as IRM (intermediate restorative material). Polyantibiotic and steroid pastes (e.g.
Ledermix) may be useful beneath such dressings, and over exposures/near-exposures
of the pulp.
The pulp chamber of abscessed teeth can sometimes be accessed by careful hand
excavation, in which case placing a dressing of dilute formocresol on cotton wool
within the pulp chamber will frequently lead to resolution of the swelling and
symptoms. An acute and/or spreading infection or swelling may require the
prescription of systemic antibiotics, although there is little rationale for the use of
antibiotics in cases of toothache without associated soft tissue infection/
inflammation.
Dental infection causing significant swelling of the face, especially where the child is
febrile or unwell, constitutes a dental emergency and consideration should be given
to referral to a specialized centre for immediate management.
Key Points
- Pain is a common presenting feature in preschool children.
- Appropriate dressing of teeth will usually help to temporarily manage pain and
localized infection. - Antibiotics should be prescribed where acute soft tissue swelling or signs of
systemic involvement (e.g. pyrexia) are present. - Children with increasing facial swelling and/or serious systemic involvement should
be referred to a specialized centre for urgent management.
7.5 PRINCIPLES OF DIAGNOSIS AND TREATMENT PLANNING FOR
PRESCHOOL CHILDREN
When planning dental treatment for preschool children, it is important to appreciate
that dental caries of enamel is essentially a childhood disease and that progression of
caries in the primary dentition can be rapid. Therefore, early diagnosis and prompt
instigation of appropriate treatment is important. Preschool children should be
routinely examined for dental caries relatively frequently (at least 2-3 times per year).
More frequent examination (e.g. every 3 months) may be justified for children in
high-risk groups (282HChapter 6). Approximal caries is common in primary molars so, in
children considered to be at increased risk of developing dental caries and where
posterior contacts are closed, a first set of bitewing radiographs should be taken at 4
years of age, or as soon as practically possible after that (283HFig. 7.4). In such children
consideration should be given to repeating bitewings at least annually.
Key Points
- Coronal enamel caries is essentially a childhood disease.
- In children deemed to be at increased risk of developing caries, bitewing
radiographs should be obtained at 4 years of age, or as soon as practically possible
after that, and consideration should be given to repeating such radiographs at least
annually.