PAEDIATRIC DENTISTRY - 3rd Ed. (2005)

(1) present caries activity;
(2) past caries activity;
(3) parent /sibling caries activity;
(4) sugar consumption;
(5) oral hygiene;
(6) fluoride exposure;
(7) teeth morphology;
(8) Streptococcus mutans levels;
(9) saliva characteristics, flow rate, and consistency.

Factors (1)-(7) will become clear when a full history and examination are carried out;
while (8) and (9) will only come into play if there is rampant caries, which the dentist
cannot explain from the history (408HFig. 9.1).

409H

Fig. 9.1 An example of caries in a 12-

year-old girl, who sucked polos non-stop,

'6 packets per day'.

9.3 TREATMENT DECISIONS

9.3.0 Introduction

The clinician must always give consideration to whether it is better either to treat a
carious lesion or remineralize it.

9.3.1 Important points in relation to treatment

1. Gaining access to the caries inevitably means destruction of sound tooth tissue. The
   operator must keep this to a minimum, consistent with complete caries eradication.


2. Once the operator places an initial restoration, he or she cannot 'undo' it and that
   tooth will inevitably require further restoration in its lifetime.


3. Every time an operator places a restoration, he or she destroys more of the original
   tooth structure, thereby weakening the tooth.


4. Even though the occlusion in a young person changes as growth occurs and teeth
   erupt, it is important to realize, that when the operator places restorations, he or she
   must replicate the original occlusal contacts in the tooth. Although, it may be
   tempting to keep the restoration totally out of the occlusion, teeth will move back into
   the occlusion, which will thereafter be slightly different and the cumulative effect of a
   lot of little changes can severely disrupt the occlusion in the long term.