familiarized with the dental environment and equipment. Starting treatment by
temporizing any open cavities as described above serves as an easy introduction to
operative care.
From that point on, planning to include both a preventive and a restorative component
at each visit allows effective treatment to progress at a reasonable pace. 304HTable 7.5
shows one way of constructing a treatment plan for a typical young child with caries.
It is customary to start with treatment in the upper arch first, as this is usually easier
for both the child and the dentist, although this approach may need to be modified if
there are lower teeth in urgent need of attention. Appropriate use of local analgesia
(305HChapter 5) and rubber dam (306HChapter 8) cannot be overemphasized and any dentist
treating young children needs to be proficient at both. Many preschool children are far
more accepting of carefully delivered local analgesia than most dentists realize. Using
techniques to deliver local analgesia painlessly are crucial (307HChapter 5, 308HSection 5.6)
and care should be taken to avoid overdosage with local analgesics (309HTable 7.6). It is
also important to explain to the child the unusual feelings associated with soft tissue
analgesia, and to warn both the child and parent of the need to avoid lip biting/sucking
whilst these effects persist (310HChapter 5, 311HSection 5.7.3).
Placement of rubber dam using a trough technique, where the clamp is placed on the
tooth first, then the dam is stretched over (as described in 312HChapter 8) is, in the author's
experience, the most straightforward approach in the young child. Careful attention to
obtaining adequate analgesia of the gingival tissues, both buccally and lingually,
ensures comfortable clamp placement. Intrapapillary injections are very useful for this
(313HChapter 5, 314HSection 5.6.3). Encouraging the child to watch in a hand mirror helps to
distract the child's attention from the intraoral manipulations during actual placement
of the dam (315HFig. 7.9).
The techniques employed for definitive restoration in young children should take into
account the often active nature of the disease in this age group. The use of plastic
restorative materials should be limited to occlusal and small approximal lesions.
Extensive caries, teeth with caries affecting more than two surfaces, and teeth
requiring pulpotomy or pulpectomy should be restored with stainless-steel crowns.
Amalgam is still widely used as a restorative material, but materials including newer
glass ionomer cements, resin-modified glass ionomers, polyacid-modified resins
(compomers), and composite resins may be preferred. However, all the latter
mentioned materials are far more sensitive to moisture contamination and technique
than amalgam, so adequate isolation, preferably with rubber dam, is essential. Cermet
restorations perform poorly in primary teeth and are best avoided. A fuller discussion
on material selection for the restoration of primary molars is given in 316HChapter 8.
Composite strip crown restorations are the most effective way of repairing carious
anterior teeth (317HChapter 8).
Key Points
- Plan to carry out treatment at a pace that the child (and you) can cope with.
- Introduce young children to new equipment using a 'tell, show, do' approach.
- Make a comprehensive treatment plan at an early stage.
- Use local analgesia and rubber dam.
- Select restorative material taking into account the high risk of further caries in the