primary teeth survive without further attention until they exfoliate. The treatment
procedures used are not particularly difficult in comparison to others that dentists
attempt on adults, and it is difficult to avoid the conclusion that the reasons for poor
results in some studies are due to poor patient management and lack of attention to
detail. 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.
- Early treatment is more successful than late. Small restorations are more successful
than large, and therefore if a carious lesion is going to need treatment it is better
treated early rather than late. This was the rationale behind the early suggestions of
Hyatt of a 'prophylactic filling' for pits and fissures and for the modern versions in the
form of fissure sealants and preventive resin restorations. The fact that small
restorations are often more successful makes for difficult decisions when the
management of caries involves preventive procedures, which need both time to work
and time to assess whether they have been effective.
8.3.3 Remove or restore
Once a decision has been made to treat a carious tooth a further decision has to be
made as to whether to remove or restore it. This decision should take into account the
following:
- The child. Each child is an individual and treatment should be planned to provide
the best that is possible for that individual. Too often treatment is given which is the
most convenient for the parent or, more likely, the dentist. Is it really in the best
interest of the child to remove a tooth which could be saved? In the United Kingdom,
general anaesthesia is still widely used for removing the teeth of young children
despite the risks of death, its unpleasantness, and the cost involved.
Key Point
- Treat the child⎯not the convenience of parents or dentist.
- The tooth. It is not usually in a child's interest for a permanent tooth to be removed.
However, if the pulp of a carious permanent tooth is exposed then a considerable
amount of treatment may be required to retain it, and the prognosis for the tooth
would still be poor. It may therefore 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.
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. However, it
is an unusual child who thinks the same way! Loss of a tooth before its time has a
considerable significance in a child's life. Losing a tooth early gives a message to the
child that teeth are not valuable and not worth looking after. It can then be difficult to
persuade a child to care for their teeth. A well-restored primary dentition can be a
source of pride to young children and an encouragement for them to look after the
succeeding teeth.
It is usually more important and fortunately rather easier to save and restore a second
primary molar than a first. While anterior teeth might be less important for the