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Personal care plan

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Developing a personal care plan

The accepted sequence for planning and providing care is as follows:

Managing pain, if present
(see Pain or infection)

↓

Caries prevention
(see Caries prevention)

↓

Managing carious lesions (and asymptomatic infection)
(see Management of caries in primary teeth, Management of caries in permanent teeth and Dental techniques)

Although some children may require pain management or caries management, it is imperative that all children receive caries prevention and appropriate behaviour management.

There is wide variation among clinicians when planning care for patients with similar diagnoses and it is unlikely that there will be a single optimal plan for a particular child patient. However, the normal sequence, following management of any pain, is to initiate an effective preventive programme first. Then, if required, a caries management plan can be implemented to manage caries in permanent teeth and to reduce the risk of any caries in the primary dentition causing the child pain or infection.

For children with caries, many factors can influence the choice of management strategy. The optimum strategy will vary and no single approach will suit every clinician, every child or every carious tooth. Furthermore, not all carious lesions in primary teeth require operative management (see Assessing risk of progression) and, because of their limited lifespan, slowing caries progression may be sufficient.

When planning care, the first priority is to keep the permanent molars free from caries, as these teeth are more likely to experience decay than other permanent teeth in a child’s dentition.53 If caries is diagnosed at these sites, then it must be managed appropriately (see Management of caries in permanent teeth). The next priority is to reduce the risk of any caries in the primary dentition resulting in pain or infection before the tooth exfoliates. This can often be achieved without using the standard adult restorative approach, instead selecting an appropriate alternative caries management strategy that reduces the risk of causing treatment-induced anxiety (see Management of caries in primary teeth).

If the child has pain, ensure this is managed first.

  • Try to avoid dental extractions at the child’s first visit if at all possible.

Discuss and explain caries prevention, with the child and parent/carer (see Caries prevention).

Discuss and explain management options for carious lesions with the child and parent/carer, which might differ if there are multiple rather than a single carious lesion (see Management of caries in primary teeth, Management of caries in permanent teeth and Dental techniques).

Plan to carry out any preventive interventions for permanent teeth before treatment of the primary teeth (e.g. fissure seal first permanent molars before restoring primary teeth).

Devise and agree an initial care plan with the child and parent/carer, which includes the expected number, content and duration of appointments, but be prepared to modify this if the child is unable to accept some treatments or there are changes in caries activity.

  • Consider whether the number of visits to the practice can be minimised by combining treatments. 

Having carefully explained the child’s oral health needs and any proposed treatment options, check that the child and/or parent/carer clearly understand the care that they are agreeing to.

Obtain valid consent for the agreed care plan from the child where possible and/or the parent/carer. 

  • It is a legal requirement that when obtaining consent clinicians take reasonable steps to ensure that patients are aware of any material risks involved in the proposed treatment, and reasonable alternative.54 
  • The SDCEP Practice Support Manual provides further details about consent.

If a child is pre-cooperative or unable to cooperate (due to young age, a learning disability, or where behaviour management techniques have been unsuccessful) or has multiple affected teeth, consider referral to assess suitability for treatment under sedation or general anaesthesia (see Referral). 

Consider dividing treatment into several stages, with a month or two between stages, if there are concerns about child or parent/carer compliance.

If required, include in your care plan collaboration with the other professionals (e.g. the child’s health visitor, school nurse, Childsmile dental health support worker, general medical practitioner, social worker) to offer and provide additional home and community support for preventive interventions and to encourage attendance for treatment (see Providing additional support).

Ensure complete and accurate records are kept, including advice given and the rationale for treatment options agreed and any referrals made. 

The use of behavioural management techniques and good clinical judgement to select treatment options will enable most children to complete a planned course of care. However, some children will have difficulty accepting dental treatment in general dental practice even with behavioural management techniques to support them. They may require sedation (for young children this is usually inhalation sedation; for older children inhalation sedation or intravenous sedation) or general anaesthesia. Referral provides further guidance on referral for care, including advice and a flowchart to aid decisions around referral for sedation or general anaesthesia. 

If during treatment a child is unwilling or unable to cope, stop the procedure. Consider alternative behaviour management and/or treatment options and agree these with the child and the parent/carer.

  • If a child resists treatment it is not appropriate to continue even if the parent/carer wishes you to or disagrees.