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Should deciduous teeth be restored? reflections of a cariologist Edwina Kidd Dental Update 2024 39:3, 707-709.
Authors
EdwinaKidd
Professor of Cariology, Guy's, King's and St. Thomas' Schools of Medicine, Dentistry & Biomedical Sciences, Floor 25, Guy's Tower, Guy's Hospital, London Bridge, London SE1 9RT
Whether deciduous teeth should be restored has caused controversy for at least 150 years and the argument rages on. Dental caries is a controllable process. The role of operative dentistry and restorations, as far as caries control is concerned, is to make cavitated, uncleansible lesions accessible to plaque control. However, deciduous teeth are exfoliated and perhaps non-operative treatments (plaque control, fluoride, diet) are all that are required to take cavitated teeth pain-free to exfoliation. Are such techniques child-friendly, obviating the need for anaesthesia or the use of handpieces? Alternatively, are they wanton neglect? This paper is written by a cariologist who never treated children, to present alternative managements and rehearse these arguments from a cariological perspective.
Clinical Relevance: This paper might serve as a discussion document for a group of dentists deciding practice policy with regard to the management of caries in deciduous teeth.
Article
The caries process is a ubiquitous, natural process occurring in the biofilm. This community of micro-organisms is always metabolically active, causing minute fluctuations in pH. Where oral hygiene is poor, sugar intake frequent and/or saliva flow diminished, the consequence may be a net loss of mineral and the formation of a visible caries lesion on the tooth surface. The lesion should be regarded as the sign or symptom of the process. However, with regular disturbance of the biofilm with a fluoride-containing dentifrice and a sensible, but not draconian diet, lesions do not have to form in the first place and established lesions can be arrested at any stage of lesion development.1
However, in the absence of control, lesions cannot only form, but can progress until the tooth is destroyed and caries is the predominant cause of premature loss of deciduous teeth. Untreated severe dental caries in pre-school children may affect their body weight, growth and quality of life. It has been reported that, following caries treatment, body weight increased and quality of life improved,2 although the evidence is mixed. A recent study suggests that treatment of the caries may not, in fact, influence body growth.3 This study suggests that, while caries activity is a negative predictor for body growth in children, dental intervention does not lead to significant improvement of growth. There appear to be no studies suggesting that untreated, non-severe primary dentition decay cases (non-rampant caries) leads to significant effects on body weight or growth.
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