maintenance of space, their premature loss can cause low esteem in both child and
parent.
- The stage of the disease. It is easier for both child and dentist to restore teeth at an
early stage of decay. Later the pulp may become involved and subsequent restoration
difficult, making loss of the tooth more likely. - The extent of the disease. A large number of teeth requiring treatment may put a
strain on a young child and, less importantly, on the parent and dentist.
Caries in children is significantly less than it was 20 years ago, and it would be good
to think that the dental profession would be able to restore the reduced number of
decayed teeth that now present.
8.4 DIAGNOSIS AND TREATMENT PLANNING
8.4.0 Introduction
This was discussed in 331HChapter 3 and will be only briefly outlined here. As stated
above the treatment of carious teeth should be based on the needs of the child. The
long-term objective should be to help the child reach adulthood with an intact
permanent dentition, with no active caries, as few restored teeth as possible, and a
positive attitude to their future dental health. If restoration is required it should be
carried out to the highest standard possible in order to maximize longevity of the
restoration and avoid re-treatment.
8.4.1 Diagnosis
An accurate diagnosis of dental caries is important in the management of the primary
dentition. Enamel of the primary tooth is thin compared with that of the permanent
teeth, and caries progresses quickly through the enamel into the dentine, especially at
the proximal area below the contact point making an early diagnosis paramount.
When caries is still confined to the enamel then preventive measures stand a chance of
halting and reversing the lesion as discussed in 332HChapter 6.
Pulpal involvement
Once the caries is into the dentine then removal of the carious tissue and restoration of
the tooth is required. Caries progresses very rapidly through the primary dentine with
early pulp involvement. When this stage of the process is reached the marginal ridge
becomes undermined and collapses. The diagnosis of the integrity of the marginal
ridge in primary molars is important in treatment planning for children. Research has
shown that once the marginal ridge of a primary molar has broken away the pulp of
the tooth is affected and irreversible changes have commenced (333HFig. 8.2).
Radiographs
The importance of radiographs for the diagnosis of caries in children cannot be over-
emphasized, as clinical examination alone would mean that many proximal lesions
could be missed (334HFig. 8.3). As mentioned earlier many early lesions may be halted or