5.2 Treatment of Patterns of Caries

Severe Early Childhood Caries

Severe ECC must be treated with preventive strategies, restorative treatment, and, in some cases, extractions. For children who are unable to tolerate administration of anesthetic and appointments that are long enough for the dentists to perform restorations, alternative restorative treatment (ART) should be considered.

ART requires that temporary restorations be sealed at the margins and does not necessitate removing all of the caries from the cavitated lesion. Glass ionomer is the temporary restorative material of choice, as it releases fluoride and bonds to the tooth, eliminating the need for the tooth to be prepared at that time for a permanent material such as amalgam.

ART can control the caries infection and stabilize the teeth until the child is able to tolerate administration of anesthetic and longer appointments.4–6 Care must be taken not to traumatize young children. Traumatic dental appointments may affect their attitudes about their teeth and oral health care for years to come.

For children requiring extensive treatment, referral to a pediatric dentist or providing treatment in the operating room should be considered. All decay should be treated, and the dentist should keep recall intervals short (3 to 6 months). If recall intervals are longer, the child is likely to develop additional caries before the next appointment. The goal is to conduct each subsequent examination before more caries has had a chance develop.7

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