Please respond to at least 2 of your peer’s posts, from an FNP perspective. To ensure that your responses are substantive, use at least two of these prompts:
- Do you agree with your peers’ assessment?
- Take an opposing view to a peer and present a logical argument supporting an alternate opinion.
- Share your thoughts on how you support their opinion and explain why.
- Present new references that support your opinions.
Please be sure to validate your opinions and ideas with citations and references in APA format. Substantive means that you add something new to the discussion, you aren’t just agreeing. This is also a time to ask questions or offer information surrounding the topic addressed by your peers. Personal experience is appropriate for a substantive discussion and should be correlated to the literature.Be sure to review your APA errors in your reference list, specifically you have capitalization errors in some words of the titles. Also, be sure you are italicizing titles of online sources.
- During a 3-year-old well child exam you note extensive dental caries to the youngsters teeth. What information will you obtain from the parents regarding the caries? You know that children with untreated dental caries are at risk for significant health complications. Using evidence-based standards for oral health, what are your treatment recommendations to address his dental issues?
Information to Obtain from Parents
Questions to ask the parents will include (Burns, Dunn, Brady, Starr, Blosser, & Garzon, 2016): Does your child still drink from a bottle? Does she/he or did she/he nap or lay down with the bottle? What type of fluids are/were used for the child to drink from the bottle? Has the child been seen by a dentist yet? Do you have city or well water? Does the child brush their teeth, and if so how many times per day? Do you assist with dental care at home? Have you noticed any dental issues in the child’s mouth? Has the child complained of mouth pain? Does the child have any other health diagnoses? Are there any other members in the household with dental caries or issues? Does the child share drinks or utensils with other members of the household? Do you have a family/pediatric dentist currently or one that you would like to use?
The standard recommendations for children age birth to five years old for oral health and prevention of oral caries are: (1) the provider should prescribe oral fluoride supplementation if the home water source is fluoride deficient, beginning at age 6 months, and (2) the child should have sodium fluoride varnish applied to all primary teeth for all infants and children beginning at the onset of primary tooth eruption (Burns et al., 2016). Guidelines also recommend that primary clinicians should encourage parents to seek a regular dental provider for their children no later than by 1 year of age, as well as the provider should refer children to a dental professional at primary tooth eruption (Burns et al., 2016). At the age of 3 in the presented case scenario, the child should have all expected 20 primary teeth, which will eventually be replaced by 32 permanent teeth (Burns et al., 2016). An old myth is that dental caries in small children aren’t a big deal because they are “just baby teeth” and they will fall out anyway. I would educate the parents that this is not the case and that the child is at great risk for complications and infection due to the dental caries (Burns, et al, 2016). The parents need to be encouraged to brush the child’s teeth with a soft toothbrush with a sweeter tasting toothpaste in a small smear to the brush about the size of a pea, twice daily (not a long line across the brush), and that it is not an issue if the child does not spit the toothpaste out because it is not harmful. I would also encourage no sweetened drinks for the child or sticky type food or vitamins, as well as instruction of decreasing sugary/carbonated intake. The parents need to understand that tooth decay is a bacterial disease that can cause detrimental results to the child’s dental status and that a dental referral is imperative. I would instruct the parents to attend the dental appointment as scheduled by my office (to ensure the appoint was actually made) and request that they follow up with me in 2-4 weeks, as this case needs to be followed closely.
Burns, C. E., Dunn, A. M., Brady, M. A., Starr, N. B., Blosser, C. G., & Garzon, D. L.
(2016). Pediatric primary care. (6th Ed.). Retrieved from
Dental caries occurs through a complex interaction over time between acidogenic microorganisms and fermentable carbohydrate, and host factors including teeth and saliva Dental caries, if allowed to progress will result in non-cavitated caries lesions initially on tooth surfaces, and eventually can progress to cavity (Maheswari et al., 2015). There are differences in the caries status among different populations. The plausible explanation for such discrepancy can be inequality in economic conditions and resources, effective fluoridation policy, efficiency of healthcare system, availability and consumption of refined sugars, standard of oral health awareness among public, dietary and oral hygiene lifestyles, as well as motivational status of parents and children (Gupta et al., 2015).
Information to Obtain for Dental Caries
The relationship between breastfeeding and early childhood caries is likely to be complex and confounded by many biological variables, such as streptococci, enamel hypoplasia, intake of sugars, as well as social variables, such as parental education and socioeconomic status, which may affect oral health. Information to obtain from the parents regarding the caries on their 3 year old child are the following: data about health and personal history. When was the last dental appointment and ask about if the child needs total assist in doing dental care at home due to poor motor coordination and no cooperation. Ask also about if there is a room for dental hygiene, how many times he brushes or someone brush his teeth, what toothpaste the child is using and if dental hygiene is practice by other siblings on the same room or not. Ask about the feeding practices if the child still in a bottle feed because inappropriate use of baby bottle has a central role in the etiology and severity of early childhood caries. The rationale is the prolonged bedtime use of bottles with sweet content, especially lactose. Parents should be taught to clean a child’s teeth with a small toothbrush as soon as teeth erupt, using the “lift the lip” method. They should check monthly to see if dental problems are beginning, looking closely for the signs of demineralization Information about the tooth decay of the parents or other siblings is important because this will give idea why the child has dental caries. Facts about how frequent is the child expose to fermented carbohydrates like if the child has frequent snacking a day and the diet and food preference. Diet affects the pH, quantity and quality of saliva. Sucrose and other fermentable carbohydrates are broken down by salivary enzymes and lower salivary and plaque biofilm pH. Ask about the vitamins the child is taking and if expose to topical fluoride. Fluoridated toothpaste works by creating a reservoir of fluoride in the fluid layer of the plaque and in the saliva that is available to remineralize or repair teeth that are being damaged by bacterial acids. Also ask also if the child has systemic disorder and if he is taking medications that can cause salivary dysfunction because without adequate saliva, the oral clearance of sugary or acidic foods will be longer (Burns et al., 2017). Lastly ask about if the child is experiencing pain, fever and other discomfort to check if complications occur and for proper referral. By these information, a clinician can come up to the factors why the child developed this caries and will come up to a plan to treat and refer as well as to prevent more dental caries to develop in the future.
Treatment for Dental Caries
Treatment of early childhood caries can be accomplished through different types of intervention, depending on the progression of the disease, the child’s age, as well as the social, behavioral, and medical history of the child. Children at low risk may not need any restorative therapy. Children at moderate risk may require restoration of progressing and cavitated lesions, while white spot and enamel proximal lesions should be treated by preventive techniques and monitored for progression. Children at high risk, however, may require earlier restorative intervention of enamel proximal lesions, as well as intervention of progressing and cavitated lesions to minimize continual caries development. Stainless steel (preformed) crowns are pre-fabricated crown forms which can be adapted to individual primary molars and cemented in place to provide a definitive restoration. They have been indicated for the restoration of primary and permanent teeth with caries, cervical decalcification, and or developmental defects (e.g., hypoplasia, hypocalcification), when failure of other available restorative materials is likely. The current standard of care for treatment of early childhood caries usually necessitates general anesthesia with all of its potential complications because the level of co-operative behavior of babies and pre-school children is less than ideal. Another approach of treating dental caries in young children is Atraumatic Restorative Treatment (ART). The ART is a procedure based on removing carious tooth tissues using hand instruments alone and restoring the cavity with an adhesive restorative material (Colak et al., 2013). When tooth decay is present, subsequent dental visits may involve arresting the decay or more extensive restorative treatment by topically treating the decayed surfaces with 38% diamine silver fluoride. For the prevention and management strategies patient or parents education is very important specifically the use of fluoride varnish, fluoride supplementation in water, correct amount of sugar in the diet, correct way of brushing the teeth and the use of fluoridated toothpaste to prevent more caries to develop (Burns et al., 2017).
Burns, C. E., Dunn, A. M., Brady, M. A., Starr, N. B., Blosser, C. G., Garzon, D. L., & Gaylord, N.M. (2017). Pediatric primary care. Retrieved from https://bookshelf.vitalsource.com
Colak, H., Dulgergil, C., Dalli, M. & Hamidi, M. (2013). Early childhood caries update: A review of causes, diagnosis, and treatments. Retrieved from https://www.ncbi.nlm.nih.gov (Links to an external site.)
Gupta, D., Momin, K., Mathur, A., Srinivas, K., Jain, A., Dommaraju, N. & Gupta, R. (2015). Dental caries and their treatment needs in 3-5 year old preschool children in rural district of India. Retrieved from https://www.ncbi.nlm.nih.gov (Links to an external site.)
Maheswari, U., Raja, J., Kumar, A. & Seelan, R. (2015). Caries management by risk. Retrieved from https://www.ncbi.nlm.nih.gov