there is also a marked difference between the same examiner on different occasions.
The implications need to be considered in relation to the decision to treat or not.
- The slow rate of caries attack. Caries usually progresses relatively slowly, although
some individuals will show more rapid development than others. The majority of
children and adolescents will have a low level of caries and progress of carious
lesions will be slow. In general, the older the child at the time that the caries is first
diagnosed the slower the progression of the lesion. However, a substantial group of
children will have caries that develops rapidly. - The fact that remineralization can arrest and repair enamel caries. It has long been
known that early, smooth surface lesions are reversible. In addition, it is now accepted
that the chief mechanism whereby fluoride reduces caries is by encouraging
remineralization, and that the remineralized early lesion is more resistant to caries
than intact enamel. Although it is difficult to show reversal of lesions on radiographs,
many studies have demonstrated that a substantial proportion of early enamel lesions
do not progress over many years. - The short life of dental restorations. Surveys of dental treatment have often shown
a rather disappointing level of success. In general, 50% of amalgam restorations in
permanent teeth can be expected to fail during the 10 years following placement.
Some studies have shown an even poorer success rate when looking at primary teeth,
and this has been put forward as a reason for not treating these teeth.
8.3.2 Reasons to treat
- Adverse effects of neglect. The fact that the treatment of approximal caries can
cause damage to the affected tooth, the adjacent tooth, the periodontium, and the
occlusion is a valid reason to think twice before putting bur to tooth. But, of course, a
case could equally well be made that the neglect of treatment will cause as much or
more damage. Lack of treatment can, and all too often does, lead to loss of contact
with adjacent and opposing teeth, exposure of the pulp resulting in the development of
periapical infection, and/or loss of the tooth. At worst, the child may end up having a
general anaesthetic for the removal of one or more teeth. A procedure which has a
significant morbidity and mortality. - Unpredictability of the speed of attack. While it is true that the rate of attack is
usually slow, it is quite possible for the rate in any one individual to be rapid so that
any delay in treatment would not then be in the best interests of the child. - Difficulty in assessing if a lesion is arrested or not. Because of the normally slow
rate of attack it is difficult to be sure if a lesion is arrested or merely developing very
slowly. It is true that remineralization will arrest and repair early enamel lesions, but
there is, in fact, little evidence that remineralization of the dentine or the late enamel
lesion is common. - Success when careful treatment is provided. The majority of published studies
show that class II amalgam restorations in primary teeth have a poor life expectancy,
but this is not the experience of the careful dentist. Some of these dentists have
published their results, which show that the great majority of their restorations in