Early childhood caries (ECC) are a clinical problem with a considerable impact, because they often require the clinician to intervene on the patient without being able to put any preventative measures in place. These, in addition to the actual role of protection from the disease, are in fact useful for the patient to get used to the clinical environment and the dentist while developing the therapeutic alliance, as well as in educating the caregiver.

As regards anxiolytic methodology, the basis is represented by the behavioural approach, while the apex corresponds to those cases assigned to sedation or general anaesthesia. Specialist associations such as the American Academy of Pediatric Dentistry (AAPD) and also the American Academy of Pediatrics (AAP) have updated their guidelines in order to include sedation protocols.

Recently, an interesting article by Meyer and colleagues proposed a protocol (in the form of decision tree) dedicated to the first and second stages of childhood conditions which would be treatable by restorative or surgical means, is not accompanied by systemic symptomatology.

Once the condition has been identified, the first data to consider is precisely the degree of collaboration offered by the patient in an outpatient setting. If sufficient, the patient can be directed towards conventional treatment. Otherwise the first alternative   is non-surgical therapy, based on close monitoring and topical application of fluorides or glass ionomer cements, products that are less demanding in operative terms than composites. This method is defined by the authors themselves as chronic disease management (CDM) and framed not as a treatment in the strict sense, but in an operational context. Within this framework the patients are grouped on the basis of age (under 2 years), weight (under 11 kg), stage of dentition (incomplete primary teeth) and compensation for general health.

However, the extension of the carious pathology must be weighed against this. In fact, general anaesthesia ensures the most acceptable cost-benefit ratio when it allows more than 3 sessions in the chair to be bypassed, paradoxically both in the healthy patient, from the systemic point of view and in the most compromised one (ASA 3 and 4).


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