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Management of Acute BBTD
ECC or BBTD
has been classified into acute and non-acute.
Both types differ in their treatments. This article emphasizes the available
treatment methods for acute S-ECC. They are described as follows.
• Immediate Treatment
Those affected with acute S-ECC express pain, infection and discomfort
as symptoms. They need medications like painkillers like paracetamol,
ibuprofen, diclofenac, naproxen, etc and antibiotics like amoxicillin,
penicillin V, erythromycin, metronidazole, etc. In case of severe cases,
hospitalization may be needed before definitive treatment.
• Stabilization of dentition
The rapid progression of caries can easily penetrate the dentine of the
permanent teeth of the young ones and enter the pulp soon which will be
damaged shortly. In the initial treatment, identification and extraction
must be considered without delaying so that the teeth are completely unrestorable.
Temporization before definitive treatment is good for those teeth.
• Definitive Treatment
Extraction of primary teeth is just one of the options for managing S-ECC.
This decision can be made after considering a few general and local factors.
The general factors include
1. Medical condition
2. Patient’s cooperation
3. Immunocompromised condition
4. Dental infection – risk for patient’s morbidity
5. Bleeding disorder
The local factors include
1. Restorability
2. The site and extent of the caries, if it includes the roots or pulp,
etc
3. Probability for malocclusion in the dentition development, i.e., balancing
and compensating the extraction must be accounted.
The employment of general anaesthesia must also be considered, since it
differs in the case of children and their tolerance levels. This is very
important in the case of several teeth being extracted and at the same
time needing others to be treated using restorative materials. The indications
for anaesthesia are
1. Children are non-cooperative such that the dentist cannot communicate
in a better manner
2. Children with learning disabilities
3. Children with extensive dental anxiety
4. Very young children who are non-cooperative even by the use of normal
behavioral guidance procedures.
5. Children with systematic disturbances or congenital anomalies which
need general anaesthesia
Follow-up
Children who have S-ECC or BBTD must be constantly reviewed for detecting
any changes, however small they may be. Children who have been detected
with clear indications of any active oral disease or any of the symptoms,
which may occur previously to the onset of the disease, must be reviewed
every 4 months until the disease is in control.
Compromised children must be reviewed based on the severity of the affected
disease or impairment or any other oral findings. Providing support through
the appropriate preventive strategies available for cases of re-mineralization
and arrest of any carious lesions is essential. It is the duty to the dentists
to provide this kind of support. For proper effective treatment, the same
dentist must be employed so that the entire history of the patient is known
better.
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