Guideline 47: Preventing Dental Caries in Children at High Caries Risk

Preventing Dental Caries in Children at High Caries Risk
Summary of recommendations

Primary prevention of dental caries

Keeping children's teeth healthy before disease occurs

An explicit caries risk assessment should be made for each child presenting for dental care.

The following factors should be considered when assessing caries risk:

clinical evidence of previous disease
dietary habits, especially frequency of sugary food and drink consumption
social history, especially socio-economic status
use of fluoride
plaque control
saliva
medical history

Behaviour modification in high caries risk children

Dental health education advice should be provided to individual patients at the chairside as this intervention has been shown to be beneficial.

Children should brush their teeth twice a day using toothpaste containing at least 1000 ppm fluoride, they should spit the toothpaste out and should not rinse out with water.

The need to restrict sugary food and drink consumption to meal times only should be emphasised.

Dietary advice to patients should encourage the use of non-sugar sweeteners, in particular xylitol, in food and drink.

Patients should be encouraged to use sugar-free chewing gum, particularly containing xylitol, when this is acceptable.

Clinicians should prescribe sugar-free medicines whenever possible and should recommend the use of sugar-free forms of non-prescription medicines.

Tooth protection in children at high caries risk

Sealants should be applied and maintained in the tooth pits / fissures of high caries-risk children.

The condition of sealants should be reviewed at each check-up.

Glass ionomer sealants should only be used when resin sealants are unsuitable.

Fluoride tablets (1 mg F daily) for daily sucking should be considered for children at high risk of decay.

A fluoride varnish (e.g. Duraphat) may be applied every four to six months to the teeth of high caries risk children.

Chlorhexidine varnish should be considered as an option for preventing caries.

Secondary and tertiary prevention of dental caries

2° Limiting the impact of caries at an early stage

3° Rehabilitation of the decayed teeth with further preventive care

Diagnosis of dental caries

Bitewing radiographs are recommended as an essential adjunct to a patient's first clinical examination

The frequency of further radiographic examination should be determined by an assessment of the patient's caries risk.

Management of carous lesions

Occlusal caries

If only part of the fissure system is involved in small to moderate dentine lesions with limited extension, the treatment of choice is a composite sealant restoration.

If caries extends clinically into dentine, then carious dentine should be removed and the tooth restored.

Dental amalgam is an effective filling material which remains the treatment of choice in many clinical situations. There is no evidence that amalgam restorations are hazardous to the general health.

Approximal caries

Preventive care, e.g. topical fluoride varnish, rather than operative care is recommended when approximal caries is confined (radiographically or visually) to enamel.

In an approximal lesion requiring restoration, a conventional Class II restoration should be placed in preference to a tunnel preparation.

Re-restoration

The diagnosis of secondary caries is extremely difficult and clear evidence of involvement of active disease should be ascertained before replacing a restoration.