Enhanced prevention

Enhanced Prevention for children at increased risk of caries

In addition to Standard Prevention

  • At each recall visit, give hands-on brushing instruction (~3 minutes) to the child and parent/carer.
  • At each recall visit, provide dietary advice as described for standard prevention.
  • Consider providing additional preventive interventions depending on the child’s circumstances, for example:
    • Recommending the use of 1350-1500 ppm fluoride toothpaste for children up to 10 years of age
    • Prescribing 2800 ppm fluoride toothpaste for children aged 10 - 16 years for a limited period. Regular review is required (see diagram for details)
    • Keeping a food and drink diary, which is reviewed in practice and advice offered
    • Keeping a toothbrushing chart to record each time teeth are brushed as a reminder
    • Action planning to encourage change
  • Consider using glass ionomer as a temporary sealant on partially erupted first and second permanent molars until the tooth is fully erupted.
  • Fissure seal palatal pits on upper lateral permanent incisors, and the occlusal and palatal surfaces of Ds, Es, first and second permanent molars, if assessed as likely to be beneficial.
  • If unable to provide fissure sealants (e.g. due to the child being pre co-operative or having a learning disability) then ensure that fluoride varnish application is optimal and attempt again as co-operation improves.
  • Ensure that sodium fluoride varnish is applied 4 times per year to children aged 2 years and over.* Some applications may be provided through Childsmile.
  • Utilise any community/home support for preventive interventions that is available locally (e.g. health visitor, school nurse, Childsmile dental health support worker).

*Many varnishes contain colophony (e.g. Duraphat®). A child who has been hospitalised due to severe asthma or allergy in the last 12 months or who is allergic to sticking plaster may be at risk of an allergic reaction to colophony. In these cases, consider using a colophony-free varnish (licenced for caries prevention in the UK) or suggest the use of alternative age-appropriate fluoride preparations (e.g. fluoride mouthwash or higher concentration fluoride toothpaste).