Clinical Decision-making for Caries Management in Children: An Update
This summary is based on the article published in Pediatric Dentistry: Clinical Decision-making for Caries Management in Children: An Update (March/April 2015)
Rebecca L. Slayton, DDS, PhD
Context
Decision-making regarding the management of caries in children is governed by many factors, including the child’s age, caries risk, perceived motivation of the child and caregiver to comply with oral health recommendations, and current oral health status of the child.
Dental caries continues to be one of the most common chronic diseases of childhood.
Medical management of this disease has the potential to decrease the burden of disease in the most vulnerable children and delay the need for surgical intervention.
Effective medical management requires early and effective risk assessment to identify individuals at risk prior to disease occurrence.
Purpose of the Review
Translate current knowledge of cariology into clinically relevant concepts and procedures.
Key Findings
- Patient-specific approaches, such as individual risk assessment, active surveillance, and preventive therapies—supplemented, when necessary, by restorative care—should be emphasized.
- Clinical findings should inform the type and frequency of therapy recommended on an individual basis.
- As more is learned about this common complex disorder, it is anticipated that educational strategies for students, practitioners, and families will change to reflect new evidence and risk-based care.
- Dentists who see young children have the opportunity to reverse this disease and preserve tooth structure necessary for optimal oral health, growth and development.
- Although we have most of the tools we need to successfully manage this disease, there is still need for additional research related to early caries detection technologies, microbial pathogen identification, and remineralization strategies.
The dental literature supports the following recommendations:
- Prevention of caries requires early and ongoing risk assessment and intervention.
- Risk indicators that contribute to caries require monitoring. These can include: past and present caries activity; socioeconomic status; sealant status; biofilm status (dental plaque); fluoride exposure; and salivary factors and biomarkers.
- Ongoing surveillance is a crucial component of caries management in order to monitor the progression or arrest of caries lesions.
- Dental caries management includes individualized prevention, therapeutic interventions, ongoing surveillance, and necessary restorative therapy.
References
Early intervention and effective preventive strategies are two powerful tools for the pediatric dentist but the reality for many of us is rampant decay in two and three year old children requiring general anaesthesia and full coverage restorations. It is important to understand that stainless steel crowns and possibly newer zirconia crowns are another effective preventive strategy. Prevention now means avoiding another round of comprehensive dental restorative therapy, leading to significant stress to the child and family, cost and increasing demands on a health care environment that is not standing up well to current stress. It is important to remember that in a high risk dental environment that more is sometimes less.
Are stainless steel crowns still used for kids? what about their unacceptable appearance? Also the healthy smile program for the low-income families does not cover the fluoride application or crowns, how can we make any improvement in kids’ health while their parents or caregivers are not able to cover the cost of these essential treatment?