Recommendations

Management of caries in primary teeth 

Refer to Sections 8 and 10 of the full guidance.

Key recommendations

For a child with a carious lesion in a primary tooth, choose the least invasive, feasible caries management strategy, taking into account:

  • the time to exfoliation
  • the site and extent of the lesion
  • the risk of pain or infection
  • the absence or presence of infection
  • preservation of tooth structure
  • the number of teeth affected
  • avoidance of treatment-induced anxiety
    (Strong recommendation; low quality evidence)

For a child in pain due to pulpitis in a vital primary tooth with irreversible symptoms and no evidence of dental abscess, consider carrying out a pulpotomy to preserve the tooth and to avoid the need for an extraction.
(Conditional recommendation; low quality evidence)

  • Taking all relevant factors into account, establish which management options are appropriate and in the best interests of the child.
    • The flow diagram and the table can be used to inform management decisions for caries in the primary dentition
    • Use of dental amalgam in primary teeth should be avoided
  • Consider using bitewing radiographs for treatment planning.
  • Discuss potential management options with the child and the parent/carer.
  • Agree a caries treatment plan, staging care as necessary.
  • Avoid operative interventions involving local anaesthetic until the child can cope.
  • Use a minimally invasive approach to caries management whenever possible.
  • Manage a primary tooth which is associated with infection (signs or symptoms of abscess, sinus, inter-radicular radiolucency, non-physiological mobility) either by extraction or, in certain circumstances consider referral for pulpectomy.
    • In some cases, local measures to bring infection under control may be appropriate
  • Avoid iatrogenic damage to the proximal surface of the adjacent tooth when preparing multi-surface cavities. When restorations involve the distal of Es, take particular care to avoid damage to the first permanent molar. The Hall Technique may be indicated.
  • Obtain valid consent from the child or their parent/carer, depending on the age of the child.
  • Do not leave infection or caries in primary teeth unmanaged.