young child.
- Stainless-steel crowns are the most effective restoration for primary molars with
caries on more than two surfaces.
318H
Fig. 7.9 Encouraging the child to watch
in a hand mirror helps to distract the
child's attention from the intraoral
manipulations during rubber dam
placement.7.8.3 Extraction of teeth
Extraction is indicated for teeth that are unrestorable, and it may also be enforced by
acute pain or infection. In preschool children the extraction of one or two teeth can
often be accomplished under local analgesia⎯inhalation or oral sedation being a
useful adjunct for anxious children. If more extractions are needed, these can
sometimes be carried out at the same time as restoring adjacent teeth. However,
general anaesthesia is the only practical strategy for some children, in which case
referral to an appropriate dental general anaesthesia facility is mandatory.
When planning extractions, it is important to consider the need for balancing (319HChapter
14 ). Factors such as the likelihood of continued future attendance and co-operation of
the child should also be borne in mind. In preschool children with extensive caries,
extraction of first primary molars with maintenance and restoration of the second
primary molars where possible is often a good plan (320HFig. 7.10). Not only does this
limit the risk of further decay by eliminating posterior primary contact areas, but it
also minimizes the deleterious effect of early extraction on the developing dentition.
321H
Fig. 7.10 Extraction of first primary
molars with maintenance and restoration
of the second primary molars.7.8.4 Replacing missing teeth
Where the child is motivated, dentures are suprisingly well tolerated. A simple
removable acrylic denture with gum-fitted primary prosthetic teeth and clasps on the
second molars can effectively restore aesthetics (322HFig. 7.11). Even full dentures can be