Removing decay and repairing damaged teeth is key to both good oral health and overall well-being. While most adults would agree with the importance of protecting their adult teeth, many overlook the developmental significance of the primary dentition, or “baby teeth.” It is crucial to maintain the health of the baby teeth (even though they will eventually be replaced) because they are necessary for eating, speaking, proper growth and development of the jaws and placement of the permanent teeth. Most pediatric dental patients have both adult and baby teeth, or mixed dentition, and a pediatric dental specialist understands how proper care of both can lead to a lifetime of healthy smiles.
Tooth Sealants
Normal pits and grooves on the chewing surfaces of back teeth can trap food that can’t be removed by brushing or washed out by water or saliva. A sealant is a tough, plastic material designed to bond (stick) to tooth enamel.
The Problem:
•Protect normal pits and grooves on the chewing surface of back teeth.
•Stop small amounts of decay from growing larger.
The Solution:
A clear or tooth colored sealants is painted onto the tooth surface to “seal” the pits and grooves and protect against decay. They are generally applied to children’s first permanent back teeth. They can also be useful for adults in certain situations.
Advantages:
Sealants are an excellent way to protect chewing surfaces of teeth from decay. They are a much better financial investment than treating decay after it has started.
Disadvantages:
Sealants are not permanent. They generally last about five years with normal wear, but can wear off or chip off earlier in certain instances. Also, sealants do not prevent decay between teeth or the onset of gum disease, so regular home care and dental visits are important.
Alternatives:
There are no appropriate alternatives to sealants. If a tooth has decay, it will need a filling or other restoration.
Fillings
An inexpensive way to restore a small amount of tooth decay.
The Problem: Decay on a small portion of any tooth.
The Solution: A composite filling is a tooth colored quartz-like material. After tooth decay is removed and cleaned, this tooth colored material is layered into the tooth. Each layer is hardened or cured with highly intense visible light, and the final surface is shaped and polished to match the tooth. The final restoration is virtually invisible.
Advantages: Composite fillings are more than just attractive. They require minimal tooth preparation, in other words less healthy tooth structure is removed to restore the tooth. Also, a sealant can be placed over the remaining exposed grooves of the tooth to minimize the risk of decay on another area of the tooth.
Disadvantages: Composite fillings can be subject to wear and tear from tooth grinding and from biting into or chewing on hard objects etc.
Alternatives: In cases of extensive decay or if the baby tooth required a pulpotomy, a crown is the best option. If the decay is not treated, it will most likely increase in size and become a larger problem.
Crowns
Protect and keep badly decayed or fractured teeth.
The Problem:
Badly decayed teeth.
Fractured teeth.
Need to protect and strengthen teeth.
Tooth has had a baby root canal “pulpotomy”.
The Solution: A crown (often called a cap) covers the tooth and restores it to its original shape and size. Decay is removed and cleaned from the tooth and a preformed crown is placed over the tooth. Unlike adult crowns, in which the crown is made to fit the tooth, which require 2 appointments, baby crowns are placed in one visit, because the tooth is prepared to fit the crown.
Advantages: Crowns are incredibly strong due to the fact that they cover the entire tooth. This protects and strengthens the remaining tooth structure. They are the best chance for survival of a tooth that has had a baby root canal.
Disadvantages: Crowns are excellent restorations and have few disadvantages, however most children’s crowns are silver in color.
Alternatives: Typically there are no good alternatives to crowns. If the tooth has sustained enough damage to require a crown then the best prognosis for the tooth is to receive the crown. Placing a filling on a tooth that should have a crown will likely result in fracture, recurrent decay, and loss of that tooth.
Space Maintainers
The Problem: Premature loss of your child’s baby tooth.
The Solution: A space maintainer — a combination of bands and wires designed to hold the remaining teeth in a position that will allow the future permanent tooth to erupt in the proper location.
Advantages: Prompt placement of a space maintainer will give the permanent tooth the best chance of erupting in the mouth in the correct location. This will minimize orthodontic problems caused by premature loss of a baby tooth.
Disadvantages: Your child will need to wear the appliance until the permanent tooth erupts. If not kept clean decay can occur under the bands.
Alternatives: If a space maintainer is not placed, the teeth will shift into the open area, making it difficult or in some cases impossible for the permanent tooth to erupt. This requires orthodontics to remedy.
Pulpotomy (Baby Root Canal)
The Problem: Decay that has reached the nerve/pulp of the baby tooth.
The Solution: Like adult root canals, the dentist will access the nerve chamber of the tooth, and remove some of the nerve/pulp of the tooth. Unlike adult root canals, this is a very short procedure, as only part of the pulp needs to be removed, and does not require the time consuming filing of adult root canals.
Advantages:
If the tooth has been symptomatic this procedure will likely alleviate the pain.
Allows for the tooth to be preserved until it is ready to fall out naturally.
Disadvantages: Pulpotomies have a 90% success rate. Occasionally, the nerve of the tooth is so badly damaged that it does not respond to pulp therapy, resulting in the need for extraction of the offending tooth. Certain circumstances increase the likelihood of failure with pulpotomies, your dentist will discuss your child’s situation with you during diagnosis.
Alternatives: The only alternative to a pulpotomy is extraction, and placement of a space maintainer. However, if it is possible to save the baby tooth, this is the best alternative because it preserves the appropriate spacing for the adult dentition.
