Spit not rinse Leave an hour between eating / drinking and brushing
• Oral hygiene for under 3 years olds:

  Carried out by an adult Small, soft brush Smear of fluoridated toothpaste containing no less than 1000ppm fluoride
• Oral hygiene for 3-6year olds?

  Under adult supervision More than 1000ppm fluoridated toothpaste Pea-sized amount Soft - medium bristles
• Oral hygiene for 7+ years

  May brush unsupervised, be able to see in a mirror 1350 - 1500ppm fluoridated toothpaste Can start to use a fluoride mouthwash but at a different time to brushing From age 10, can also prescribe 2800ppm fluoride toothpaste for those with active caries
• How do we deliver toothbrushing instruction?

  • Watch what they do (or carer if very young)
  • Show what they've missed -disclose
  • Correct the technique
  • Get them to demonstrate again
  • Use small scrubby circles
  • Cover gums as well as teeth
  • Develop a set pattern so that no area gets missed
  • Demonstrate flossing if permanent teeth
  • Carers may find it easier to brush from behind child
  • Children with orthodontic appliances may need to be shown interdental brushes as well
• What is the behaviour change - transtheoretical model ?

  • Be clear about why change is required; outline the benefits

  • Advice must be tailored to individual

  • Avoid blame, praise what is already going well

  • Set realistic and relevant goals

  • Consider incentives

  • Use of technology, phone and tablet apps

  
• What are some barriers to change?

  • Information overload

  • Unrealistic targets / expectations

  • Lack of support

  • Poor understanding of patient's background

  • NICE guidance on behaviour change, 2007
• Feeding advice for babies?

  • breast milk only food or drink babies need till 6m, first formula milk is the only suitable alternative to breast milk
  • free-flow cup from the age of 6m, bottle feeding discouraged from 12 months old
  • only breast or formula milk or cooled, boiled water should be given in bottles
  • only milk or water should be drunk between meals and adding sugar to foods or drinks should be avoided
• Liquid medications should be sugar free or taken at mealtime