Caring for children: little teeth, big challenges

Abstract

The need to restore the carious primary dentition remains an area of considerable controversy and debate. Huge disparity exists between how British general dental practitioners manage carious primary teeth compared to permanent teeth. 1 Indeed, recent data show that only around 10% of carious primary teeth are actually filled. In contrast, paediatric dentists strongly advocate a restorative approach, their casemix being largely comprised of children suffering from the sequelae of untreated caries. A multi-centre randomised controlled trial (the FiCTION trial) is currently underway to explore the effectiveness of a restorative versus a preventive strategy for the primary dentition, the findings of which should have great public health significance. Furthermore, there is increasing basic science research to support the potential of the primary tooth pulp for healing and repair, even though it is a 'temporary' structure destined for physiological root resorption and exfoliation. 2 Many myths about the pain processing potential and inflammatory responses of the primary tooth have now been dispelled and treatments should strive to be much more biologically compatible. A RESTORATIVE VERSUS PREVENTIVE APPROACHUndoubtedly, there are many challenges in providing restorative care for young children in primary care settings, not least time and financial constraints, as well as a perception that children may not cope well with treatment. A number of studies have explored the barriers to treating children in practice and have revealed some fascinating insights. 3 However, good decision-making, evidence-based restorative choices and a child-friendly approach will maximise successful clinical and patientreported outcomes.In my presentation at the forthcoming BDA conference, I will be highlighting the importance of decision-making for young children and will consider what patientrelated and clinical factors indicate a restorative approach. There are situations where even a specialist paediatric dentist would not get a hand-piece out! It should also be stressed that an individualised preventive strategy should always be in place, as this provides the foundation of any treatment plan. The range of restorative materials available for the primary dentition will be described, taking into account each of their advantages and limitations. The current literature will be reviewed for the best evidence-base practice and outcomes.It is interesting to reflect on how little amalgam is now used in the primary dentition; indeed it is actively discouraged in some countries. The advent of adhesive materials has largely contributed to the demise of amalgam as they offer a more cosmetic and, of course, a mercury-free alternative. However, glass ionomers in particular may lend themselves to abuse, and ultimately high failure rates, through poor clinical technique. PREFORMED METAL CROWNSAnother restorative choice for carious primary molars is the preformed metal crown (previously known as stainless steel crowns) (Fig. 1). This is further area where...