Children make up a significant proportion of the patients seen in everyday care, and present with both common and unique issues within the dentition. In 2024/25, there were 12 million courses of treatment provided to paediatric patients in England, a 7% rise from 2023/24.[i] In the 12 months prior to 31 March 2025, 6.9 million child patients were seen by professionals, approximately 57% of the mid-year child population for England in 2024.i
Tooth decay is a significant challenge affecting paediatric patients today, caused by a high-sugar diet and insufficient oral hygiene routines.[ii] Clinicians should advise on how to minimise the development of caries, but also be prepared to intervene when problems emerge.
Remove and restore
In many cases, the progression of caries will require a clinical team to remove affected tissue and restore the tooth. Amalgam has been ruled out for use in deciduous teeth and children under 15 years old,[iii] and following a phase-out in countries in the European Union last year, a global ban will begin for all treatment in 2035.[iv] Composite materials are therefore a preferred solution.
Removing carious tissue can prevent the further spread of decay, and a composite restoration may optimise aesthetics and restore function. This requires extreme care and a minimally invasive workflow, as clinicians must identify the line between hopeless decayed tissue and that which may yet remineralise.
A fresh approach
When assessing non-invasive, efficient treatment methods for arresting tooth decay, silver diamine fluoride (SDF) is a debated solution. The clear, topical liquid is applied to the affected area, and releases silver and fluoride for synergistic effects; silver is bactericidal and disrupts the cariogenic biofilm, whilst fluoride promotes remineralisation.[v]
The solution is licensed for use in the UK when treating sensitivity only, and its application for managing decay is currently ‘off-label’, but this is becoming increasingly recommended overseas.[vi]
Systemic reviews have found that SDF is an effective solution for arresting caries, whilst being simple to provide, non-invasive, painless, inexpensive and non-aerosol-generating.[vii] One systematic review and meta-analysis from 2017 found that the use of SDF was 89% more effective in controlling caries than other treatments.[viii]
It must be warned that the product has a staining potential, meaning it is not commonly used in treatments for the permanent dentition.viii SDF permanently affects carious tissue, turning it a dark brown or black, with potential brown staining of soft tissues for 1-3 weeks if application is not performed with care.v
As an understanding of its potential for use grows, SDF could become a more prominent solution for preventing the spread of caries in the primary dentition, whilst avoiding invasive care. This is both maintains natural tissue, and reduces the need for more anxiety-inducing procedures such as extractions.
Arrest at source
In cases where the primary molars are affected by caries, the Hall Technique is judged to be an effective approach. It involves the cementation of a pre-formed stainless-steel crown over the affected tooth, without the need for local anaesthesia, caries removal or tooth preparation of any kind.[ix] Case selection is key.
Its implementation arrests the carious tissue, sealing the plaque layer which then changes its composition to become less cariogenic.[x] A 2017 paper notes that the Hall Technique is predictable and highly effective, with increased success rates (no pain or infection) when compared to other treatments in 99% of cases at one year, 98% over two years and 97% over five years according to trials in the UK.[xi]
As expected, a stainless steel crown has aesthetic limitations, and may not be preferred by patients for this reason.
Prevention is key
As ever with the management of dental caries, prevention is always better than cure. Encouraging parents to attend regular dental appointments both early in a child’s life and when the permanent dentition erupts, not only allows the clinical team to monitor an individual’s development, but also minimises the chance of caries developing.
Pit and fissure sealants are one such solution. Recognised as an effective way to prevent carious lesions in the permanent dentition,[xii] the sealants avoid plaque and food debris from collecting in the grooves of occlusal surfaces, enabling simpler cleaning.[xiii]
Material choice is crucial. It must be able to manage occlusal forces, whilst enabling simple application. Aesthetics must also be considered for complete patient satisfaction. The new Solventum™ Filtek™ Easy Match Flowable Restorative is an ideal choice, using a three-shade system to simplify preparation routines and ensure a natural appearance with confidence. Indicated for pit and fissure sealants, the flowable restorative offers excellent polish retention and wear resistance. Plus, if caries does develop, the material can be highly effective for aesthetic and functional restorations throughout the dentition.
Support for childhood caries takes on a wide manner of forms. Intervention after caries has developed is key to prevent further pain and infection, but prevention will always be preferred. Luckily, the dental team is best placed to support either situation.
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[i] NHS Business Services Authority, (2026). Dental statistics – England 2024/25. (Online) Available at: https://www.nhsbsa.nhs.uk/statistical-collections/dental-england/dental-statistics-england-202425 [Accessed April 2026]
[ii] NHS, (2025). Tooth decay. (Online) Available at: https://www.nhs.uk/conditions/tooth-decay/ [Accessed April 2026]
[iii] NHS Business Services Authority, (2026). Can I provide an amalgam filling? (Online). Available at: https://faq.nhsbsa.nhs.uk/knowledgebase/article/KA-02021/en-us [Accessed April 2026]
[iv] European Commission, (2025). Global ban on mercury in dental treatment adopted. (Online) Available at: https://environment.ec.europa.eu/news/global-ban-mercury-dental-treatment-adopted-2025-11-07_en [Accessed April 2026]
[v] Scottish Dental Clinical Effectiveness Programme, (N.D.). Silver diamine fluoride. (Online) Available at: https://www.childcaries.sdcep.org.uk/guidance/dental-techniques/non-restorative-cavity-control/silver-diamine-fluoride/ [Accessed April 2026]
[vi] NHS Northern Care Alliance, (2025). Oral Surgery – Silver Diamine Fluoride (SDF) liquid treatment. (Online) Available at: https://www.northerncarealliance.nhs.uk/patient-information/patient-leaflets/integrated-community-services-silver-diamine-fluoride-sdf-liquid-treatment?q=%2Fpatient-information%2Fpatient-leaflets%2Fintegrated-community-services-silver-diamine-fluoride-sdf-liquid-treatment [Accessed April 2026]
[vii] Yan, I. G., Zheng, F. M., Gao, S. S., Duangthip, D., Lo, E. C. M., & Chu, C. H. (2022). A review of the protocol of SDF therapy for arresting caries. international dental journal, 72(5), 579-588.
[viii] Chibinski, A. C., Wambier, L. M., Feltrin, J., Loguercio, A. D., Wambier, D. S., & Reis, A. (2017). Silver diamine fluoride has efficacy in controlling caries progression in primary teeth: a systematic review and meta-analysis. Caries research, 51(5), 527-541.
[ix] University of Dundee, Innes, I., Evans, D., (N.D.) The Hall Technique, A child centred approach to managing the carious primary molar. (Online) Available at: https://heeoe.hee.nhs.uk/sites/default/files/1311845532_nqvh_the_hall_technique_manual.pdf [Accessed April 2026]
[x] Altoukhi, D. H., & El-Housseiny, A. A. (2020). Hall technique for carious primary molars: a review of the literature. Dentistry journal, 8(1), 11. Altoukhi, D. H., & El-Housseiny, A. A. (2020). Hall technique for carious primary molars: a review of the literature. Dentistry journal, 8(1), 11.
[xi] Innes, N. P. T., Evans, D. J. P., Bonifácio, C. C., Geneser, M., Hesse, D., Heimer, M., … & Santamaria, R. M. (2017). The Hall Technique 10 years on: Questions and answers. British dental journal, 222(6), 478-483.
[xii] Amend, S., Boutsiouki, C., Winter, J., Kloukos, D., Frankenberger, R., & Krämer, N. (2024). Clinical effectiveness of pit and fissure sealants in primary and permanent teeth of children and adolescents: an umbrella review. European Archives of Paediatric Dentistry, 25(3), 289-315.
[xiii] Oral Health Foundation, (2026). Pit and fissure sealants. (Online) Available at: https://www.dentalhealth.org/pit-and-fissure-sealants [Accessed April 2026]
