







































Gupta et al.                                                                                                                                        Asian Journal of Dental and Health Sciences. 2024; 4(4):1-4 

[1]                                                                                                                                                                                                                                              AJDHS.COM 

 

 

Available online at ajdhs.com 

Asian Journal of Dental and Health Sciences 
Open Access to Dental and Medical Research 

Copyright  © 2024 The  Author(s): This is an open-access article distributed under the terms of the CC BY-NC 4.0 
which permits unrestricted use, distribution, and reproduction in any medium for non-commercial use provided the 

original author and source are credited  

 

 

Full Mouth Rehabilitation of Early Childhood Caries Under General Anesthesia: 
A Case Report of 2 Cases 

Dr. Gupta Sonal 1* , Dr. Baby Abia 2 , Dr. Ayub Sheenam 3 , Dr. Prawin Akil 4  

1 Head of the Department, Department of Pediatric and Preventive Dentistry, Kanti Devi Dental College and Hospital, Uttar Pradesh, India, Mob- 
9837229077,  

2 Post Graduate Student, Department of Pediatric and Preventive Dentistry, Kanti Devi Dental College and Hospital, Uttar Pradesh, India, Mob-
7624855642,  

3 Post Graduate Student, Department of Pediatric and Preventive Dentistry, Kanti Devi Dental College and Hospital, Uttar Pradesh, India, Mob-
7463828726,  

4 Post Graduate Student, Department of Pediatric and Preventive Dentistry, Kanti Devi Dental College and Hospital, Uttar Pradesh, India, Mob-
7010241285,  

Article Info: 
_____________________________________________ 
Article History: 

Received   19 August 2024     
Reviewed  17 September 2024 
Accepted   07 October 2024 
Published 15 December 2024 

_____________________________________________ 
Cite this article as:  

Gupta S, Baby A, Ayub S, Prawin A, Full Mouth 
Rehabilitation of Early Childhood Caries 
Under General Anesthesia: A Case Report of 2 
Cases, Asian Journal of Dental and Health Sciences. 
2024; 4(3):1-4                                                                      

DOI: http://dx.doi.org/10.22270/ajdhs.v4i4.97       

Abstract 
_________________________________________________________________________________________________________________ 

ECC is a rising healthcare concern in developing countries. It leads to immediate or late 
complications, which may affect the overall well-being and development of the child. Hence treating 
it as well as modifying its risk factors at the earliest is required. Treating s-ECC may require extensive 
procedures and long appointments to which many children especially under the age of five do not 
comply. In such situations when all the other means of management has failed, treatment can be 
done under general anaesthesia which reduces the trauma caused by multiple dental visits. A 
treatment is successful only if regular recall and checkup is done. This report presents the case a 4 
yrs old female patient with Frankel’s definitely negative behaviour diagnosed with ECC and describes 
in detail its restorative and rehabilitative management carried out under General Anaesthesia. 

Keywords: General anaesthesia Full mouth rehabilitation, Early childhood caries. 

*Address for Correspondence:   

Dr. Gupta Sonal, Head of the Department, Department of Pediatric and Preventive Dentistry, Kanti Devi Dental College and Hospital, Uttar Pradesh, 
India. 

 

INTRODUCTION  

One of the most prevailing diseases among children 
worldwide is the Early Childhood Caries.1According to 
AAPD, ECC is defined as “the presence of one or more 
decayed (non-cavitated or cavitated lesions), missing 
(due to caries), or filled tooth surfaces in any primary 
tooth” in a child under the age of six.2 The WHO oral 
status and health report (2022) estimated that ECC is 
12th most prevailing disease with almost 514 million 
children suffering from it. The US Department of Health 
and Human Services reports that early childhood caries 
(ECC) is five times more common than asthma and 
seven times more common than hay fever.3  

It is caused by an imbalance in the oral microflora 
mainly due to sugar rich diet. Along with it poor oral 
hygiene, poor socio-economic status to get regular 
checkups and lack of knowledge leads to fast and 
aggressive progression of early childhood caries. It 
affects the general health of children.1  

The complexity of the ECC treatment depends on a 
number of variables, such as the child's age, the degree 
of dental damage, and any coexisting complications. 
Enamel proximal lesions and white spots in mild cases 
of ECC may not require extensive restoration. By 
providing dietary guidance, topical fluoride indications, 
and parent education, the clinician can stop additional 
decay and spread.4 

In cases ranging from moderately severe to advanced 
ECC tooth extractions followed by space maintainers, 
extensive restorations, and pulp therapy are utmost 
necessary. But because of the age group's lack of 
compliance in most cases, deep sedation or general 
anaesthesia is used in these situations.4 

Very often General Anesthesia is required to complete 
necessary dental treatment in young and uncooperative 
children. Treatment is done in the hospital, ambulatory 
surgery centre or office setting. In spite of the low 
incidence of adverse reactions from General 

                     Open Access                                                                                                                                                                                                                     Case Report                                                                           

http://jddtonline.info/
http://dx.doi.org/10.22270/ajdhs.v4i4.97
https://crossmark.crossref.org/dialog/?doi=10.22270/ajdhs.v4i4.97&amp;domain=pdf
https://orcid.org/0000-0002-7842-2217
https://orcid.org/0009-0000-7395-9341
https://orcid.org/0009-0005-4252-7016
https://orcid.org/0009-0008-3619-5299


Gupta et al.                                                                                                                                        Asian Journal of Dental and Health Sciences. 2024; 4(4):1-4 

[2]                                                                                                                                                                                                                                              AJDHS.COM 

anaesthesia, deep sedation or moderate sedation can be 
safely and efficiently used in the completion of dental 
treatment provided with well-trained professionals 
following established protocols and guidelines16.Thus 
this case report describes the full mouth rehabilitation 
of a 4yrs old an uncooperative child with ECC under 
general anaesthesia. 

CASE REPORT  

A 4-years old female patient came to the Department of 
Paediatric & Preventive Dentistry of K.D. Dental college 
and hospital, Mathura; with chief complaint of decayed 
teeth in upper & lower back teeth region since 8 months. 
Pt. did not reveal any relevant past dental and medical 
history. Patient behaviour was rated as Frankel’s 
definitely negative. On extraoral examination no 
abnormalities were detected. Intraoral examination 
revealed primary dentition with Grossly decayed teeth 
irt.64,85; deep proximal caries irt 74,84; smooth surface 
caries irt 52,51,61,62; occlusal caries irt 54,65,75.  

It was diagnosed as case of Early childhood caries and 
full mouth rehabilitation under general anaesthesia was 
advised. Consent for the treatment was attained from 
the parents. 

Treatment Planned: No intervention was required in 
the emergency phase. Antibiotic (Syrup Amoxicillin 5 ml 
BD) & Analgesic (Syrup Ibugesic 5ml BD) was to be 
administered in the systemic phase. As a preventive 
measure oral hygiene instruction and diet counselling 
was done. Pre-anaesthetic checkup was carried out in 
the preparatory phase which included blood 
investigation (Complete Blood Count, Random Blood 
Sugar, Bleeding Time, Clotting Time, Liver Function Test, 
Kidney Function Test, Electrocardiography, Chest X-Ray) 
and viral markers (HIV, HCV, HBV).  

Treatment Done: After execution of the systemic phase 
and the preventive phase and upon normal reports from 
preanesthetic assessments, patient was admitted one 
day prior to K.D Medical college and hospital, Mathura, 
Uttar Pradesh. Preanesthetic Non pharmacological 
management was carried out by educational videos and 
pictures about the procedure. Preanesthetic medication 
of oral Midazolam (0.5-0.7mg/kg) was given to induce 
anxiolysis and sedation. Intravenous anaesthetic 
induction was carried out with Propofol (continuous 

infusion of 500mcg/kg/min for 4-6min up to a max of2-
3mg/kg). In the maintenance phase, oral cavity was 
maintained in an open position with the help of Molt’s 
mouth prop, rubber dam isolation done. Corrective 
procedures were carried out quadrant wise that 
included  

Corrective procedures were carried out quadrant wise 
that included pulpectomy irt #84 #85 #74 #64 by 
obtaining straight line access, adequate irrigation with 
1%NaoCl and normal saline alternatively, root canals 
were obturated with Metapex, post obturation seal was 
done with Glass ionomer cement and as the crown 
structure was not sufficient to retain the restoration a 
stainless-steel crown was adapted on to each pulpaly 
treated teeth.  

#52, #51, #61, #62 were affected by smooth surface 
caries involving more than two tooth surfaces. Celluloid 
strip crown (3M ESPE, USA) was selected according to 
each teeth size and was cut to appropriate length, vent 
holes were made in the proximal region. After 
customising the crown to fit the teeth, caries were 
excavated from teeth surface using hand instruments, 
teeth surface cleansed with water to remove caries 
debris, followed by etching with 37% phosphoric acid, 
dentin conditioning and photoactivation , the strip 
crown was filled with composite resin (3M ESPE St, 
Paul, MN, USA)(A1 shade) and adapted to the tooth 
surface, excess material was removed with a probe and 
it was photoactivated for 40sec.occlusal adjustments 
and polishing was done soon after. 

Occlusal caries irt #54, #65, #75 were excavated, cavity 
air dried and restored using GIC (GC Gold Label- High 
strength Posterior Restorative). 

Topical fluoride (Duraphat®) was applied and rubber 
dam removed. Thorough intraoral examination was 
carried out to ensure that the oral cavity was devoid of 
any foreign bodies/Dental materials. 

Post operative care: After successful treatment pt. was 
stabilised and was discharged after 6 hours of 
monitoring. Antibiotics and Analgesics were prescribed, 
post operative and  oral hygiene instructions were given 
and soft diets was advised and patient was recalled for 
check-up after 1 week followed by successive visits 
every 6 months. 

 

Pre-Treatment Photographs 

    

 
FRONTAL VIEW MAXILLARY OCCLUSAL VIEW MANDIBULAR OCCLUSAL VIEW` 



Gupta et al.                                                                                                                                        Asian Journal of Dental and Health Sciences. 2024; 4(4):1-4 

[3]                                                                                                                                                                                                                                              AJDHS.COM 

 Post- Treatment Photographs 

  

 

 

 

 

DISCUSSION 

Despite many recent awareness and advancements in 
the preventive measures, ECC continues to be most 
prevalent among pre-school children hence requiring 
intervention by a dental professional at an early 
stage4.Oral health related quality of life is a vital part of 
general health and well-being.  

Early childhood caries has a negative impact on children 
life including pain while sleeping or mastication, 
reduced appetite, weight loss, alteration in sleep wake 
cycle, low self-esteem and decrease in academic 
performance7.Adding to it the dental impact it can have 
on the successor teeth increases the need to intervene 
the situation with appropriate treatment. 

The management of patients with ECC is not a simple 
task keeping in mind the tender age of the patient 
adding to the anxiousness and uncooperativeness 
towards the dental treatment. Success of the treatment 
depends on the cooperativeness during the dental 
procedure. 

In this case report, the child was very reluctant and 
uncooperative on her first dental visit. So patient was 
counselled and behaviour shaping was done with 
various non pharmacological behaviour modification 
techniques, which did not give a positive outcome and 
hence lowered the success rate of future 
treatments6.Although dental care under GA is a more 
costly option, there are situations like this when it is the 
best course of action for treating children who are 
difficult to manage. 

The oral rehabilitation of child suffering from ECC 
depends on the age of child, their cooperation 
throughout the procedure, any underlying medical 
history etc. Apart from functional rehabilitation, 
aesthetic rehabilitation in young children also is a key 
factor concerning aesthetics and phonetics8. 

In this case primary molars #84 #85 #74 #64 
pulpectomy was done 1%NaoCl was used as suggested 
by Paragliola et al and Pashley et al)9,10 and normal 
saline alternatively, root canals were obturated with 
Metapex. Etman A et al, Ramar K et al11,12suggested in 

their studies that metapex was a better than other 
dental materials Post obturation seal was done with 
Glass ionomer cement and as the crown structure was 
not sufficient to retain the restoration a stainless-steel 
crown was adapted on to each pulpally treated teeth. 
Moskovitz et al had suggested that the endodontically 
treated primary teeth should be given stainless steel 
crown if there was no adequate tooth structure to retain 
the post endo restoration for long-term prognosis13. 

The premature loss of deciduous anterior teeth will alter 
the path of eruption of permanent incisors. This will 
lead to a great arch length discrepancy, finally resulting 
in malocclusion. The age of 2-4 is considered very 
significant because there are increased risk primary 
incisors being affected by Trauma/ ECC. Partial or total 
loss of anterior teeth at this age will cause phycological 
imbalance on children and thus effecting their self-
esteem and social skills14,15. 

Hence in this case #52, #51, #61, #62 were affected by 
smooth surface caries. Since it was not pulpally affected, 
restoration using strip crown was done (Thribhuvanan 
L et al). This restored the aesthetics and aided in 
establishing the phonetics. 

Success of a treatment depends on the recall visits and 
proper follow-up. Recall appointments should be 
planned depending on the clinicians’ assessments of 
patient’s caries risk (Negi D et al)6. Hence in this case 
patient was recalled after 1 week followed by successive 
visits every 6 months. 

When dealing with extensive ECC damage in 
uncooperative children, general anesthesia may be 
preferable in some instances. However, strict adherence 
to post-operative plans is essential to preserve any 
positive rehabilitation outcomes. Unreported caries 
recurrence may be the result of poor follow-up 
compliance or participant withdrawal16. 

CONCLUSION  

Early childhood caries is a deleterious condition that 
requires prompt intervention. The aim of treating under 
General Anaesthesia is to restore the oral health of the 
patient in a single visit and prevent any anxiety 

PLACEMENT OF SSC 

CROWN IN 64 

PLACEMENT OF SSC 

CROWN IN 74 
PLACEMENT OF SSC 

CROWN IN 84,85 



Gupta et al.                                                                                                                                        Asian Journal of Dental and Health Sciences. 2024; 4(4):1-4 

[4]                                                                                                                                                                                                                                              AJDHS.COM 

associated with frequent dental visits as treatment for 
ECC requires extensive work. To ensure complete 
success of the treatment the risk factors associated with 
ECC should also be identified and appropriate treatment 
should be initiated to prevent the decline of oral health 
and regular oral hygiene should be maintained and 
monitored.  

Conflict of Interest Statement: Authors disclose no 
potential conflicts of interest 

Source of Support: Nil 

Funding: This work is not financiered 

Ethics Statement: Not Applicable 

Acknowledgements: Not applicable 

Author Contributions: All authors have equal 

contribution in the preparation of manuscript and 

compilation. 

REFERENCES 

1. Meyer F, Enax J. Early childhood caries: epidemiology, aetiology, and 
prevention. International journal of dentistry. 2018 May 22;2018. 
https://doi.org/10.1155/2018/1415873 

2. American Academy of Pediatric Dentistry. Policy on early childhood 
caries (ECC): Consequences and preventive strategies. The 
Reference Manual of Pediatric Dentistry. Chicago, Ill.: American 
Academy of Pediatric Dentistry; 2023:88-91. 

3. Devan I, Ramanarayanan V, Janakiram C.Prevalence of early 
childhood caries in India: A systematic review andmeta analysis. 
Indian J Public Health 2022;66:S3 11. 
https://doi.org/10.4103/ijph.ijph_1078_22 

4. Tungare S, Paranjpe AG. Early childhood caries 2018 

5. Shreyans Jain, Nilesh Rathi, Nilima Thosar, Sudhindra Baliga, Pooja 
Bhansali, Kalyani Rathi, Nikita Sharma. Full mouth rehabilitation 
ofa pediatric patient under general anesthesia-A case report. 
Medical Science, 2020;24(101):22-25 

(2) (PDF) Full mouth rehabilitation of a pediatric patient under 
general anesthesia-A case report. 

6. Negi D. Full mouth rehabilitation of child with early childhood 
caries. Int J Pedod Rehabil 2021;6:35-7 
https://doi.org/10.4103/ijpr.ijpr_12_21 

7. Singh N, Dubey N, Rathore M, Pandey P. Impact of early childhood 
caries on quality of life: Child and parent perspectives. Journal of 
oral biology and craniofacial research. 2020 Apr 1;10(2):83-6. 
https://doi.org/10.1016/j.jobcr.2020.02.006 

8. Thribhuvanan L, Saravanakumar MS, Anjana G. Full Mouth 
Rehabilitation of a 4-Year-Old Child with Severe Early Childhood 
Caries: A Case Report. J Pediatr Dent 2021;7(2):99-103 
https://doi.org/10.14744/JPD.2021.07_54 

9. . Paragliola R, Franco V, Fabiani C. Final Rinse Optimization: 
Influence of Different Agitation Protocols. J Endod, 2010; 36:282-
5. https://doi.org/10.1016/j.joen.2009.10.004 

10. Pashley EL, Birdsong NL, Bowman K, Pashley DH. Cytotoxic effects 
of NaOCl on vital tissue. J Endod, 1985; 11:525-528. 
https://doi.org/10.1016/S0099-2399(85)80197-7 

11. Etman A. Success of pulpectomy in primary molars using a 
modified obturating materials (a comparative study between 
Metapex and Endoflas). Egyptian Dental Journal. 2023 Oct 
1;69(4):2599-607. 
https://doi.org/10.21608/edj.2023.222984.2637 

12. Ramar K, Mungara J. Clinical and radiographic evaluation of 
pulpectomies using three root canal filling materials: An: in-vivo: 
study. Journal of Indian Society of Pedodontics and Preventive 
Dentistry. 2010 Jan 1;28(1):25-9. https://doi.org/10.4103/0970-
4388.60481 

13. MOSKOVITZ, M., YAHAV, D., TICKOTSKY, N., & HOLAN, G. (2010). 
Long-term follow up of root canal treated primary molars. 
International Journal of Paediatric Dentistry, 20(3)l207-213. 
https://doi.org/10.1111/j.1365-263X.2010.01038.x 

14. Kanasi E, Dewhirst FE, Chalmers NI, et al. Clonal analysis of the 
microbiota of severe early childhood caries. Caries Res 
2010;44(5):485-497 https://doi.org/10.1159/000320158 

15. Thribhuvanan L, Saravanakumar MS, Anjana G. Full Mouth 
Rehabilitation of a 4-Year-Old Child with Severe Early Childhood 
Caries: A Case Report. J Pediatr Dent 2021;7(2):99-103 
https://doi.org/10.14744/JPD.2021.07_54 

16. Campbell RL, Shetty NS, Shetty KS, Pope HL, Campbell JR. Pediatric 
dental surgery under general anesthesia: uncooperative children. 
Anesthesia progress. 2018 Dec 1;65(4):225-30. 
https://doi.org/10.2344/anpr-65-03-04

 

https://doi.org/10.1155/2018/1415873
https://doi.org/10.4103/ijph.ijph_1078_22
https://doi.org/10.4103/ijpr.ijpr_12_21
https://doi.org/10.1016/j.jobcr.2020.02.006
https://doi.org/10.14744/JPD.2021.07_54
https://doi.org/10.1016/j.joen.2009.10.004
https://doi.org/10.1016/S0099-2399(85)80197-7
https://doi.org/10.21608/edj.2023.222984.2637
https://doi.org/10.4103/0970-4388.60481
https://doi.org/10.4103/0970-4388.60481
https://doi.org/10.1111/j.1365-263X.2010.01038.x
https://doi.org/10.1159/000320158
https://doi.org/10.14744/JPD.2021.07_54
https://doi.org/10.2344/anpr-65-03-04

