3.2 Treatment for caries of primary teeth 

Keypoints:

   → There are three categories of treatment options according to different pediatric patients' condition: conservative treatment; minimally invasive treatment and restoration.

                                                                                                                                      

⑴ Objectives of treatment for dental caries in primary teeth

Keypoints:

   → As pediatric dentists, we should try our best to cease the lesion progression, maintain the intergrity of the dentition, and improve all aspects of oralfactial functions (such as mastication).                                                                                                                     

⑵ Options of treatment 

    

 ● Drug therapy 

Reference material:

    Without doubt, the repeated use of fluorides is of critical importance for the control and prevention of dental caries in both children and adults. Numerous controlled clinical investigations have consistently demonstrated the cariostatic properties of fluoride provided in a variety of forms. As a topically applied therapeutic agent, fluoride is effective in preventing future lesion development, in arresting or at least slowing the progression of active cavitated lesions, and in remineralizing active incipient lesions. Topical fluoride also has some antimicrobial properties.

      ● Enameloplasty

Keypoints:

  → Open the proximal contact and apply the fluoride varnish.

      ● Restorative treatment

Keypoints:

  → Knowing about the objections of restorative (such as restrain the progression of caries; recover the masticatory function; preserve the vitality of dental pulp; occlusal guidance; maintain good succession; restore the phonation. )

⑶ Filling restoration 

Keypoints:

   → Alternative filling restorative materias: composite resin; cements, comper and other fluoride-releasing materials;

   → Alternative appliances: laser and rubber dam.

⑷ SSC, strip crown 

Reference material:

  → The indications for the use of stainless steel crowns in pediatric dentistry include the following: 

  ■ Restorations for primary or young permanent teeth with extensive and/or multiple caries lesions;

  ■ Restorations for hypoplastic primary or permanent teeth that cannot be adequately restored with bonded restorations;

  ■ Restorations for teeth with hereditary anomalies, such as dentinogenesis imperfecta or amelogenesis imperfecta;

  ■ Restorations for pulpotomized or pulpectomized primary or young permanent teeth when there is increased danger of fracture of the remaining coronal tooth structure;

  ■ Restorations for fractured teeth;

  ■ Restorations for primary teeth to be used as abutments for appliances;

  ■ Attachments for habit-breaking and orthodontic appliances.

  → SSC restoration procedures:

  ① Preparation of the tooth; 

  ② Selection of crown size; 

  ③ Contouring of the crown (when necessary).

  → Strip crown:

      Webber and associates described the resin crown technique where in the tooth is restored with resin-based composite with a celluloid crown form used as a matrix. They point out that very little finishing of the restoration is required when the celluloid crown has been properly fitted.

      The jacket crown technique incorporates the use of a celluloid crown form and resin-based composite as advocated by Webber and associates and today is commonly called a “strip crown.” In a retrospective study by Kupietzky and others, strip crowns were shown to perform well for restoring primary incisors with large or multisurface caries for periods of more than 3 years. There was an 80% overall retention rate for the 145 restorations.

                                                                                                                                     

⑸ Features for the restorative treatment in primary teeth 

Keypoints:

  → Bebavior guidance all the time; 

  → Pay attention to characteristics of primary teeth (such as thinner enamel-dentin, larger pulp chamber, higher pulp horns, borad dentinal tubules and definite constriction at cervical region);

  → Superfical enamel needs more etching time;

  → Not necessary to restore the contact point, check the occlusion after multiple teeth restoration with extensive tissue loss;

  → Mechanical strength and releasing fluoride (such as GIC,resin-modified GIC etc.)

                                                                                                                                      

⑹ Attentions for treatment of dental caries in primary teeth

Keypoints:

  → Options of treatment according to children’  needs;

  → Give some instruction to parents and children after restoration.

                                                                                                                                      

⑺ Summary of options for management of caries in primary teeth