Severe Early Childhood Caries: A Case Report

A 3-year-old child with severe early childhood caries (S-ECC) was treated under general anesthesia, with all 20 primary teeth requiring therapeutic intervention. Due to the patient’s young age, extensive carious involvement, and inability to cooperate with routine dental procedures in an outpatient setting, general anesthesia proved to be an ideal approach. The patient presented to the hospital with the chief complaint of "multiple cavities in the entire mouth over six months." Following a comprehensive oral examination and radiographic evaluation, the diagnoses included: Moderate caries in teeth 55 and 65; Deep caries in teeth 53, 54, 63, 64, 71, 72, 73, 81, 82, and 83; Pulpitis in teeth 74, 75, 84, and 85; Chronic pulpitis in teeth 51, 52, and 62; Chronic apical periodontitis in tooth 61; Interventions included composite fillings, indirect pulp capping, pulpotomy, stainless steel crowns for posterior teeth, and esthetic strip crowns for anterior teeth, achieving favorable clinical outcomes. The management of S-ECC with coexisting crowded primary dentition requires meticulous planning. In this case, the anatomical complexity impeded plaque control, exacerbating caries progression. The single-visit comprehensive rehabilitation under general anesthesia not only addressed acute pathologies but also mitigated long-term risks through preventive restorations (e.g., stainless steel crowns). Crowding-induced challenges underscore the need for interdisciplinary collaboration between pediatric dentists and orthodontists. This case highlights the importance of addressing both behavioral factors (e.g., oral hygiene practices) and anatomical risk factors (e.g., dental crowding) in pediatric caries prevention strategies.