Tooth decay is the most common childhood disease in America. It is a bacterial infection that causes breakdown of the outermost layer of the tooth. Tooth decay starts as a white spot on the tooth that can progress to a cavitation (hole) within a matter of months. Left untreated, the bacteria in the cavity spread to the nerve of the tooth, and from there can cause a serious infection. How far the infection ultimately spreads depends on many variables. The infection can be as mild as swelling around the tooth or could lead to a life-threatening facial infection requiring an emergency tracheotomy. Dental infections can also become septic and travel through the bloodstream to infect major organs. Prevention is the best method to keep these harmful bacteria from wreaking havoc. Despite our best efforts in prevention, cavities do occur. Restorative dentistry is a procedure that repairs or limits damage from cavities, protects and preserves tooth structure, and restores esthetics. Restorative procedures include fillings, crowns, and cosmetic bonding to repair broken teeth. More advanced decay requires pulpal therapy or possibly extractions.
Composite is a tooth-colored filling material that provides an esthetic dental restoration for front and back teeth. It can be used for small to average-sized cavities in primary teeth and almost any permanent tooth. Placement of white fillings is very technique sensitive and requires a high level of child cooperation and good oral hygiene practices at home. Advances in dental science have allowed composite fillings to approach the strength and durability of conventional silver fillings. Our office does not place silver (amalgam) fillings.
Crowns for Primary Teeth
Crowns on baby teeth (or even young permanent teeth in some cases) are indicated when:
- The cavity is large and covers multiple surfaces of the primary tooth
- Permanent teeth are extensively decayed or have severe developmental defects
- The child is at a high risk for future cavities
- A tooth has received a nerve treatment (pulp therapy).
There are several types of crowns used in pediatric dentistry, including stainless steel, veneered, zirconium, and resin crowns. The restoration recommended for your child is based upon the location in the mouth, your child’s occlusion (bite), and level of cooperation, along with several other factors. Dr. Stacey can help you select the most appropriate crown for your child.
Stainless Steel Crown (posterior teeth)
The stainless steel crown (SSC) is the most durable, long-lasting dental restoration for primary teeth. It is silver in color and covers and protects the tooth until it is naturally lost. The SSC is an economical, time-efficient, mercury-free dental restoration that has been used in pediatric dentistry for over 60 years. There is a large body of dental literature that supports its durability and safety.
Zirconium Crown (anterior or posterior teeth)
The zirconium crown is an all-ceramic crown that can be placed on an anterior (front) or posterior (back) primary tooth. These crowns are relatively new to pediatric dentistry and are the most esthetically pleasing of all crown restorations. The procedure to prepare the tooth and place the crown is more technique sensitive than silver or coated crowns, and it requires a degree of patient cooperation for placement. These beautiful ceramics cannot be used successfully on every tooth requiring a crown. Dr. Stacey is happy to discuss the pros and cons with you if your child is in need of an esthetic restoration.
Resin Crown (anterior tooth)
If a child has limited anterior (front) tooth decay, a resin crown may be the treatment of choice. The resin crown is a tooth-colored crown that can be used to create a very natural-appearing restoration when decay is not extensive and the gums are healthy.
Veneered Crown (anterior tooth)
A child with severe decay on his or her front teeth may require this type of esthetic crown. A stainless steel crown is coated with an attractive resin material, and the crown is placed over the tooth after the decay is removed. This is a great restorative option to maintain teeth that may otherwise require extraction.
Pulp Therapy – Pulpotomy/Pulpectomy (i.e., “Nerve Treatment” or “Baby Tooth Root Canal”)
Pulpotomies and pulpectomies (the procedure depends upon the amount of tissue removal) are used to save severely decayed or broken teeth from extraction. A baby tooth root canal consists of removing infected tissue and replacing it with a medicament that will allow the tooth to function and exfoliate naturally. Whenever possible, primary teeth are preserved to help guide the permanent teeth into proper placement, as well as provide your child with increased dental function and esthetics. Root canals are usually very successful, but infection can still occur and regular follow-up is important.
An extraction may be required for teeth that have severely extensive decay and are not able to be restored with pulp therapy and crowns. Sometimes primary teeth will also need to be removed to facilitate the eruption of the permanent tooth. If an extraction becomes necessary on a back tooth, Dr. Stacey will discuss space maintenance therapy to preserve the space for eruption of the permanent tooth.