IN PRACTICE PREVENTION Intro – We are presenting on the In Practice Prevention Programme – I.P.P. North Yorkshire & Humber L.D.N.

My - Dentist Hessle Road Colin Langley Havelock Wave 1 543 Dental Centre Alpha NorthAllerton My - Dentist  Hessle Road Colin Langley Havelock Swaby's Dental Practice Bridlington – My -Dentist Jennyfields Alpha Catterick Christopher Ayer  

PREVENTION CARE PATHWAYS Ensures consistent / comprehensive approach Care Pathway Manual Care Pathway Check list Quality Assurance

ENTRY TO I.P.P PROGRAMME Diagnosis of caries at OHA by GDP Referral for GA extraction by GDP.

IPP GA PATHWAY MOSTLY DELIVERED BY THE CDS FOLLOWING REFERRAL BY GDP AND GA PRE ASSESSMENT. OVER 2 APPOINTMENTS GA 3-6 GA 6-16

IPP CARIES PATHWAYS Mostly delivered by GDS Practices Three Appts

Themes cross all Pathways. INTRODUCTION: Why the child is on the IPP Programme What the IPP Programme is What the aims of the IPP Programme are

CARIES RISK ASSESSMENTS/ PLAQUE SCORES Risk status Visual record of caries risk Visual record of oral hygiene Tool for Behaviour change Ask open questions How can you improve?

CARIES RISK ASSESSMENT 3-6

CARIES RISK ASSESSMENT 6-16

PLAQUE SCORES

Caries Risk / Plaque Scores Record Compare Motivate

F.V APPLICATION

F.V. Doses Duraphat® will be prescribed for each individual child by a dentist. The correct dose for children with deciduous teeth (i.e. under 6 years old) is 0.25ml of Duraphat®. For children over 6 the recommended dose is 0.4ml.

Fluoride varnish is quick and easy to apply Fluoride varnish is quick and easy to apply. After cleaning and checking the teeth, they are then dried and the varnish applied using a small brush. Applying varnish should not be uncomfortable.

your child should not be given fluoride drops or tablets for two days Don’t eat/drink for 30 mins • your child should eat soft foods for the rest of the day, which will help the fluoride varnish to stay on the teeth for longer. • you do not brush your child’s teeth tonight, but from tomorrow morning brush them at least twice daily, in the morning and last thing at night.

TOOTHBRUSHING 2 SECTIONS IPP 1 – Brief advice IPP 2 – More advanced TBI and teaching.

BRUSHING IPP1 Ask many times do they brush each day?  Ask how long they  brush for?   Ask what tooth paste they use? Brush twice daily  - once last thing at night  and once more during the day -if possible in the morning Brush for at least 2 mins Brushing should be supervised. Use F toothpaste - at least 1,000ppm and advise 1350-1500ppm.  

Use only a smear - 0-3. Use only a peas sized volume of paste - 3-6 Use a small headed brush Spit don’t rinse.

BRUSHING IPP2 PERSONALISED TBI REFER TO PLAQUE SCORE REFER TO CARIES RISK ASSESSMENT FEEDBACK ON PATIENT’S BRUSH AND PASTE DEMO MODIFIED BASS TECHNIQUE ON MODEL ASK PATIENT TO BRUSH THEIR OWN TEETH AND TIME IT

FEEDBACK CORRECT BRUSH CORRECT PASTE / F CONTENT TECHNIQUE TIME

BRUSH DJ http://www.brushdj.com/

Diet Advice IPP 1 Simple advice Reduce amount and frequency of sugars Avoid sugar containing food and drinks at bed time Use sugar free meds where appropriate

Provide a diet sheet OR suggest photographing all food consumed for three days Ask child to bring in the diet record for IPP2 and also bring in their tooth brush and tooth paste.

IPP 2 / PERSONLISED DIET ADVICE Work through the diet diary / food photographic diary and establish: the number of intakes of food and drinks per day the number of intakes that contain added sugars and how many were consumed between normal mealtimes • whether any intakes containing sugars were taken within one hour of bedtime (when the caries protective effects of saliva are reduced) Ensure meds are sugar free

Describe advised sugar intakes: 3-6 – 19g or 5 teaspoons 6-10 – 24g or 6 teaspoons 10+ - 30 g or 7 teaspoons Demonstrate and Discuss sugar swaps and the sugar app.  

CHANGE 4 LIFE https://www.nhs.uk/sugar-smart/home#top

SUGAR APP

ADDITIONAL F 6-16 P/Ws Enquire whether additional fluoride measures have been prescribed  Ask the child if they have been prescribed any high F M/W or toothpaste?  Where caries is present / orthodontic appliances/ cariogenic meds or diet. Assess Caries Risk Assessments

Use a fluoride mouth rinse daily (0 Use a fluoride mouth rinse daily (0.05% NaF-) at a different time to brushing AND / OR Sodium fluoride 2,800ppm toothpaste Indications: high caries risk patients aged ten years   Sodium fluoride 5,000ppm toothpaste Indications: patients aged 16 years

D.C.P TREATMENT PRESCRIPTIONS

I.P.P P/W – CHECK LIST

PATHWAY MANNUAL PATHWAY SUMMARY INTERVENTION SUMMARY DBOH SUMMARY GUIDANCE GUIDANCE : D.B.O.H S.D.C.E.P

Visit 1   Discuss with parent/child reasons for inclusion in the scheme: IPP is a programme aimed at reducing dental decay Oral Health can be improved by adopting healthy life practices

Caries risk assessment assess baseline Plaque score Perform a: Caries risk assessment assess baseline Plaque score No Plaque visible Plaque visible on the gum margins of anterior teeth Plaque visible on the mid third of anterior teeth

Toothbrushing and toothpaste advice   Questions to ask parent Ask about tooth brushing: How many times each day does the child brush? How long does the child brush for each day? What toothpaste does the child use?

Advice to provide to parent and patient   Parents/carers should supervise brushing (DBOH) Brush at least twice daily, last thing at night and at least one other occasion, with a fluoridated toothpaste (DBOH) As the child is at high risk recommend use of fluoridated toothpaste containing 1,350-1500ppm fluoride (DBOH)

Those children aged 8 years upwards with active caries the dentist should prescribe Fluoride mouthrinse daily (0.05%NaF) for use during an different time to brushing (DBOH) For those aged 10 years plus with active caries the dentist should prescribe 2800ppm Fluoride toothpaste (DBOH) It is good practice to use only a pea sized amount of toothpaste (DBOH

Encourage your child to spit out after brushing and do not rinse, to maintain fluoride concentration levels (DBOH) (try to avoid swallowing) Use a small headed toothbrush (DBOH) Systematically clean all tooth surfaces – demonstrate on model, no method has been shown to be more effective than another one (DBOH) Disclosing tablets can be used to help identify areas that have been missed (DBOH) Don’t allow children to lick or eat toothpaste from the tube (keep out of reach) (DBOH)

Diet advice in line with DBOH Give brief advice on the following: The frequency and amount of sugary food and drinks should be reduced (DBOH) Avoid sugar containing foods and drinks at bedtime (DBOH) Sugar free medicines should be recommended (DBOH) Application of Fluoride Varnish in-line with ChildSmile Guidelines  

Preparation for visit 2:   Distribute diet sheet or alternatively photograph all food and drink that the patient consumes over a 2-3 day period Ask patient to bring in own toothbrush and toothpaste for demonstration next visit

VISIT 2 Advice systematic brushing, cleaning all of the surfaces, demonstrate the Modified Bass technique using the models Patient should have brought own toothbrush and toothpaste and demonstrate to the IPP provider their brushing technique All surfaces / 2 mins

Check to see if GDP has prescribed: Fluoride mouthrinse 0.05% NaF for children aged 8 years and over (DBOH), If the child is aged 10 years or older see whether the GDP has prescribed 2800ppm Fluoride toothpaste (DBOH) .

 Provide personalised diet advice based upon responses from diet sheet/photographs Number of intakes of food per day The number of intakes that contain added sugars and the numbers of times these were consumed between meals, discuss strategies to reduce these to 4 or less

Key messages (DBOH): The frequency and amount of sugary food and drinks should be reduced (DBOH) Avoid sugar containing foods and drinks at bedtime (DBOH) Sugar free medicines should be recommended (DBOH) Briefly describe the eatwell plate

Visit 3 Record a plaque score Advise patient regarding risks of erosion if relevant to diet analysis  Avoid frequent intake of acidic food and drinks (DBOH) Keep acidic drinks to mealtimes and limit the number of fruit drinks (less than one per day) (DBOH)  

Reinforcement of toothbrushing technique and tailored personalised diet advice in-line with messages from DBOH (see visit 2).   Apply fluoride varnish in-line with protocol outlined in ChildSmile (see notes in visit 2).

I.P.P PEER REVIEW 543 Dental Centre Alpha NorthAllerton My - Dentist  Hessle Road Colin Langley Havelock Swaby's Dental Practice Bridlington – My -Dentist Jennyfields Alpha Catterick Christopher Ayer  

IPP Q.A PEER REVIEW / QUALITY AUDIT SYSTEMS PROCESS OUTCOMES

SYSTEMS HOW DOES THE PRACTICE RUN IPP WHAT IS YOUR PRACTICE TARGET FOR IPP DELIVERY HOW MANY IPP PATHWAYS HAVE YOU DELIVERED HOW MANY FTA'S DID IPP GENERATE AS A PERCENTAGE OF TOTAL IPP APPOINTMENTS WHAT IS THE BREAKDOWN OF PATHWAYS FOR CARIES AND FOR GA PATWAYS.

PROCESS Completing 90-100% of the recommendations . Completing 70-90% of the recommendations. Completing <70% of the recommendations. VIDEO ASSESSMENT OF ONE INTERVENTION/MESSAGE R A G

OUTCOMES % SATISFACTION LEVEL OF PATIENT FEEDBACK 70% SCORES 1 AND 2 LESS THAN 50% SCORES 1 AND 2  

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