Caries Management in Primary Teeth

Depending on the severity of extension of caries, a carious tooth in a pediatric patient can be treated with various procedures.

Treating a primary tooth (milk tooth) can be different from the treatment done for permanent and adults tooth due to various reasons.

  • Primary tooth would exfoliate after a certain milestone.
  • Certain procedures done to the primary / milk tooth can have effect on the developing permanent tooth bud lying under it.
  • Presence or absence of primary precursor tooth plays a significant role in occlusion and alignment of permanent tooth.
The crown of the tooth has three layers. The enamel, dentine and pulp. The pulp contains nerves and vessels that supply the tooth.
Management of caries in a pediatric patient

The treatment for a carious tooth is dependent on the layer up to which the caries has extended.

Caries in the first layer (enamel)

If the extent of caries is minimal, we just remove the carious portion and place a restoration above it. We generally restore the tooth using tooth coloured material like GIC.

Caries involving the second layer (enamel and dentine)

In such case the dentist tends to excavate and remove the carious portion and place a restoration above it.

If the carious lesion is wide and a considerable amount of tooth structure has been removed we place a crown (stainless steel crown) over the restored tooth to provide strength and prevent its fracture due to masticatory load.

When the caries has reached near the pulp

In such cases a procedure known as indirect pulp capping is performed.

In this procedure the dentist removes all or most of the infected dentine and carious portion and then place a layer of protective dressing (calcium hydroxide) over it and above it we place a temporary restoration. The main aim is stepwise removal of caries in order to protect the tooth.

The dentist then recalls the patient after 4 weeks and if no signs of pulpits or no pain is present then a permanent restoration is placed over it.
Indirect pulp capping

When the caries extension has lead to pulpal exposure

In such cases if the radicular pulp is not affected yet (no inflammation or irritation) then pulpotomy procedure is performed .

Steps in a pulpotomy procedure

  • Area is anesthetized using local anesthesia
  • A cavity is prepared to open the pulp chamber
  • The coronal pulp is removed
  • Hemostasis is obtained using a cotton pallet
  • A dressing medicament is placed over it for fixation of radicular pulp
  • Restoration of the tooth
  • Crown / cap placement
Pulpotomy Procedure

When the radicular pulp is also involved or in cases of a non-vital tooth

In such cases pulpectomy (known as RCT in permanent tooth) is performed.

Steps in pulpectomy

  • Anesthetizing the concerned tooth using local anesthesia
  • Preparation of a cavity to access the pulp chamber
  • Removal of the entire pulp using files
  • Irrigating the canal
  • Obturating the canal
  • Restoring the tooth
  • Crown placement

non vital tooth

When the tooth is grossly decayed and it is no longer possible to save the tooth

In such cases when very little tooth structure is present the dentist would perform extraction (removal) of the tooth under local anesthesia.

How to prevent caries in children

Home care

Oral hygiene –

  • one should start brushing as soon as the first tooth erupts in the oral cavity.
  • Proper brushing technique
  • Brushing twice a day
  • Using fluoridated tooth paste .
  • Brushing should be guided by the patient till the child reaches the age of three .

Dietary habits –

  • Reducing / avoiding sugar intake in between meals .
  • Fibrous diet
  • Proper rinsing of teeth after every meal .

Dental visits –

  • Taking the child for a regular dental checkup (every six months) and familiarizing the child with a dentist

Professional  care

  • Early detection of caries
  • Diet councelling
  • Flouride application
  • Pits and fissure sealant

Milestone dental clinic provides the facility of child caries management. The parents need to note that prior appointment needs to be taken and the treatment will take atleast two visits. We need to understand that a child takes times to get accustomed to the clinic and so not all treatments are possible on the first visit.

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