Pediatric Dentistry · patient case with 1 question
Child with caries in several primary teeth
Patient: Female, 6 years old
Chief Complaint: Mother: “Her dentist said she has several cavities.”
Background: Healthy, cooperative, attends regularly, low sugar frequency, brushes twice daily with fluoride toothpaste. Fluoridated water supply.
Vital Signs: BP 94/60 mmHg · HR 92 bpm · T 98.4°F
Findings: Tooth L: large cavitated lesion involving BOTH the occlusal and lingual surfaces with undermined marginal ridge. Tooth K: DISCRETE proximal lesion on the radiograph, cavitated but confined to the outer dentine, marginal ridge intact. Tooth S: small cavitated occlusal lesion only. All teeth vital and asymptomatic.
Question 1
What is the most appropriate restoration for tooth K, the discrete PROXIMAL lesion?
Show answer and explanation
Correct answer: C. A conservative Class II restoration in composite or amalgam
- A. Silver diamine fluoride ARRESTS caries; it does not restore contour or contact. It has a real place — in a pre-cooperative child, in a tooth close to exfoliation, or as an interim measure where definitive care must be deferred — but this child is cooperative and the lesion is restorable.
- B. A sealant is for a NON-cavitated pit and fissure lesion. A cavitated proximal lesion cannot be sealed, and tooth S with its small cavitated occlusal lesion needs a conservative composite rather than a sealant.
- C. CORRECT. A SINGLE-SURFACE proximal lesion in a primary molar, cavitated but limited and with an intact marginal ridge in a low-risk, cooperative child, is restored CONSERVATIVELY as a Class II. The evidence favours a stainless steel crown for MULTI-SURFACE or extensive lesions, but restoring one proximal surface does not require full coverage.
- D. A stainless steel crown is the correct answer for tooth L, not K. The indications are multi-surface caries, extensive or undermined tooth structure, a tooth that has had pulp therapy, hypoplastic enamel, or a child at high caries risk or with poor cooperation. Tooth L, with a large lesion crossing occlusal and lingual and an undermined ridge, meets several of these.
Note: What this case adds is the sorting by LESION EXTENT across three teeth in the same mouth. The rule: non-cavitated pit and fissure → seal; single-surface cavitated → conservative restoration; multi-surface, extensive, post-pulpotomy or high-risk child → stainless steel crown; unrestorable or non-cooperative → SDF and arrest.