Management of caries in primary teeth - accessible version
Decision-making for managing the carious primary tooth in a child with no medical complications
A text version of the decision making process for managing the carious primary 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. Are there signs and symptoms of infection?
2. Are there signs and symptoms of infection?
These include:
• Swelling (intra- or extra-oral), redness, lymphadenopathy
• Sinus or abscess swelling
• Pathological mobility or tooth tender to percussion
• Intraradicular pathology radiographically
If yes: Consider local measures to control infection, extract the tooth or consider carrying out a pulpectomy
If no: go to 3. Is the tooth restorable?
If yes: go to 4. Is the tooth close to exfoliation?
If no: try non-restorative cavity control (see Notes) or extract the tooth
4. Is the tooth close to exfoliation?
If yes: Carry out site-specific prevention or non-restorative cavity control (see Notes)
If no: go to 5. Has caries arrested?
Is the enamel smooth, dentine hard and lesion dark in colour?
If yes: Carry out site-specific prevention or non-restorative cavity control (see Notes)
If no: go to 6. Radiography
On a radiograph, is there clear separation between the carious lesion and the pulp?
If yes: see 7. Tooth/lesion-specific management options.
If no: explain to the child/carer the uncertain prognosis and consider appropriate management options
7. Tooth/lesion-specific management options
For descriptions of initial and advanced lesions in primary teeth, see Lesion classification.
Anterior tooth
Initial lesion: A management option is site-specific prevention
Advanced lesion: Management options are selective caries removal, complete caries removal or non-restorative cavity control (see Notes)
Molar tooth, occlusal lesion
Initial lesion: Management options are sealant or site-specific prevention
Advanced lesion: Management options are selective caries removal or the Hall Technique or non-restorative cavity control (see Notes)
Molar tooth, proximal lesion
Initial lesion: Management options are site-specific prevention or Sealant/infiltration
Advanced lesion: Management options are the Hall Technique, selective caries removal or non-restorative cavity control (see Notes)
Non-restorative cavity control includes making the lesion cleansable, supporting improvements in toothbrushing and diet, fluoride varnish application, silver diamine fluoride application.