For a 3-year-old child with severe caries in four primary incisors, what is the best course of action?

In the context of a 3-year-old child with severe caries in four primary incisors, extraction is often considered the most appropriate course of action. When primary teeth are significantly decayed, especially to the point of severe caries, they may be too compromised to effectively maintain through restorative measures like fillings.

Preserving the primary teeth is important for a child's dental development, as they hold space for the permanent teeth that will erupt later. However, if the teeth are severely decayed, the risk of infection, pain, and other complications increases. Removing the compromised teeth helps prevent these issues from arising.

Fluoride treatments can be beneficial for preventing further decay but would not address the current severe state of the caries. Monitoring for growth may help understand the child’s overall development, but it does not directly resolve the current dental problems. Similarly, fillings may not be viable if the structure of the teeth is too damaged or if there is a risk of pulp involvement, which would necessitate extraction anyway.

Therefore, extraction provides a definitive solution to eliminate infected teeth and allows for proper dental health and function as the child grows.