Management of caries in permanent teeth - accessible version
Decision-making for managing the carious permanent tooth in a child with no medical complications
A text version of the decision making process for managing the carious permanent tooth in a child with no medical complications is outlined below.
To use this version, follow the instructions at each decision point to determine a suitable management strategy.
1. Is there caries-related dental pain?
If yes: refer to the Diagnosis and management of dental pain or infection flowchart
If no: go to 2. Is the tooth restorable?
If yes: got to 3. Are there signs and symptoms of infection?
If no: extract the tooth
3. Are there signs and symptoms of infection?
These include:
• Sinus or abscess
• Swelling
• Periradicular pathology radiographically
If yes: Consider local measures to control infection and go to 4. Dental infection
If no: go to 5. Tooth/lesion-specific management options
Is the tooth a first primary molar in a child ≤ 10 years old (see Note)?
If yes: Refer to FPMs of poor prognosis for management options
If no: Carry out pulpectomy/root canal therapy or extraction
5. Tooth/lesion-specific management options
For descriptions of initial and advanced lesions in primary teeth, see Lesion classification.
Anterior tooth
Initial lesion: Management options are site-specific prevention or sealant/infiltration
Advanced lesion: Management options are selective caries removal or complete caries removal and restore
Molar tooth, occlusal lesion
Initial lesion: A management option is sealant (as appropriate to the lesion) and seal remaining fissures
Moderate lesion: Management options are sealant or selective caries removal to firm/leathery dentine or complete caries removal and restore
Extensive lesion: If a dentine bridge is visible, a management option is selective caries removal to soft dentine. If there is no dentine bridge visible, consider either selective caries removal or pulpotomy
Molar tooth, proximal lesion
Initial lesion: Management options are site-specific prevention or Sealant/infiltration
Moderate lesion: Management options are Sealant/infiltration or Selective caries removal to firm/leathery dentine or Complete caries removal and restore
Extensive lesion: If a dentine bridge is visible, a management option is selective caries removal. If there is no dentine bridge visible, consider either selective caries removal to soft dentine or pulpotomy
The RCSE Guideline for the Extraction of First Permanent Molars in Children provides further information about optimal age for extraction.