Table 8.

4 summarizes the preventive regimens that should be employed for rampant

caries in different age groups.

Table 8.4 Prevention of rampant caries in children and adolescents

Primary dentition 0-6 years
Dietary advice Dietary counselling with parents on good nursing techniques
Fluoride therapy Toothpaste (1000+ ppm F)
Drops/tablets if in area without water fluoridation
Topical varnish application every 3 months
Plaque control Oral hygiene instructions to parents
Toothbrushing with parental supervision
Early visit to dentist at
about 12 months of age
with 3-6 month recall
Mixed dentition 6-12 years
Dietary advice Dietary counselling with parents and patients
Fluoride therapy Toothpaste (1000+ ppm F)
Tablets if in area without water fluoridation
Mouthrinse (0.05% daily)
Topical gel/varnish application every 3 months
Plaque control Oral hygiene instructions to patient
Toothbrushing without parental supervision
Disclosing tablets
Fissure sealants
3-6 month recalls
Permanent dentition 12 years+
Dietary advice Dietary counselling with parents and patients
Fluoride therapy Toothpaste (1450+ ppm F)
Mouthrinse (0.05% daily)
Topical gel/varnish application every 3 months
Plaque control Oral hygiene instructions to patient
Toothbrushing
Disclosing tablets
Interdental cleaning with floss or wood sticks
Fissure sealants
3-6 month recalls

Once rampant caries is under control, then comprehensive restorative treatment can be
undertaken. This should aim to retain the primary dentition with the methods
described in this chapter and in Chapter 7, and deliver the child pain free into
adolescence and adulthood.

8.10 SUMMARY

1. A full preventive programme must be instituted before any definitive restorations in

a child with a high caries rate.
2. Repetitive treatment should be avoided and with careful treatment planning and
choice of restorative materials long-lasting restorations can be carried out in children.

3. The stainless-steel metal crown is the most durable restoration in the primary
dentition for large cavities and endodontically treated teeth.

4. Resin-modified glass ionomers and polyacid-modified composite resins may have

an increased role in the future in the restoration of primary teeth.

5. Rubber dam should be placed, if at all possible, prior to the restoration of all teeth.

6. Careful evaluation of the state of pulp inflammation should be carried out before
the placement of proximal restorations in primary teeth. Wherever the pulp is deemed
to be involved, pulp therapy should be carried out prior to the coronal restoration.

7. Formocresol is likely to be replaced with newer, safer medicaments such as Ferric

Sulphate.