(IV) PREVENTIVE DENTISTRY

A. HOME DENTAL CARE (continued)

 The brushing technique should be effective and yet simple.

 Some modifications to the toothbrush to and brushing techniques.
 Tooth brush modifications:
1. custom-design a handle: with an impression to the patient’s hand, or with a balloon
to facilitate the grip of the tooth brush.
2. Electric toothbrushes: advantage: When children get used to the vibration and noise
of the tooth brush: desensitization so patient is less afraid of noises at the clinic
especially if it is followed by positive reinforcement. Also, the color and design is
motivational)
3. Super brush: facilitates brushing both buccal, lingual, and the occlusal surfaces at
the same time
4. Finger brush: in younger and kids who are very difficult to manage
5. Collis Curve brush: curved brush bristles that are very soft. Easy to use and does not
cause any harm to the kid. Cleans B,L and occlusal surfaces
6. Dental Wipes: temporary solution to be used until the tooth brush is available
(travelling patients)
7. Sponge brush: the sponge is placed in the mouth and chewed. Also a temporary
solution
 Auxiliaries:
1. Wrapped tongue blade: used in helping the parents to open the kid’s mouth
2. Mouth prop with/without occlusal guards: fitted in the parent’s finger and placed in the
kid’s mouth in order to help the kids open his mouth.
 Flossing:
1. with supervision
2. use of floss holders

 Brushing techniques:
 Generally, the brushing techniques are the same as healthy adults. However , this is
sometimes difficult for the parents to perform.
 2 minutes – 2 times per day
 Simple technique that can be used: Horizontal scrub technique
o Using a soft tooth brush
o Brush is moved back and forth in horizontal strokes

B. DIET AND NUTRITION

 A proper non-cariogenic diet is essential.

 Diet survey identifies the allowances made for certain conditions for which dietary
modifications are required.
For example:
1. conditions associated with difficulty in swallowing, such as severe cerebral
palsy, may require that the patient be on a pureed diet.
2. Patients with diabetes have diets that restrict specific foods or total caloric
consumption.
  Dietary recommendations should be:
o made individually
o consultation with the patient’s primary physician or dietitian.
 The oral side effects of their medications should be reviewed with the parents or guardians
at each visit to identify specific concerns.
 For example: increased caries or gingival overgrowth.
 Discontinuation of the nursing bottle by 12 months of age
 Cessation of at-will breast-feeding after teeth begin to erupt to decrease the likelihood of
early childhood caries.

C. Fluoride Exposure:
 Use of systemic fluoride is important.
 An analysis to determine the level is indicated.
 Regardless of the systemic intake, topical fluoride should be applied after a regularly
scheduled professional prophylaxis.
 5% neutral sodium fluoride varnishes have been shown to be beneficial.
 An American Dental Association–accepted dentifrice containing a therapeutic fluoride
compound should also be used daily.

D. PREVENTIVE RESTORATIONS

Pit and fissure sealants and preventive resin restorations: reduce occlusal caries effectively.
 For a patient who requires dental work under general anesthesia: restored with amalgam
or long-wearing composites to prevent further breakdown and decay.
 Patients with severe bruxism and interproximal decay: restored with stainless steel crowns
to increase the longevity of the restorations.

E. REGULAR PROFESSIONAL SUPERVISION

Regular follow-up visits are important.

Although most patients are seen semi-annually:

 professional prophylaxis
 examination
 topical fluoride application

Certain patients (those institutionalized) require recall examinations every 2, 3, or 4 months.

(V) MANAGEMENT OF A CHILD WITH SPECIAL HEALTH CARE NEEDS

DURING DENTAL TREATMENT:
The principles of behavior management are even more important in treating a child with SHCN.

Child is often apprehensive due to hospital visits or previous appointments with a physician.
Additional time must be spent with the parent and the child to establish rapport and relief the
child’s anxiety.
If patient cooperation cannot be obtained: the dentist must consider alternatives

 protective stabilization
 conscious sedation
 general anesthesia

A. PROTECTIVE STABILIZATION/CLINICAL HOLDING

Certain neuromuscular disorders: need to diagnose and treat, as well as to protect the safety of the
patient, parent, staff and practitioner, may justify the use of stabilization. (AAPD)

This decision depends on:

 patient’s emotional development

 physical and medical conditions (e.g. asthma compromised respiratory function)
 dental needs,
 other alternative behavioral modalities
 quality of dental care.

Use of behavioral management or sedation can reduce the amount of stabilization required.

Stabilization can be performed by the dentist, staff, or parent, with or without the aid of a
stabilization device. (by lightly restraining the patient’s hand)

Parental consent:

Consent: must be documented, before protective stabilization is used.

 clear understanding of the type of stabilization to be used

 the rationale
 the duration of use.

Types of restraints used:

 Mouth: to help open the child’s mouth

1. Wrapped tongue blades
2. Disposable mouth prop
3. Molt mouth prop (metallic device)
4. McKesson bite blocks
 Body:
1. Papoose Board
2. Pedi-Wrap
3. Triangular sheet with leg straps
4. Cushions to give support: spina bifida patients
5. Beanbag dental chair insert
 Head:
1. Head positioner
2. Proper positioning of the dentist’s hands, forearm, and body
3. Papoose Board head positioner

 Extremities:
 1. Towel and tape on forearm
2. Posey strap
 Wheelchair tilter to accommodate the patient’s own wheelchair for dental treatment.

 Protective stabilization should not:

o be used as punishment
o be used solely for the convenience of the staff.

 The patient’s record should display:

o an informed consent
o the indications for use
o the type of stabilization used
o the duration of application.

 The tightness and duration of stabilization must be monitored and reassessed at regular
intervals.

 Stabilization around the extremities or chest must not actively restrict circulation or
respiration.

 Stabilization should be terminated as soon as possible in a patient who is experiencing

severe stress or hysterics to prevent possible physical or psychological trauma.

Indications:
• A patient who requires immediate diagnosis and/or limited treatment and cannot cooperate
because of lack of maturity, mental or physical disability.

• A patient who requires diagnosis or treatment and does not cooperate after other behavior
management techniques have failed and for whom pharmacological management is contra-
indicated.

• The safety of the patient, staff, parent or practitioner would be at risk without the use of
protective stabilization.

Contraindications:
• A cooperative non-sedated patient.

• Patients who cannot be safely stabilized due to medical or physical conditions.

• Patients who have experienced previous physical or psychological trauma from protective
stabilization (unless no other alternatives are available).

 Fearful child.

• Non-sedated patients with non-emergency treatment requiring lengthy appointments.