In our survey the mean DEFS DMFS index was higher

In our survey, the mean DEFS/DMFS index was higher for the < 3-years-old group (39.98) compared with the 3–6-years-old group (31.46) and the > 6-years-old group (17.18). During early development, younger children often have difficulty carrying out proper oral care due to their physical limitations. After 6 years of age, the exfoliation of primary teeth and the eruption of permanent teeth seem to decrease the DEFS/DMFS index until children reach 12 years. In addition, this all the way could be due to case selection associated with the hospital setting, namely that patients in the > 6 years age group may visit the hospital not for dental caries itself but rather because there is a need for surgery or because they suffer from severe dental phobia. The overall mean number of treated teeth was 16.79±8.95, with the highest number being 22.94±6.69 in the < 3-years-old age. If a patient is treated in an outpatient department, each 1-hour appointment is only able to treat one or two teeth. Moreover, if the teeth need pulp therapy, there is a great deal of discomfort and the need for more advanced treatments. In such circumstances, most children would have difficulty cooperating with these treatments. In addition to this, if the patient lives in a remote area far away from the hospital or a dental clinic, finishing all the treatment requires more time. In such circumstances, GA is a good option, as it allows all the treatments to be finished in one morning. The management of patients with rampant caries that require treatment under GA may involve the extraction of all teeth affected by caries, followed by restoration of the remaining teeth using CRFs or SSCs, together with pulp therapy for teeth with deep caries. Restoration of primary teeth with stainless steel crown has shown the highest rate of success compared with other types of restorative material, and such an approach is useful when treating primary teeth. Recently, Almeida et al reported that a group of children with early childhood caries who were treated under GA had a significantly higher subsequent caries rate than a control group who were initially caries free. They concluded that a more aggressive approach may be warranted when children have early childhood caries and require treatment under GA. O\'Sullivan and Curzon, in their investigation of restorations done under GA, also found that amalgam and composite resin restorations had higher failure rates than SSC restoration. Only 3% of SSC restorations failed in O\'Sullivan and Curzon\'s study, while 29% of amalgam and composite restorations failed. Another study conducted by Tate et al reported that the failure rates for SSC, amalgam, CRF, and composite strip crown restorations were 8%, 21%, 31%, and 51%, respectively. SSC restoration was the most reliable and surpassed amalgam, while composite restoration was the least durable for patients treated under GA, especially the use of composite strip crowns. The 3–6-years-old group had a significant higher number of primary teeth extractions. First, Cold-sensitive may have been due to the fact that patients at 6 years of age were at a stage at which there was early mixed dentition, and under such circumstances, many primary teeth, such as the central and lateral incisors, showed some degree of root resorption and mobility. As a result of such instability, extraction of the affected teeth was the first choice. Second, many of these children had rampant caries that involved the upper anterior primary teeth and an advanced caries extension, and in such circumstances, the tooth structure was seriously damaged. Tate et al showed that the failure rate of composite strip crowns was high, which were highly prone to fracture, especially after pulpectomy. In such circumstances, any severely damaged upper anterior primary teeth need to be removed and replaced with a kiddy denture. In the > 6-years-old group, there was a significantly higher number of permanent teeth that had been extracted, and this was associated with a lower number of SSCs, fewer pulpotomies, and fewer pulpectomies. This greater number of extractions of permanent teeth may have been related to some young permanent molars having advanced decay and poor restorability. If the tooth germ of the third molar was seen in a panoramic film, extraction of a first permanent molar and replacement with a second molar may have been performed. The lower number of SSCs, pulpotomies, and pulpectomies was likely due to the fact that most primary teeth among this age group were at a late stage and would exfoliated in a few years. In such circumstances, the need for endodontic treatment and SSC restoration may have been converted to tooth extraction or composite resin restoration.