- Operative treatment of dental caries in the primary dentition - M.
S. Duggal and P. F. Day
8.1 INTRODUCTION
While there is no doubt that the best way to tackle the problem of dental caries is
through an effective programme of prevention as outlined in the previous chapters, it
is unfortunate that many children still suffer from the disease and its consequences.
Hence there is a need to consider operative treatment to prevent the breakdown of the
dentition.
Over the years the treatment of dental caries in children has been discussed and many
attempts made to rationalize the management of the disease. Writing more than 150
years ago, Harris (1939) was one of the first to address the problem of restoring the
primary dentition. Even in those days he was emphasizing the importance of
prevention by good toothbrushing. Caries could be arrested by 'plugging', but from his
description he obviously found treatment for the young patient difficult and not as
successful as in adults. However, he did emphasize the importance of looking after
the teeth of children: 'If parents and guardians would pay more attention to the teeth
of their children, the services of the dentist would much less frequently be required',
and, 'Many persons suppose that the teeth, in the early periods of childhood, require
no attention, and thus are guilty of the most culpable neglect of the future well-being
of those entrusted to their care'. Unfortunately, this statement still applies today.
The huge number of different techniques and materials that have been advocated over
the years since Harris wrote those words testify to the fact that no ideal solutions have
so far been found. Unfortunately, most treatments are advocated on the basis of
dentists' clinical impressions and there have been very few objective studies that have
attempted to discover which treatments succeed and which do not.
Treatment can be a stressful experience for the child, the parent, and the dentist. It is
important that there is a positive health gain from any treatment that is provided.
It is impossible to cover the whole field of operative treatment for children in one
chapter and the reader is directed to other texts for a fuller account of available
techniques. However, it is possible to outline the rationale for providing operative
treatment, to give advice on the selection of appropriate ways of providing care, and
to describe a few of the more useful treatment methods.
8.2 PHILOSOPHY OF CARE
Children are the future dental patients and, therefore, the dental care that they receive
should promote positive dental experiences, which in turn would promote positive
dental attitudes. When faced with a tooth that has caries, the first decision has to be
whether it does in fact require treatment or not. It may be felt that the caries is so
minor and prevention so effective that further progress of the lesion is unlikely. Less
rationally it may be felt that a carious tooth with a non-vital pulp is unlikely to cause
great problems and may be left to its own devices. Recently there has been much
discussion in the United Kingdom on whether most carious primary molars need to be
restored at all! In the authors view there is no doubt that untreated caries in the