primary dentition causes abscesses, pain, and suffering in children. This can then need
hospital admission and invasive treatment, sometimes under general anaesthesia,
whereas a simple restoration, at the time when the caries was diagnosed, would have
prevented this extremely distressing episode for the child. It is therefore essential for
all dentists involved in the care of young children to learn restorative techniques that
give the best results in primary teeth and this should always be alongside excellent
preventive programmes, and this chapter is devoted to the discussion of such
techniques. Good quality restorative care (328HFig. 8.1 (a) and (b)), as and when caries is
diagnosed, would also obviate the need for extractions of primary teeth under general
anaesthesia for thousands of children, particularly in the United Kingdom. A
treatment philosophy which the authors believe is effective in the management of
caries in children is shown in 329HTable 8.1.
330H
Fig. 8.1 A well-restored primary
dentition (a) upper arch and (b) lower
arch in a child. High quality restorative
care is supplemented with prevention in
the form of sealants placed in other
molars deemed to be susceptible to future
carious attack.8.3 REMOVE, RESTORE, OR LEAVE
8.3.0 Introduction
There are certain situations where the clinician might decide not to carry out invasive
restorative procedures in primary teeth and instead use a rigorous preventive
approach. Such an approach can be justified where it is likely that remineralization
would occur or the tooth maintained in a state, free from pain or infection until
exfoliation. Recently (Pitts and Longbottom, 1995) it has been proposed that it should
be possible to divide lesions into those for which preventive care is advised (PCA)
and those for which operative care is advised (OCA). More work is required on this
concept but the following sections discuss conflicting reasons to treat or not to treat