Lecture Notes: Prevention and Management of Dental Caries in Children

Overview

• Program Accreditation: NICE accredited the process for 5 years from March 2016.
• Publisher: Scottish Dental Clinical Effectiveness Programme (SDCEP), within NHS Education for Scotland.
• Reproduction: Allowed for non-commercial educational purposes within NHS Scotland.

Key Recommendations

• Oral Health Promotion: Personalised advice for all children.
• Toothbrushing: Encouragement to brush teeth twice daily using fluoride toothpaste.
• Dietary Advice: Guidance on a healthy diet to prevent caries.
• Fissure Sealants: Application on permanent molars early after eruption.
• Fluoride Varnish: Application twice a year for children aged 2+.

Introduction

• Dental caries is highly prevalent worldwide; significant improvements seen in Scotland.
• Untreated dental caries impacts quality of life and school performance.
• SDCEP guidance aims at individual child-focused clinical interventions.

Overarching Principles

• Goals:
  • Prevent disease in both primary and permanent dentition.
  • Reduce risk of pain/infection and dental anxiety.
  • Foster a positive attitude towards oral health.

Assessing the Child and Family

• Rapport: Establishing good communication with the child and parent/carer is crucial.
• Assessment: Motivation and ability of the parent/carer to maintain child’s oral health.
• Clinical Assessment: Includes checking for caries, pain, and infection.

Caries Risk Assessment

• Factors include previous caries experience, dietary habits, and social history.
• Regular review of caries risk assessment is essential.

Managing Dental Care

• Behavioral Management: Techniques to promote a positive dental attitude.
• Anxiety Management: Tools to reduce dental anxiety in children.

Caries Prevention

• Standard Prevention: Regular brushing with appropriate fluoride toothpaste.
• Enhanced Prevention: Additional measures for children at higher risk.
• Professional Interventions: Fissure sealants and fluoride varnish applications.

Management of Dental Caries

• Primary Teeth:
  • Least invasive strategies preferred.
  • Consider time to exfoliation, lesion extent, and risk of pain/infection.
  • Techniques include selective caries removal and Hall Technique.
• Permanent Teeth:
  • Emphasize preservation of tooth structure.
  • Use selective or stepwise caries removal for management.

Techniques for Caries Management

• Selective Caries Removal: Minimal removal to allow for restoration.
• Hall Technique: Sealing over caries with preformed metal crowns.
• Use of Fissure Sealants: Not removing caries, but sealing it.

Referral and Additional Support

• Referral: To appropriate services if care cannot be provided locally.
• Child Protection: Procedures in place for concerns over child neglect or abuse.
• GIRFEC: Scottish approach for child wellbeing, focusing on early action.

Quality Improvement and Research

• Areas for improvement include accuracy of records and effectiveness of caries management strategies.
• Continued research is required in various aspects of caries prevention and management.

Conclusion

• The guidance provides a systematic approach for dental professionals to manage and prevent caries in children.
• Collaboration among health professionals is essential to improve oral health outcomes.