3BDS: Paedriatics 5

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what is diet and what is nutrition?
Diet is the selection of food drinks etc.
Nutrition is the intake of nutrients
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what causes local environmental changes with respect to pH, nutrient substrate for micro-organisms, saliva, pedicle composition
diet
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How often can we eat sugary stuff?
caries risk to be significant if consumed more than 4 times daily.
WHO recommend free sugars no more than four times a day
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How much sugary stuff can we eat?
“There is evidence of moderate quality to show that dental caries is lower when free-sugars intake is < 10%” total energy intake
 “There may be benefit in limiting sugars to < 5% E to minimize the risk of dental caries throughout the life course”
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3 key requirements for affecting change in health related behaviour:
1. knowledge what to do
2. skills (how to do it)
3. attitude (the motivation to do it)
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how and when to guide the change
when: If the child or parent/carer is lacking motivation to change;
how:Provide encouragement using verbal persuasion
 Identify barriers to change and try to resolve them
 Provide instruction which actively involves the parent/ carer and child (food and
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what should we be telling people
- Restrict food and drink containing sugar to no more than four occasions in any one day
-Snack on sugar free snacks - be wary of other health concerns when recommending this – cheese is high in fat
-Do not eat or drink after brushing at night
Be aware of
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what is high/medium/low sugar content
high=more than 15g per 100g of food
medium=5g and 15g per 100g of food
low=5g or less per 100g of food
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back to nutrition: what are some general health considerations
Base meals on starchy foods
 Eat lots of fruit and vegetables
 Eat more fish
 Cut down on saturated fat and sugar
 Eat less salt
 Drink plenty of water
 Support and promote breast feeding
 Infants should be exclusively breast fed for the first 6 mo
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what does WHO recommend in both adits and children ?
reducing the intake of free sugars to less than 10% of total energy intake
Suggests a further reduction of the intake of free sugars to below 5% of total energy intake
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why is fluoride good?
Inhibits demineralization, slowing decay
 Makes enamel more resistant to erosion
 In high concentrations, can inhibit bacterial metabolism/ enzyme activity
 Fluoride is currently recognized as the major factor that is responsible for the reduction in c
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when does demineralisation occur?
when there is an imbalance between mineral loss and gain
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how does fluoride work?
controls caries lesion development primarily topically by effect on de- and remineralization processes
 takes place at the interface between tooth surface and oral fluid
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why does the solubility of apatite increases 10 times with a decrease of 1pH unit
because H+ combines with PO43- and OH- to form H2PO43- and H2O
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what is the consequences of
' H+ combines with PO43- and OH- to form H2PO43- and H2O'
the concentrations of free PO43- & OH- are reduced thus turning the solution under saturated with respect to enamel, promoting enamel dissolution
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how can avoid the following ' H+ combines with PO43- and OH- to form H2PO43- and H2O'
Avoidable by increasing the concentrations of Ca2+ and/or PO43- in the fluid
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the rate of demineralization which this takes place is directly proportional...
to the mineral saturation of the surrounding saliva
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what happens to the pH whenWhen bacteria metabolize sugars & saliva/biofilm
decreases
<4.5<pH<5.5
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what would happen to Hap if saliva & biofilm become under saturated with respect to it
HAp dissolves from subsurface
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what would happen to Hap if saliva & biofilm are still supersaturated with respect to PHAp
FHAp forms in surface layers
This makes the tooth more resistant to subsequent demineralization
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what is the primary mineral in saliva
hydroxy- apatite
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what is the pH for dissolution of HA and FA
HA: 5.5
FA: 4.5
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What is the direct mode of action of fluoride when inhibiting bacteria
Interacts with enzyme enolase to reduce acid production
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What is the indirect mode of action of fluoride when inhibiting bacteria
Limits phosphoenolpyruvate, inhibiting decreasing the amount of sugar entering the cell.\enters the cell as hydrofluoric acid, reducing cellular PH
Overall effect is reducing acidic environment
Mutans streptococcus is sensitive to fluoride - inhibitory ef
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types of fluoride delivery
Toothpastes  Mouth rinses  Varnishes
 Gels
 Tablets
 Water
 Milk
 Salt
 Slow release glass beads
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what is a common fluoride varnish
Duraphat
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how much fluoride in fluoride varnish
22,600 PPM fluoride (2.26%)
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how much would 1ml of varnish contain if there's 22,600 PPM fluoride 2.26%
1 ml of varnish (equivalent to 1 gram equivalent to 1000mg) will contain 22600 divided by 1000= 22.6mg Fl
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when is fluoride varnish contra indicated
asthma, allergies to colophony/Elastoplast, patients with ulcerative gingivitis/stomatitis
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what does SDCEP guidelines say about fluoride varnish application
a) for all patients
a: Apply 5% sodium fluoride varnish twice a year for all children over 2 years of age
 It is acceptable for a child to have it four times a year if they are getting the applications from Childsmile
 Do not apply to teeth if patient has had it applied in
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what does SDCEP guidelines say about fluoride varnish application b) for high risk patients
Apply 5% sodium fluoride varnish an additional 1-2 times per year
 Importantly, the maximum is still only four times a year. Always confirm whether the patient has received fluoride varnish from another source (Childsmile etc.)
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what is important to confirm before applying the fluoride varnish?
Always confirm that the patient has not recently had varnish applied recently from another venue
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how much fluoride varnish should be used for patients
a) aged 2-5
b) 6+
a)0.25ml
b)0.4ml
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what happens if you ingest too much fluoride
Nausea and vomiting associated with the ingestion of topical fluorides
 Dental fluorosis (an aesthetic concern) while tooth enamel is developing until about age 6, due to daily ingestion of topical fluoride, such as from toothpaste or from prescription h
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what is considered a 'toxic dose'
considered to be 5mg/kg body weight
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what is the clinical course of systemic toxicity
Abdominal pain (GI sign and symptoms)
 Abnormal taste (salty or
soapy taste)
 Convulsions
 Diarrhoea
 Drooling
 Eye irritation if placed in eye
 Headache
Heart attack
 Irregular heartbeat  Nausea
 Shallow breathing  Slow heartbeat
 Tremors
 Vo
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what do you do in acute overdose?
Minimize absorption by giving a calcium containing solution (e.g. milk) - prevents absorption
 Find out how old the child is (or what they weigh)
 Find out how much has been eaten
 Transfer to A&E for a full assessment, monitoring and managing plasma c
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Enamel fluorosis and primary dentine fluorosis occur as a result of ..
excess fluoride ingestion and only while teeth are forming
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children and young people up to the age of 18 years who are at standard risk of developing dental caries should be advised to use toothpastes in the range ...
1000-1500 ppmF”
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children aged from 10- 16 years who are at increased risk of developing dental caries should be advised to use toothpastes at a concentration of...
2800 ppmF”
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Under 3 years of age, should use a small smear of toothpaste
containing not less than
1000 ppmF
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What conc of fluoride should 7+ should use?
1350-1500 ppmF
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what should you advice, prescribe for high risk patients
for over 3, over 16, over 7s
Advice and hands on brushing instruction at every visit
 1350-1500 ppmF for patients over 3 years old
 Prescribing 2800 ppmF for patients over ten years old
 5000ppmF for patients over 16
 strategic use of Fluoride mouthwashes for over 7s, especially
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any lesion, at any stage of tissue destruction, non-cavitated or cavitated, can become arrested. This statement is true irrespective of the age of the patient”
true or false
true
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Card 2

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what causes local environmental changes with respect to pH, nutrient substrate for micro-organisms, saliva, pedicle composition

Back

diet

Card 3

Front

How often can we eat sugary stuff?

Back

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Card 4

Front

How much sugary stuff can we eat?

Back

Preview of the front of card 4

Card 5

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3 key requirements for affecting change in health related behaviour:

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