Child Tooth Decay Treatment Options
Our goal is to save teeth and preserve as much tooth structure as possible. Even the best filling is never as good as healthy tooth structure. When a cavity is small and limited to the dentin, a tooth colored composite restoration is often the best option for restoring it. At Stellar Kids Dentistry, we do not do mercury containing amalgam fillings.
Composite: This is generally the best filling material for cavities. All of our restorative materials and fillings are free of Bisphenol A (BPA) and Bisphenol A dimethacrylate (Bis-DMA). Our composite restorations are conservative and match the shape and color of your child’s teeth.
Glass Ionomer: Much more common in Europe, we may recommend a glass ionomer restoration for your child. GI restorations are faster to place than composites which is helpful when patients are pre-cooperative. Also, they are more biocompatible and have active fluoride rechanging and release. However, GI does not have the strength and wear characteristics of composite fillings. Our preferred glass ionomer is Equia Forte, as it is currently the best product on the market.
When cavity decay or trauma has damaged a tooth to the point that it cannot support a filling, or when a pulpotomy (nerve treatment) has to be performed, it is best to seal and protect the tooth with a crown.
A crown or cap is a shell-like covering that completely restores a damaged tooth. It is more durable than fillings. Crowns are beneficial when a baby tooth has extensive decay, fracture, or when the enamel is poorly formed, soft, or didn’t develop properly. Unlike adult crowns, all of our crowns are custom fitted and require only one visit.
Stainless steel and porcelain crowns are placed on baby molars due to the extra strength needed for chewing. Composite crowns are placed on the front teeth for a more natural look.
At Stellar Kids Dentistry, we use composite crowns to restore large cavities on front teeth. We are also experienced in several other restoration types, such as Cheng, Acero, NuSmile (stainless steel with esthetic veneers), and Sprig (all zirconia). However, composite crowns are the best. They are the most conservative (requiring the least amount of tooth structure removal) and the more lifelike in terms of esthetics.
Porcelain (Zirconia) crowns are a good option to restore large cavities on back teeth. They are esthetic and metal free. However, they do have some significant drawbacks. Since they are made of porcelain, they are brittle compared with stainless steel and require bulk for strength. To achieve the appropriate thickness, additional removal of tooth structure is required. This weakens the remaining tooth structure. Also, since they require more extensive preparation, it’s almost always necessary to perform an additional pulpotomy procedure on your child’s tooth. Finally, many insurance companies do not allow porcelain restorations for baby teeth. Ultimately, their cosmetic appearance is the only true benefit. Though we are very experienced with Zirconia crowns, stainless steel crowns are better in almost every other way.
Stainless Steel Crowns
Stainless Steel Crowns are the best option for baby molars since they fully cover and protect the tooth. They provide excellent strength and seal when a tooth requires a pulpotomy. And, they replace the size and feel of the tooth. Baby molars are important placeholders for the permanent tooth that will eventually replace it. SSCs ensure there is no chance of another cavity forming on that same tooth.
Indirect/Direct Pulp Cap:
When a cavity is near the nerve of the tooth, a pulp cap can preserve the health of the pulp chamber (nerve) and prevent future sensitivity. We’ll sometimes place this medicated base or liner over the deepest portion of the cavity. This is called pulp capping and is more common with permanent teeth than primary teeth. We then build a filling over this base.
When tooth decay is very near or penetrated into the pulp chamber of a baby tooth, it is sometimes necessary to perform a pulpotomy prior to restoration. Using an egg analogy, the ‘yolk’ of a tooth is where the living part of a tooth resides. It includes the sensory nerves, soft tissue, and blood supply. These living tissues are defenseless against the bacteria of dental caries. Without removing the decay and performing a pulpotomy, the inflammation in the pulpal area will progress. Your child’s tooth may develop a dental infection and pain. This would result in an early loss of their tooth.
A pulpotomy is the removal of the inflamed and infected nerve tissue, while leaving the healthy root canals intact. It ensures that your child’s tooth does not develop future pain or dental infection. At Stellar Kids Dentistry, our pulpotomies are not “baby root canals.”
An opening is made in the top of the tooth and the infected nerve tissue will be cleaned and disinfected. An MTA medication is placed onto the floor of the pulp chamber to promote healing of the still vital portion of nerve in the tooth roots. Then, a soothing intermediate restorative material (IRM) fills the rest of the inside. After a pulpotomy is performed, a crown is placed to seal and protect the tooth.
Without this treatment, your child could eventually experience pain or a dental infection and may need to have their tooth removed prematurely.
When the nerve of a baby tooth is irreversibly inflamed or infected, a more extensive nerve treatment is necessary. This ‘baby root canal’ cleans, disinfects, and fills the entire root system of the baby tooth. This uncommon procedure is a last resort when a tooth is in pain or in very early stages of infection.
It is somewhat similar to a pulpotomy. However, all the nerve and vital tissue inside the pulp chamber and roots are cleaned and disinfected. The root is sealed and filled with a calcium hydroxide/iodoform paste (Vitapex). Then, a crown is placed.
A careful extraction is the removal of a tooth and tooth root with minimal injury to the surrounding gums. There are several reasons a tooth may need extraction.
- An over-retained baby tooth that is not very loose and is causing it’s permanent tooth to grow in crooked
- The baby tooth has a large cavity, pain, or infection and can’t be saved.
- Severe dental trauma
- Orthodontic crowding
- Supernumerary or extra tooth (mesiodens is one sub-type)
- Impacted or ankylosed tooth (i.e. tooth is fused to adjacent bone)
- Wisdom teeth that don’t have enough space in the mouth
111 SE Everett Mall Way, Ste. D
Everett, WA 98208
T: (425) 212-1810
13209 44th Ave SE, Ste. 101
Mill Creek, WA 98012
T: (425) 381-4990