Treatment of dental caries in the preschool child

Dental caries is still one of the most prevalent pathological conditions in the child population of most Western countries. A UK study of children aged from 1.5 to 4.5 years demonstrated that 17% have decay, and a more recent survey of 3-year-old children in England found 12% to have decay with up to a third of 3-year-olds affected in the worst areas of the country (Public Health England 2014). Although the most recent surveys show a slow decline in decay levels, on average 25% of five-year-old children have decay, peaking at over 50% in the worst affected parts of England. Dental caries is associated with significant morbidity in children, and the treatment of dental caries (and its sequelae) is currently the most common reason for administration of general anaesthesia (GA) to children in the UK. Successfully managing decay in very young children presents the dentist with a number of significant challenges. This chapter will outline approaches to the management of the preschool child with dental caries. Early childhood caries (ECC) is a term used to describe dental caries presenting in the primary dentition of young children. Terms such as ‘nursing bottle mouth’, ‘bottle mouth caries’, or ‘nursing caries’ are used to describe a particular pattern of dental caries in which the upper primary incisors and upper first primary molars are usually most severely affected. The lower first primary molars are also often carious, but the lower incisors are usually spared—being either entirely caries free or only mildly affected. Some children present with extensive caries that does not follow the ‘nursing caries’ pattern. Such children often have multiple carious teeth and may be slightly older (3 or 4 years of age) at initial presentation. This presentation is sometimes called ‘rampant caries’. However, there is no clear distinction between rampant caries and nursing caries, and the term ‘early childhood caries’ is widely recognized as a suitable all-encompassing term. In many cases, ECC is related to the frequent consumption of a drink containing sugars from a bottle or ‘dinky’ type comforters (these have a small reservoir that can be filled with a drink).