Although advances in the application of preventive dentistry techniques, widespread acceptance of community fluoridated water, and increased dental education in parents have reduced the incidence of caries in children, there is still a high prevalence of early childhood caries (ECC) especially in the lower socioeconomic population.

ECC, formerly termed “nursing bottle caries” and “baby bottle decay,” is the term currently used to describe the occurrence of caries in young children’s teeth. It affects 1-12% of the pediatric population in developed countries, and up to 70% in underdeveloped countries. It is defined by the American Academy of Pediatric Dentistry as “the presence of 1 or more decayed (noncavitated or cavitated) lesions, missing (due to caries), or filled tooth surfaces in any primary tooth in a child 71 months of age or younger. Severe ECC is defined as any sign of smooth surface caries in a child younger than 3 years of age or 1 or more cavitated, missing (due to caries), or filled smooth surfaces in primary maxillary anterior teeth, or a decayed, missing, or filled score of >4 (age 3), >5 (age 4) or >6 (age 5) surfaces.”

ECC is a result of excessively frequent ingestion of liquids containing fermentable carbohydrates (milk, formula, juice, soda) by the child at sleep time particularly through a bottle. Prolonged breast feeding has also been implicated in ECC.1

The clinical appearance of severe ECC follows a definite pattern. There is early carious involvement of the maxillary incisors followed by the maxillary and mandibular first primary molars and the mandibular cuspids.2

Aesthetic treatment of severely decayed anterior primary teeth is one of the greatest challenges to pediatric dentists. In the last half century the emphasis on treatment of extensively decayed primary teeth shifted from extraction to restoration. Early restorations consisted of placement of stainless steel bands or crowns on severely decayed teeth. While functional, they were unaesthetic and their use was limited to posterior teeth.

Over the last two decades there has been an explosive interest by adults in aesthetic restoration of their compromised dentition. Similarly, a higher esthetic standard is expected by parents for restoration of their children’s carious teeth. Thus the choice of full coverage restorations for primary teeth must provide an aesthetic appearance in addition to restoring function and durability.

Aesthetic full coverage restorations are available for anterior and posterior primary teeth. This continuing education course will concentrate on aesthetic full coverage restorations for anterior primary teeth.