Prevention for the Child

• Social factors affecting caries risk:

  • Socially deprived
  • Parent's education
  • Siblings with caries
  • Vulnerable group eg in care, homeless, prisoner, asylum seeker
  • Attendance pattern
  • Access to dental surgery/distance to travel
  • Dental anxiety
• Medical factors affecting caries risk:

  • Xerostomia
  • Sugary medications
  • May affect behaviour and compliance
  • May affect dexterity and ability to perform oral hygiene
  • Diet
• Dental/tooth factors affecting caries risk:

  • Fixed/removable orthodontic appliances
  • Dentures
  • Current active caries
  • DMFT >4 & dmft >4
  • Caries in 6s at 6 years old
  • Hypoplastic or hypomineralised teeth
  • Crowding
• Fluoride factors affecting caries risk:

  • Use of fluoride toothpaste of appropriate fluoride concentration
  • Rinsing after brushing
  • Living in fluoridated area
  • Part of a fluoride varnish scheme
• Diet factors affecting caries risk:

  • 3+ sugary snacks a day
  • Bottle feeding with juice/fizzy drinks/added sugar
  • Sugar-containing food and drink < 1 hour before bed
• Oral hygiene factors affecting caries risk:

  • Low frequency of brushing
  • Poor technique
  • Unsupervised brushing (when supervision required)
• 5 pillars of prevention:

  • Diet analysis and advice
  • Fissure sealants
  • Fluoride varnish
  • Oral hygiene instruction
  • Recall intervention
• Risk factors for dental fluorosis in order of risk:

  • Inappropriate use of fluoride supplements
  • Age of child when toothbrushing started
  • Soya or milk-based infant formula use
  • Frequency of brushing/swallowing toothpaste
  • Residence in an optimally-fluorridated area

  
• Evidence-based prevention: recall interval (NICE guidelines):

  • Recall interval should be determined for each patient according to their oral disease risk
  • The shortest interval between oral health reviews for all patients should be 3 months
  • The longest interval between oral health reviews for patients < 18 years old should be 12 months
  • The longest interval between oral health reviews for patients > 18 years old should be 24 months
• Prevention of caries in the primary dentition: All children aged 0-3 years - advice:

  • Breast feeding provides best nutrition for babies. Support mothers to breastfeed.
  • Gradually introduce wide variety of solid foods (of different texture & flavour) from 6 months old.
  • From 6 months old, introduce drinking from free-flow cup. From 1 year old, discourage feeding from bottle.
  • Do not add sugar to weaning foods and drinks.
  • As soon as teeth erupt in mouth parents must brush them at least twice a day with SMEAR of fluoridated toothpaste containing > 1,000 ppmf - especially at night.
• Prevention of caries in the primary dentition: All children aged 0-3 years - advice:

  • Spit, don't rinse, after brushing
  • Reduce frequency and amount of sugary food and drink consumption (< 5 intakes containing NME sugars).
  • Avoid sugar-containing food and drink within an hour of bedtime.
  • Sugar-free medications recommended.
• Prevention of caries in the primary dentition: Children aged 0-3 at HIGHER RISK of caries - advice:

  • As for low risk plus: brush at least twice a day with SMEAR of fluoridated toothpaste containing 1,350-1,500 ppmf - especially at night
  • Professional intervention:
  • Apply fluoride varnish to teeth two or more times a year (22,600 ppmf, 2.2% NaF) - 3 month interval normally
  • Reduce recall interval - 3 month interval (NICE Guidelines)
  • Diet investigation and advice
• Prevention of caries in the primary dentition: All children aged 3-6 years - advice:

  • Brush at least twice a day with PEA SIZED amount fluoridated toothpaste containing > 1,000 ppmf - especially at night
  • Spit, don't rinse, after brushing
  • Reduce frequency and amount of sugary food and drink consumption (<5 intakes containing NME sugars)
  • Avoid sugar containing food and drink within an hour of bedtime
  • Sugar-free medications recommended
  • Professional intervention:
  • Apply fluoride varnish to teeth twice a year (22,600 ppmf, 2.2% NaF)
• Prevention of caries in the primary dentition: Children aged 3-6 at HIGHER RISK of caries - advice:

  • As for low risk plus: brush at least twice a day with PEA SIZED amount of fluoridated toothpaste containing 1,350-1,500 ppmf - especially at night
  • Professional intervention:
  • Apply fluoride varnish to teeth two or more times a year (22,600 ppmf, 2.2% NaF) - 3 month interval normally
  • Reduce recall interval - 3 month interval (NICE Guidelines)
  • Diet investigation and advice
• Prevention of caries in: All children aged +7 - advice:

  • Brush at least twice a day with fluoridated toothpaste (1,350-1,500 ppmf) - especially at night
  • Spit, don't rinse, after brushing
  • Reduce frequency and amount of sugary food and drink consumption (<5 intakes containing NME sugars)
  • Avoid sugar-containing food and drink within an hour of bedtime
  • Professional intervention:
  • Apply fluoride varnish to teeth twice a year (22,600 ppmf, 2.2% NaF)
• Prevention of caries in: Children aged +7 at a HIGHER RISK of caries - advice:

  • As for all children aged 7+ but also...
  • Professional intervention:
  • Apply fluoride varnish to teeth two or more times a year (22,600 ppmf, 2.2% NaF) - 3 month interval normally
  • For those aged 8+ with active caries, prescribe fluoride mouth rinse (0.05% NaF) for use at a different time to brushing
  • For those aged 10+ with active caries, prescribe 2,800 ppmf toothpaste
  • For those aged 16+ with active caries, prescribe 5,000 ppmf toothpaste
  • Diet investigation & advice
  • Fissure seal permanent molars with resin
• Fluoride varnish:

  • Duraphat contraindicated in person with a history of hypersensitivity to colophony or a history of bronchial asthma (in these cases use Profluorid)
  • Method:
  • Dispense correct dose onto pad
  • Dry the teeth (3-in-1 +/- cotton wool roll)
  • Paint entire tooth surface, avoid gingivae, using micro-brush
  • Varnish sets in a few seconds
  • Fluids/soft foods only for 4 hours (avoid hard foods)
  • No food or drink for 30 mins
• Fluoride varnish - dosage for single application:

  • Primary: up to 0.25ml (5.65mgF)
  • Mixed: up to 0.40ml (9.04mgF)
  • Permanent: up to 0.75ml (16.95mgF)
• Silver Diamine Fluoride (SDF):

  • Applied to cavitated carious lesions to arrest or slow progress of dental caries
  • 38% SDF = 44,800 ppmf
• Silver Diamine Fluoride (SDF):

  • Benefits
  • Simple technique
  • No drilling
  • Good evidence that it arrests caries
  • Disadvantages/risks
  • Stains caries black
  • Soft tissue staining
• Silver Diamine Fluoride (SDF) - technique:

  • Ensure pt wearing bib & safety glasses
  • Apply vaseline to lips & soft tissues
  • Dry teeth with cotton wool/gauze
  • Isolate teeth with cotton wool +/- dry tips
  • Work a nurse who'll load microbrush with SDF
  • Apply SDF to the carious lesion only - don't touch soft tissues/gingiva
  • Apply for at least 1 min, ideally 3
  • Remove excess SDF/dry teeth at the end with gauze/cotton wool roll/new microbrush
  • Consider applying FV afterwards to disguise metallic taste
  • Follow up in 2 weeks & reapply if necessary
  • 3-6 month recall according to caries risk
• Silver Diamine Fluoride (SDF) - contraindications:

  • Infection
  • Irreversible pulpitis
  • Caries into pulp
  • Inflamed/ulcerated gingiva
  • Allergy to metals
  • Very poor cooperation

  
• Oral hygiene instruction:

  • Make it relevant
  • Direct it to the appropriate person
  • Tell-show-do
  • Appropriate brush (small head medium-soft brush)
  • Appropriate toothpaste (fluoride concentration and amount)
  • Appropriate technique
  • When (twice a day - especially before bed)
• Oral hygiene instruction - disclosing tablets:

  • Use if the child can spit properly
  • Good visual aid - also has the "yuck" factor
  • Vaseline lips before giving the tablet!
• Diet advice:

  • Make it relevant
  • Age of pt
  • Take into account family life
  • Who do they spend time with
  • Make it achievable
  • Consider use of extra resources
  • savekidsfromsugar.co.uk
  • Sugar Smart app
  • Review the advice you've given
• Fissure sealants:

  • Key to the success of fissure sealants is good MOISTURE CONTROL
  • Cotton wool rolls
  • Dry tips
  • Aspirators
  • Saliva ejectors