Paul Ashley

Paul Ashley

Paediatric Dentist working at the UCL Eastman

Location London, UK


  • Depends on cooperation

  • I also get triggered when parents ask children to be 'brave'. If I'm doing my job properly they won't need to be

  • Nice example Jenny

  • Definitely important to be reading subtle signs/body language etc. It's a shame that these sorts of measurements aren't more reliable.

  • 0.4mm is usually recommended

  • You don't want to go into the pulp. So if the patient has symptoms of reversible pulpitis then stop before you go into the pulp

  • Fixed the link - thanks for spotting that

  • yes

  • You'd always want to restore if you can to try and make the biofilm easier to access. But in very young children sometimes that is impossible. In those cases you may adopt an interim strategy of prevention eg SDF until they are cooperative now for restorations

  • Evidence suggests that if BWs confirm caries has not progressed significantly into dentine then a sealant is OK

  • With experience but also understanding that radiographs are an imperfect tool so you won't always get it right

  • Use a fast hand piece to cut a vertical line along the buccal surface of the crown from the gingival margin up to the occlusal plane. Then you can usually use an excavator to pry it off

  • I don’t think there is an upper limit. In fact some people believe it has benefit for elderly patients who may not be able to access care@EstherAdeyemi

  • You managed this nicely. Yes - it is stressful!

  • Thank-you for this. I think this sort of insight from the wider team is invaluable and it shows that behaviour management starts the minute the child walks into the building, not just when they sit on the dental chair

  • Good question. I think if you're sure the PDL is totally dead then I don't see why not.

  • I wouldn't stress too much about the type of milk. Tho' I guess there are so many milk alternatives nowadays that it could get confusing. You want to use something that will protect the periodontal ligament cells. Any milk will probably be OK. Or saline I guess. Or water at a push.

  • @NicolaJames So what you can do is cover it over with a filling material? But the stain is pretty much part of the surface of the caries. So aside from covering it, or physically removing it, not much to be done.

  • Agree re your approach - always best to start off with something easy. Yes - sometimes we push extractions to the end, but by doing it sooner in the plan you eliminate that cause of pain

  • Yes! But you need to be sure the sibling understands their role as well. They could make it more difficult for you!

  • We use it all the time instead of MTA - mostly for obturating non-vital immature incisor teeth. I guess we might also use it if you were doing a partial or coronal pulpotomy in the case of incisal fracture as well. The obvious advantage is that it's much less likely to stain. We haven't really talked about it on this course as the emphasis here is emergency...

  • Yes and in a way the promoting positive attitude is the most important bit. We need to train them to be good adult patients!

  • Thank-you Mariam. We've certainly found using Futurelearn a little bit different to the more conventional methods of delivering online teaching that we use for our Blended MSc

  • Yes it really does - this is a great resource that I don't think is used enough

  • Yes - I think the key thing for me is being a bit gloomy about the whole thing. Need to manage expectations

  • Thanks Wendy - I'd thought I'd updated the link but will check now

  • I think we need better dental materials

  • Yep

  • And re sugar amount vs frequency - the trend is to take a whole plate approach now. Think of overall health eg diabetes, obesity etc. So preferred messages are around overall amount.

  • It's tricky one and I'm not sure there are easy answers. Some colleagues take the approach of saying - that's fine but it means you need to eliminate refined sugar from the diet. But it's difficult.

  • Agreed - start with resin based. If that fails - then use GIC

  • So you can use SDF on the NHS?

  • And the problem is they don't come in that often, and when they do you have to get it right. The IADT guidelines are useful to refer to in these situations

  • I think that's a valid point. We use ceiling projectors sometimes

  • Like it - I think that might work well in IS as well, I sometimes get them to do some simple motions with their legs then let them go loose and floppy as a way of getting them relaxed

  • It really is. Particularly in cases of intrusion where sometimes parents really want you to do something

  • Hello everyone - I hope this is useful for you

  • Nice to meet you all

  • Hi Anna - from experience I would say don't rush into making any decisions!

  • Yes - let us know if there are any other specific resources that could be helpful.

  • Yep - that is the chief risk. Not a lot you can do about that, when consenting I usually point out that it's black discolouration or extraction

  • Hello Shaima!

  • @InaSpector Yes - you don't want to lose the tooth up the suction. Embarrassing! re clots - sometimes you need to wash these out with saline

  • Immunisation is a good question which I think I will add. It can give other clues as well regarding the families attitudes to health and evidence based medicine

  • So first, you need to work out when to be open about what you're doing. I'm comfortable with hiding the injection with small children. But once they get past 7-8 you can get yourself in a mess as they might figure out what is going on. And then you lose trust and it's a disaster.
    If you are going for concealment, you need to have good teamwork with your...

  • Good idea - sometimes we have to ask families the same things in different ways to get the answer

  • I think this is a very good point and I don't have an answer. I am sure our service must have made some children more phobic because we were forced to do difficult extractions under LA mid-pandemic

  • Happens to all of us

  • Some very nice insights Leigh. Thank-you

  • I agree as well. I'm not sure there is a good answer to this

  • Using a technique like STA or the Wand is helpful. Until the kids figure out it's a needle just a different shape?

  • The Wand is great - but I think it's perfectly possible to deliver pain free local anaesthesia with standard techniques

  • Agree - if it's GA why not do some caries removal before crown placement.

  • This plan looks very sensible to me. I would of thought 6 month SDF should be enough? @EmmaClarke

  • So if they are going to exfoliate within a year or two, sure - why bother. But if it's going to be a few years 'til they exfoliate? We should do what we can to keep them.

  • So I base my teaching off this

    Pitts, N., Duckworth, R., Marsh, P. et al. Post-brushing rinsing for the control of dental caries: exploration of the available evidence to establish what advice we should give our patients. Br Dent J 212, 315–320 (2012).


  • That is a very difficult situation. I'm not sure the dentures will help to maintain bone however.

  • It's tricky and the important part is lowering patient expectations. Both upper incisors are likely to become ankylosed and this child is pre-growth spurt. If they are ankylosed then when they start to grow the teeth are likely to become infra-occluded which is an unmanageable situation.

  • I think it should definitely be considered

  • The best thing is always to put the tooth back in ASAP. So if you can help that happen, you should

  • Interesting point and something I used to recommend. I think the new guidance emphasises getting the tooth back in the socket because there maybe a remote chance of revascularisation

  • Yep - watch and wait for intrusion.

  • If it gets the F paste in the mouth twice a day then it will definitely help

  • I think we would stick to using it with primary teeth with active caries that look pretty grotty already.

  • Good question. I'm not sure I know the answer.

  • I totally agree that optimum use is at another time. But if that is not possible there is some limited evidence to show that using after brushing is still worth it.

  • Interesting point. In the UK it's acceptable to give a young child 1450 if they are at caries risk. So I guess I wouldn't worry too much about it?

  • Toddlers are going to swallow toothpaste whatever you do. Probably better to limit the amount on the brush.

  • I don't disagree with you Shaun. But our ethos is to teach from the evidence. And that points to fluoride availability, not biofilm disruption. Evidence for biofilm removal on its own to prevent caries is poor.

    The light bulb moment for me was a young child who refused to let her mother clean her teeth properly. The mother couldn't see the point of the...

  • Oranurse is the main one we recommend

  • Diet is always critical. But. How good are we at driving change in diet?

  • Done

  • GIC? I think it needs to be RMGIC.

  • Re IV - no we are the same, 12 and up. Tho' we are currently planning to go down to 8 or 10. I mentioned IV because there are some countries where it will be used in young children.

  • Agree - but it needs to be RMGIC as the physical properties are better

  • I don't think it's that straightforward and I don't think we're quite ready to say we shouldn't intervene at all. But I agree that RMGIC does seem to be a good all rounder.