- Operative treatment of dental caries in the young permanent
dentition - J. A. Smallridge and B. Williams
9.1 INTRODUCTION
Caries is still a considerable problem in children and adolescents. In the recent report
from the 2002/2003 BASCD Survey which looked at dental disease levels in 77,693
14-year-old children in England and Wales, Pitts et al. (2004) found that on average
half of the children examined had dentinal decay, with a mean of three permanent
teeth decayed into dentine.
The first permanent teeth erupt into the mouth at approximately 6 years of age, but
may appear as early as the age of 4. The eruption of the anterior teeth usually causes
great excitement, as it is associated with 'the fluttering of tooth fairy wings'. However,
the eruption of the first permanent molars largely goes unnoticed until there is a
problem. The mean eruption time for first permanent molars has been determined as,
6.1 years in girls and 6.3 years in boys, but there is a tremendous variation in both the
time of eruption and the time it takes for the tooth to emerge into the mouth. It takes
12-18 months for a first or second molar to erupt fully. The first permanent molars are
teeth that commonly exhibit disrupted enamel; the reported incidence of defects range
from 3.6-25%. The occlusal surfaces of these molar teeth account for about 90% of
caries in children.
Restoration of the young permanent dentition is part of a continuum and cannot be
regarded in isolation. The restoration is only one small part of the child's treatment
and is the 'surgery' to remove the carious infected area of the tooth and replace it with
a suitable restorative material. It does nothing to cure the disease and must form part
of a much wider treatment modality, which includes identification of the risk factors
contributing to the disease followed by introduction of specific prevention counter
measures.
Efforts must be applied to all of these areas to attempt to provide the optimum
conditions for future tooth survival. These risk factors and preventive measures are
addressed in other chapters, such that the authors can confine themselves to appraisal
of methods of treatment of caries in the young permanent dentition. They cannot hope
to completely cover every aspect of operative treatment in one chapter; there are other
texts that should be read to give a fuller account of the available techniques (see
sections 9.15 and 9.16). However, the authors intend to give an outline of some of the
options available.
9.2 ASSESSMENT OF CARIES RISK
Caries risk must influence decisions on when to treat, when to monitor, which
material to use, etc.; the authors will review it briefly, despite the fact that it has been
discussed in 407HChapter 3. The idea of a caries risk assessment for each child patient is to
ensure that the chosen diagnostic tests, preventive treatment, and any provided
restorations, are geared specifically to the need of that patient.
Factors requiring consideration are: