the exact recall interval (3, 6, 9, or 12 months) should be tailored to meet, and vary
with the child's needs. This requires an assessment of disease levels as well as risk
of/from dental disease.
3.7.6 Treatment planning for general anaesthesia
Treatment planning for general anaesthesia is an extremely complex area that merits
special mention. However, a full discussion lies outside the scope of the current
chapter. It is sufficient to emphasize here that, in this context, a comprehensive
approach must be taken. Providing treatment under general anaesthesia for a child
who has been shown to be unable to cope with operative dental care under local
anaesthesia (with or without the support of conscious sedation) will do absolutely
nothing to improve his or her future co-operation. Such treatment should, therefore,
include the restoration or extraction (as appropriate) of ALL carious teeth.
Key Point
The practice of extracting only the most grossly carious or symptomatic teeth (and
assuming that other carious teeth can be restored under local anaesthetic at a later
stage) predisposes to a high rate of repeat general anaesthesia and should be
discouraged.
The orthodontic implications of any proposed treatment should always be considered.
This is particularly so when the loss of one or more permanent units is to be included
in the treatment plan. In such cases, the latter should ideally be drawn up in
consultation with a specialist in orthodontics.
Treatment under general anaesthesia, irrespective of whether this includes restorative
treatment or is limited to extractions, should be followed with an appropriate
preventive programme. Failure to provide this almost inevitably leads to the child
undergoing further treatment (usually extractions) under general anaesthesia.
3.7.7 Treatment planning for complex cases
The clinician should always have a clear long-term 'vision' for the management of the
individual patient. In creating this, appropriate specialist input to treatment planning
should be sought where indicated. At the simplest level, an orthodontic opinion
should be obtained before committing a child to multiple visits to restore first
permanent molars of poor prognosis. However, it is in the treatment planning of
complex cases (such as those presenting with generalized defects of enamel or dentine
formation, hypodontia, or clefts of lip and palate) that interdisciplinary specialist input
is essential. For example, such input may result in
- the retention of anterior roots to maintain alveolar bone in preparation for future
implants; - the use of preformed metal crowns to maintain clinical crown height in preparation
for definitive crowns; - the use of direct/laboratory-formed composite veneers in preparation for porcelain
veneers when growth (and any orthodontic treatment) is complete.
Key Point