In general, the older the child at the time that the caries is first diagnosed, the slower the progression of the lesion. They are certainly the preferred treatment option for primary molars with anything other than minimal caries. Is it really in the best interest of the child to remove a tooth which could be saved? Good-quality restorative care (Fig. http://www.oralhealthplatform.eu/our-work/the-state-of-oral-health-in-europe/ Such an approach can be justified where it is likely that remineralization would occur or the tooth would be maintained in a state free from pain or infection until exfoliation. It is easier for both child and dentist to restore teeth at an early stage of decay. Therefore it may be in the child’s long-term interest to lose it and to allow another tooth to take its place, either by natural drift or with orthodontic assistance. Therefore local analgesia is mandatory, and is easily performed these days with topical analgesia, fine-gauge needles, and short-acting local analgesic agents. Because of the normal slow rate of attack it is difficult to be sure if a lesion is arrested or merely developing very slowly. The risk for an adjacent tooth has been demonstrated in the literature. The decayed part of the tooth is removed and replaced by filling containing dental adhesives, such as silver amalgam. DOI:10.1002/14651858.CD002281.PUB3 Therefore it is essential for all dentists involved in the care of young children to learn restorative techniques that give the best results in primary teeth, and this should always be alongside excellent preventive programmes. where teeth have been restored or extracted) is decreasing rather than increasing, suggesting that the opposite is true. It is not usually in a child’s interest for a permanent tooth to be removed. Treatment planning includes consideration of: • the motivation of the child and parent, and their likely compliance with the preventive plan suggested; • the extent of decay and the surfaces involved; • the age of the patient and time that teeth are expected to survive until exfoliation; • any symptoms associated with the decay; • the health of the underlying dental pulp. The D1355 procedure is a Primary teeth are often considered by parents and some dentists as being disposable items because there comes a time when they will be exfoliated naturally. Recommendation:The panel was unable to make a recom- mendation on superiority of any particular type of vital pulp therapy owing to lack of studies directly comparing these interventions. Destruction of the marginal ridge of a primary molar by caries indicates probable pulpal involvement. Because the entire crown of the tooth is covered, the stainless steel crown rarely needs to be replaced owing to recurrent caries or new caries at a site distant to the original filling. The longevity of composite material appears to be similar to that of RMGIC or compomer for occlusal and small proximal restorations in primary teeth. Even when coarse criteria such as those developed for the UK Child Dental Health Surveys are used, there is variation between examiners. They are sensitive to variations in technique and take longer to place than equivalent amalgam restorations. • Early lesions that remineralize are less susceptible to caries. Professionally, there are four main ways to deal with dental caries. No.:CD00282. Partial, i.e. However, this can allow the teeth to erupt into contact again or the interocclusal position to change and alter the occlusion. As discussed in earlier chapters, there are a number of different techniques and philosophies in treating dental caries. This chapter is devoted to the discussion of such techniques. Subsequent visits will invariably start with a simple visit using local anaesthetic (e.g. However, a substantial group of children will have caries that develops rapidly. 4. Treatments, Signs, and Symptoms. Table 8.1 Five-point treatment philosophy for the provision of high-quality dental care for children. Where caries is more extensive or involves more than two surfaces a stainless steel crown should be the default material for posterior primary molars. The importance of the history and examination cannot be underestimated. The Oral-B iO features the latest in oral care technology to effectively, yet gently, clean all areas of the mouth including tooth surfaces. The presence of pain may change the order and priority of treatment visits, but wherever possible an extraction should be avoided as a first experience of operative dentistry. Dental caries, which is also referred to as tooth decay or cavities, is one of the most common and widespread persistent diseases today and is also one of the most preventable. Art. It should be the aim of the profession to develop better and more effective ways of treating the disease, rather than throwing our hands up in surrender and expressing frustration just because so many restorations for primary teeth are placed without adherence to good principles of restorative dentistry. between BWs can be increased to 24 months or even longer. Hence there is a need to consider operative treatment to prevent the breakdown of the dentition. Finally, in each visit one or more items of preventive advice should be focused on. This can then need hospital admission and invasive treatment, sometimes under general anaesthesia, whereas a simple restoration, at the time when the caries was diagnosed, would have prevented this extremely distressing episode for the child. 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