Pediatric Dentistry · patient case with 1 question
Four carious primary teeth and one that is not
Patient: Male, 5 years old
Chief Complaint: Mother: “The dentist at school said he has holes in his teeth.”
Background: Cooperative for examination and radiographs. Bottle used at night until age three. Snacks frequently. No fluoride exposure. Caries risk assessed as HIGH.
Findings: Teeth #L and #K have deep frank cavitation extending well into dentine and involving multiple surfaces. Tooth #T has deep occlusal caries. Tooth #S has a NON-CAVITATED occlusal lesion confined to enamel with an INTACT surface, not reaching the dentino-enamel junction radiographically.
Question 1
What is the appropriate management of tooth #S?
Show answer and explanation
Correct answer: B. Resin-based sealant with fluoride varnish and short-interval review
- A. Any conventional restoration requires cavity preparation, which means cutting away sound tooth structure in order to treat a lesion that has not yet cavitated. The lesion has not earned a restoration.
- B. CORRECT. A NON-CAVITATED lesion confined to enamel with an INTACT surface does not require restoration. A RESIN-BASED SEALANT arrests it by cutting the biofilm off from its substrate; the evidence for sealing over incipient occlusal lesions is good, and bacteria beneath a properly sealed surface become non-viable. This is the minimally invasive answer, and it should be combined with fluoride varnish, dietary counselling and short-interval review, since the caries risk is clearly high.
- C. Extraction of a restorable — indeed barely carious — primary molar loses the space and is wholly unjustified.
- D. A stainless steel crown is the correct answer for #L and #K — deep multi-surface caries in a primary molar in a high-risk child, where a crown outperforms an intracoronal restoration for longevity. It is substantial over-treatment for a lesion that has not broken the enamel surface.
Note: ⚠️ Read WHICH SURFACE the stem specifies, because the answer changes. A sealant cannot be placed on a PROXIMAL surface — an incipient non-cavitated proximal enamel lesion is managed by remineralisation with fluoride varnish or silver diamine fluoride, interproximal cleaning and radiographic monitoring. The general rule: non-cavitated enamel lesion → seal or remineralise; cavitated dentinal lesion in a primary molar in a high-risk child → stainless steel crown.