400H
Fig. 8.29 Root canal filling in an upper
primary central incisor.8.9 TREATMENT OF A CHILD WITH HIGH CARIES RATE
It is absolutely true that restoration of children's teeth without adequate prevention is
like replacing windows in a burning house. When presented with a child with a high
caries rate, establishing a good preventive regime should be the first and foremost
item in the treatment plan. However, it would be a folly to think that prevention alone
will maintain the child in a pain free state. Restorative treatment or extraction of
decayed teeth that are not suitable for restoration should be planned alongside
securing good prevention. Therefore, when dealing with a high caries risk child, a
comprehensive visit by visit treatment plan that deals with the preventive and
restorative care of the child should be established.
The type of treatment instituted for patients with rampant caries depends on the
patients' and parents' motivation towards dental treatment, the extent of decay, and
the age and co-operation of the child. Initial treatment, including temporary
restorations, diet assessment, oral hygiene instruction, and home and professional
fluoride treatments, should be performed before any comprehensive restorative
programme commences. However, in patients presenting with acute and severe signs
and symptoms of gross caries, pain, abscess, sinus, or facial swelling, immediate
treatment is indicated. This may involve extractions and even a general anaesthetic in
a young child. It is wiser to extract all the teeth with a dubious prognosis under one
general anaesthetic rather than have an acclimatization programme interrupted by a
painful episode in the future.
401HTable 8.4 summarizes the preventive regimens that should be employed for rampant
caries in different age groups.