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Planning Treatment for Children

General Philosophy of the Authors

Dentists who treat children are in a unique position not only to provide dental treatment when required, but to influence the future behaviour, attitudes to oral health and attitude towards dentistry in general. Children deserve the highest quality care and highest quality restorative dentistry should be provided to them, supplemented with rigorous pre­vention. Prevention of dental caries in children should be a priority but sadly nearly half of 5-year-olds, even in developed countries, still develop dental caries. A non-interventionist approach, as has been advocated in some countries such as the UK, or poor restorative patchwork dentistry, is doomed to failure and only leads to pain, infection and suffering in children, requiring more invasive interventions. These are traumatic and expensive and negatively influence the child’s future behaviour and attitudes to dentistry. Good restorative and preventive care obviates the need for extraction of primary teeth under general anaesthesia, a practice which should have only a small place in the dental care of young children. In addition, in a developing child, the dentist has the task of monitoring the dentition, diagnosis and management of anomalies as well as having a knowledge of medical conditions and the provision of safe restorative care for children.

Philosophy of Treatment Planning

• Gain the trust and cooperation of the child.
• Make an accurate diagnosis and devise a treatment plan appropriate to the child’s need.
• Comprehensive preventive care.
• Deliver care in a manner the child finds acceptable.
• Use materials and techniques which provide effective and long-lasting results.

History

This should include medical history, social history, history of the present complaint and the past dental history. What were the “likes” and “dislikes” of the child at previous dental visits? In addition, parents’ assessment of the previous and expected child’s behaviour is useful.

Examination

• A good examination using tell–show–do, including charting for teeth present and caries, including areas of early decalcification.
• Any missing teeth.
• Gingival health.
• Developmental defects.
• Tooth surface loss.
• Initial occlusal assessment.

Radiographs and Other Investigations

Appropriate radiographs such as bitewings or OPG (Chapter 10) or any other special tests such as pulp sensibility tests.

Diagnosis

In children the diagnosis needs to encompass two aspects:

• diagnosis of the dental/oral condition;
• the child’s behaviour and the behavioural approach likely to succeed in provision of the treatment.

Diagnosis should be specific. For example, a diagnosis “dental caries” in itself is incomplete as it does not specify the reason the child has dental caries. Th/>

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