progress.
Following stabilization, the child's response to acclimatization and compliance with
the suggested preventive regime should be assessed. This is particularly important
before proceeding with definitive treatment. For example, in a scenario in which a
child has not responded to acclimatization and has either refused stabilization or
accepted this only with extreme difficulty, the dentist may be entirely justified in
considering extractions. This will allow the child and his or her family to enjoy a
period where no active treatment is required and in which prevention can be
established (always provided, of course, they return for continuing care).
3.7.4 Scheduling operative treatment
In any treatment plan, it is necessary to give careful consideration to the order in
which items of operative care are provided. The following are general rules of thumb:
- small, simple restorations should be completed first;
- maxillary teeth should be treated before mandibular ones (since it is usually easier
to administer local anaesthesia in the upper jaw); - posterior teeth should be treated before anteriors (this usually ensures that the
patient returns for treatment); - quadrant dentistry should be practised wherever possible (this reduces the number
of visits to a minimum) but only if the time in chair is not excessive for a very young
patient; - endodontic treatment should follow completion of simple restorative treatment;
- extractions should be the last items of operative care (at this stage, patient co-
operation can more reliably be assured) unless the patient presents with an acute
problem mid-treatment.
3.7.5 Recall
Treatment planning (in its broadest sense) clearly does not end with the completion of
one treatment journey. The determination of a recall schedule tailored to the needs of
the individual child is an essential part of the treatment-planning process.
It is generally accepted that children should receive a dental assessment more
frequently than adults since
- there is evidence that the rate of progression of dental caries can be more rapid in
children than in adults; - the rate of progression of caries and erosive tooth wear is faster in primary than in
permanent teeth; - periodic assessment of orofacial growth and the developing occlusion is required.
In the latter context, there is considerable merit in ensuring that recall examinations
coincide with particular milestones in dental development, for example, around 6, 9,
and 12 years. Generally speaking, recall intervals of no more than 12 months offer the
dentist the opportunity to deliver and reinforce preventive advice during the crucial
period when a child is establishing the basis for their future dental health. However,