336H
Fig. 8.3 (a) A clinical examination in the upper arch gives a
little clue to the presence of proximal carious lesions on both
the upper right first and second primary molars. (b) However,
extensive caries is evident when these were examined with
BW radiographs.
8.4.2 Treatment planning
Following diagnosis of the extent of caries in each tooth and the probable state of the
pulp, a logical treatment plan should be made which would usually involve treating a
quadrant of the mouth at a time. It used to be felt that multiple short visits placed least
stress on a child particularly if they were under 6 years of age. However, the most
important aspect of child management is to gain the confidence of the child and make
sure that there is as little discomfort as possible. Restorative care must be conducted
with good pain control and management of a child's behaviour. Local analgesia is
therefore mandatory and is easily performed these days with topical analgesia, fine
gauge needles, and short-acting local analgesia agents. Due consideration should be
given to the use of a rubber dam that ensures a much higher quality of restorations
that last for the duration of a tooth as well as being an aid in behaviour management.
Once the tissues have been anaesthetized and the child is confident that there will be
no pain, it is usually best to complete treatment on a whole quadrant. The number of
visits can then be kept to a minimum and a reservoir of co-operation maintained. If a
child is in pain then it matters little if an appointment is 5 or 45 min. Where there is
pulpal involvement of primary teeth then pulpotomies or pulpectomies are essential.
Such teeth also need restoration with preformed metal crowns, which have repeatedly
been shown to have one of the highest success rates of any restoration for children's
teeth. No doubt, the least interventionist approach can be the correct one for some