Abstract

Introduction: Severe Early Childhood Caries (S-ECC) is an acute pattern of dental caries, that causes pain, infection, early teeth loss and chewing difficulties. Its treatment is also difficult because affected patients usually need repetitive visits to the dentist that may cause behavioral problems during dental procedures. In S- ECC affected children, a combined therapeutic approach is some- times required to manage both patient behavior and restoration success. Case report: A healthy 5-year-old boy was referred to the Special- ization Program in Pediatric Dentistry, Universidad de Talca, Chile. He presented a history of S-ECC and behavioral problems. Clinical examination revealed an early extraction, several enamel defects, arrested caries with Silver Diamine Fluoride (SDF), and infiltrated restorations. After obtaining informed consent, a pre- ventive stage was undertaken based on oral hygiene instruction, dietary advice, sealants and biannual fluoride varnish applications. Then, enamel defects, SDF-arrested caries and infiltrated restora- tions were treated with resin-modified glass ionomer (RMGI). Patient behavior management was achieved using linguistic tech- nique. Tooth 8.4 was restored using preformed metal crowns affecting patient behavior. So, Hall Technique (HT) was used instead to restore tooth 7.4 with better results. At 6-months fol- low-up, the patient presented no pain or discomfort. RMGI and crown-based restorations remain intact, with good sealing, peri- odontal health and no radiographic signs of pulpal pathology.Comments: This combined restorative technique; HT, SDF and RMGI seem to be effective in treating S-ECC patients with behavioral problems for at least 6 months. Long-term follow-up evaluating this treatment approach in similar clinical situations is suggested.