handicapped children with extensive caries, and in some medical conditions where
multiple treatment episodes over a prolonged period increase the risks of systemic
complications. Extractions under general anaesthesia may be preferable to no
treatment at all in the management of extensive caries in young children, especially
when facilities for restorative care under general anaesthesia are not available or
parental motivation is poor and reatten-dance for multiple visits is unlikely to occur.
In addition, general anaesthesia may be the only practical approach for children with
acute infection.
Where general anaesthesia is employed in the dental treatment of the preschool child,
the emphasis must be on avoiding the need for repeated general anaesthesia. Hence,
each procedure needs careful planning with consideration being given to the
management of all disease present in the child's mouth, while also considering the
effect of premature extractions on the developing dentition. This may require the
extraction plan to be quite radical, especially where facilities for restorative care
under general anaesthesia are not available.
Key Points
- Sedation can be a useful adjunct for anxious preschool children.
- General anaesthesia should only be used where other management strategies have
failed or are deemed inappropriate.
299H
Fig. 7.7 Comprehensive full mouth care
under intubated general anaesthesia
enables children with multiple carious
teeth to be expediently rendered caries-
free in one procedure.7.8 TREATMENT OF DENTAL CARIES
7.8.1 Temporization of open cavities
As an initial step in the management of caries, open cavities should be hand-
excavated and temporized with a suitable material such as a reinforced zinc oxide and
eugenol cement, or, better still, a packable glass ionomer cement (300HFig. 7.8). Carious
exposures of vital or non-vital teeth can be dressed with a small amount of a
polyantibiotic steroid paste (Ledermix) on cotton wool covered by a suitable dressing
material.
Dressing open cavities has a number of advantages. It serves as a simple and
straightforward introduction for the child to dental procedures. By removing soft
caries and temporarily occluding cavities, the oral loading of mutans streptococci is
significantly reduced. It helps to reduce sensitivity, making toothbrushing and eating
more comfortable, and also makes inadvertent toothache less likely. If a suitable
material is used, it can produce a source for low-level fluoride release within the