title: Clinical outcomes for early childhood caries: influence of aggressive dental surgery.
abstract: OBJECTIVE
  The objective of this study was to assess the relationship between the number of stainless steel crowns (SSCs) placed, number of surfaces at risk (SAR) post dental surgery, and the risk for relapse in patients treated for Early Childhood Caries (ECC).
  
  
  METHODS
  The study population consisted of 57 children treated for ECC under general anesthesia, ranging in age from 2.3 to 7.3 years old at the time of entry. Dental surgery utilized an aggressive approach: teeth that had necrotic pulps or were nonrestorable were extracted; decayed primary mandibular incisors that could not be treated by stripping were extracted; primary maxillary incisors with 3 or more carious surfaces were extracted; single-surface lesions of primary molars that did not compromise cusp integrity were restored with intracoronal amalgam restorations; primary maxillary, incisors and canines with smooth-surface lesions affecting 2 or less surfaces were treated with intracoronal composites; primary molars and canines requiring vital pulp therapy were restored with SSCs; primary molars with caries lesions affecting 2 or more surfaces (including smooth-surface, white-spot lesions) were restored with SSCs; primary canines with caries affecting 3 or more surfaces were restored with stainless steel crowns; topical fluoride was applied after all restorative therapy was completed. The cohort was examined for new caries lesions 6 months post dental surgery. Relapse was defined as the presence of new smooth-surface caries lesions as defined by Radike. Comparisons between relapse (R) and nonrelapse (NR) groups, with respect to the number of SSCs placed and the number of SAR, were performed using t tests and Wilcoxon tests. A 0.05 level of significance was employed in all statistical tests.
  
  
  RESULTS
  Twenty-one of the 57 (37%) patients relapsed. No statistically significant difference for the number of SSCs placed or SAR existed between the R group (SSCs: mean = 4.57, median = 4 +/- 2.18; SAR: mean = 39.76, median = 40 +/- 13.62) and NR group (SSCs: mean=5.44, median = 5.5 +/- 2.62; SAR: mean = 39.98, median = 39.5 +/- 15.19).
  
  
  CONCLUSIONS
  The risk for relapse in children treated for ECC is not associated with the number of SSCs placed or SAR; aggressive dental surgery for ECC does not result in acceptable clinical outcomes.
authors.affiliation: Division of Pediatric Dentistry, University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: C E
authors.initials: CE
authors.lastname: Graves
authors.forename: R J
authors.initials: RJ
authors.lastname: Berkowitz
authors.forename: H M
authors.initials: HM
authors.lastname: Proskin
authors.forename: I
authors.initials: I
authors.lastname: Chase
authors.forename: P
authors.initials: P
authors.lastname: Weinstein
authors.forename: R
authors.initials: R
authors.lastname: Billings
mesh_terms: D002648:Child; D002675:Child, Preschool; D003188:Composite Resins; D003442:Crowns / Q000706:statistics & numerical data*; D003723:Dental Amalgam; D003731:Dental Caries / Q000628:therapy*; D019232:Dental Restoration Failure; D003793:Dental Restoration, Permanent / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012008:Recurrence; D013193:Stainless Steel; D018709:Statistics, Nonparametric; D014081:Tooth Extraction; D016896:Treatment Outcome
chemical_list: D003188:Composite Resins; D013193:Stainless Steel; D003723:Dental Amalgam