It has been suggested that laser irradiation may eliminate the need for etching, but as
yet there is not scientific literature to back this claim.
In summary, some of the preliminary reports on the use of lasers give much room for
optimism. They not only suggest that it might be possible to use lasers to help prevent
decay, but it may also be possible to perform certain surgeries and prepare cavities
with little pain for the patient. However, greater clinical trial validation of these
claims is needed before lasers can be considered superior to conventional methods, so
that failure to utilize the former will be considered as a disservice to the patients. As
yet the equipment cost and the need for different laser types for various types of
treatment make their use prohibitive for most UK dentists.
9.13 RAMPANT CARIES
It is important to consider the many factors that determine the treatment of a child
with a high caries rate (509HFig. 9.48). If the child presents with an acute problem of pain
or swelling, then immediate treatment is indicated to relieve the child of the pain.
After that, it is important that the clinician considers the attitude of the child and his
or her parents together with motivation towards dental treatment, the co-operation of
the child, the age, and the extent of decay.
It may be possible to place temporary restorations while preventive strategies are
commenced. These will include:
- Dietary analysis and appropriate advice to the child and the parent.
- Plaque control, oral hygiene instruction depending on age to the child or the parent,
the techniques of toothbrushing, and disclosure. - Fluoride
-tooth paste
-mouth rinse;
-varnish application every 6 months.
- Fissure sealants
- Regular recall.
Once the caries is under control, definitive restorative treatment can commence.
510H
Fig. 9.48 Rampant caries in a 13-year-
old girl. She only attended because the
incisor had fractured. Her whole attitude
to dentistry needs to change in order to
treat her successfully.