Restorations placed in a mouth in which the caries process is still active are prone to
failure: repeated restorations may be detrimental to the child's ability to co-operate
and the dentist-parent relationship (as well as frustrating to the dental team).
Likewise, managing a child's grossly carious teeth by multiple extractions without
ensuring that he or she receives appropriate preventive input does nothing to assist
that child in maintaining dental health in the future.
An added advantage of a 'prevention first approach' is its importance in behaviour
management, acclimatizing the child to future treatment. Procedures such as fluoride
varnish applications or disclosing are good confidence-building steps.
Key Point
Preventive advice, whether this is in relation to diet, oral hygiene, fluoride
supplementation, or even the prevention of dental trauma, should be realistic and
specifically tailored to the individual child and parent.
Any preventive strategy should be dictated by an individual's risk assessment: for
instance low caries risk children do not routinely require fissure sealants. The delivery
of preventive advice and interventions should not be restricted to the commencement
of treatment. Rather, prevention should be reinforced as treatment progresses,
modifications being incorporated should these become necessary.
Clearly, prevention is not simply a job for the members of the dental team. It
demands the creation of a partnership in which both the child and the parent are key
players, though the relative role and prominence of each will differ with the age of the
child. In the case of young children, parents are (or, at least, should be) responsible
for food choices and oral hygiene, though the latter responsibility is not infrequently
abdicated before the child has sufficient manual dexterity to brush adequately alone.
As the child approaches the teenage years (and particularly when he or she enters
secondary schooling), parental control inevitably decreases. Any discussion of the
proposed treatment plan should, therefore, include an agreement as to what is required
of the child and/or parent as well as what will be offered by various members of the
dental team (including professionals complementary to dentistry). It may be helpful
to document this agreement in the form of a written 'contract'.
3.7.3 Stabilization
Where a child has open cavities, a phase of stabilization should precede the provision
of definitive treatment, whether this is to be entirely restorative in nature or a
combination of restorations and extractions. In this process, no attempt is made to
render the cavities caries free; rather, minimal tissue is removed without local
anaesthesia, allowing placement of an appropriate temporary dressing. The inclusion
of such a phase in a holistic treatment plan reduces the overall bacterial load and
slows caries progression, renders the child less likely to present with pain and sepsis,
and buys time for the implementation of preventive measures and for the child to be
acclimatised to treatment.
However, one word of caution is offered: it is essential that the parent understands the
purpose of stabilization and that what have been provided are not permanent
restorations. Otherwise, it is possible that they will perceive that treatment is failing to