466H
Fig. 9.28 The operator has sealed the
remainder of the fissure system.9.10 EXTENSIVE/DEEP CARIES
9.10.0 Introduction
Unfortunately, a situation sometimes arises where the caries is already extensive prior
to the initial consultation, and the clinician needs to consider preservation versus
extraction issues.
Rampant caries does occur in the permanent dentition as well as the primary dentition
and once again treatment planning has to consider the person as a whole⎯indeed with
children, sometimes the whole family⎯not just the teeth involved in one particular
individual. This involves decision-making on
- The advisability of restoration versus planned extraction.
- How to restore if that is the favoured modality.
- How to prevent onset of further lesions, that is, reduce the risk factors by examining
diet, oral hygiene, fissure sealing, fluoride treatment, and a rigid recall regime.
9.10.1 Extraction considerations
If there is extensive caries affecting the first permanent molars it may be expedient to
consider extraction rather than restoration. It is however, important to check for the
presence and development of the second premolars before prescribing extraction of
the first permanent molars since lack of the premolars necessitates all possible
measures to attempt to retain the first permanent molars. The decision on extraction is
dependent on the age of the child, the stage of development of the dentition, and the
occlusion. This is discussed in detail in 467HChapter 14.