Today, several dental filling materials are available. Teeth can be filled with silver amalgam (which consists of mercury mixed with silver, tin, zinc, and copper), or more commonly with tooth-colored materials called composite resin or glass ionomer fillings.
The Stainless Steel Solution
When a baby tooth is extensively decayed and using other filling materials isn’t likely to be successful, the American Academy of Pediatric Dentistry (AAPD) recommends restoring the tooth with a stainless steel crown especially if the tooth has received pulpal therapy. After removing the decay, the dentist will fit and cement a prefabricated crown made of stainless steel over the tooth. Here are some advantages of stainless steel crowns:
- Very little sensitivity
- Less likely to need retreatment
- More successful than metal fillings in children under four years old
- Good choice for children who need general anesthesia
- Often used as an attachment for a space maintainer
If the pulp or nerve of the tooth is involved, the dentist may also need to perform pulpal therapy before placing the crown. But rest assured it is quite common, even for young permanent teeth.
What is Pulp Therapy?
The pulp of a tooth is the inner central core of the tooth. The pulp contains nerves, blood vessels, connective tissue and reparative cells. The purpose of pulp therapy in Pediatric Dentistry is to maintain the vitality of the affected tooth (so the tooth is not lost). Dental caries (cavities) and traumatic injury are the main reasons for a tooth to require pulp therapy. Pulp therapy is often referred to as a “nerve treatment”, “children’s root canal”, “pulpectomy” or “pulpotomy”.
A pulpotomy removes the diseased pulp tissue within the crown portion of the tooth. Next, an agent is placed to prevent bacterial growth and to calm the remaining nerve tissue. This is followed by a final restoration (usually a stainless steel crown).
A pulpectomy is required when the entire pulp is involved (into the root canal(s) of the tooth). During this treatment, the diseased pulp tissue is completely removed from both the crown and root. The canals are cleansed, disinfected and in the case of primary teeth, filled with a resorbable material. Then a final restoration is placed. A permanent tooth would be filled with a non-resorbing material.
The most common oral surgery performed in our office is extraction of permanent and primary teeth. The most common reason is due to decay. Radiographic examination is necessary to identify differences in root anatomy prior to extraction.
Children may need space maintainers if they lose a tooth early to maintain space for the permanent tooth/teeth.
A space maintainer is a metal appliance that is custom-made by a dentist . If a space is not maintained, then teeth can shift into the open space and orthodontic treatment may be required. Not every child who loses a baby tooth early or to dental decay requires a space maintainer; however, a professional consultation with your dentist should be conducted to determine if a space maintainer is needed.
Types of Space Maintainers
There are two types of space maintainers for children, bilateral and unilateral.
The unilateral space maintainers are placed on one side of the mouth to hold space open for one tooth . They might be referred to as “band and hoop” or “distal shoe”. The unilateral space maintainer wraps around the outside of the tooth and is connected to a metal loop that holds the space intact.
The bilateral space maintainer is cemented to a molar tooth on both sides of the mouth and connected by a wire on the inside of the lower front teeth.
Wearing the Space Maintainer
Once the space maintainer is made by the dentist or orthodontist, it may take the child a few days to get accustomed to wearing the appliance. The dentist will review with the child and parent the proper ways to clean the space maintainer thoroughly in order to keep the gum tissue healthy and free of dental plaque.
For all space maintainers, it is important to avoid chewy and sugary foods, especially gum or candy, which may loosen or get caught on the appliance.
The child should be seen by the dentist or orthodontist on a regular basis to monitor the progress of treatment with the space maintainer and continue to receive a regular six-month professional cleaning appointment with your dentist.
Nitrous oxide, more commonly known as laughing gas, is often used as an anxiety reliever during a dental visit, with parental consent. The gas is administered with a mixture of oxygen and has a calming effect that helps phobic or anxious patients relax during their dental treatment. Patients are still conscious and can talk to their dentist during their visit. After treatment, the nitrous is turned off and oxygen is administered for five to 10 minutes to help flush any remaining gas. The effects wear off almost immediately. Your dentist will provide you with pre- and post- instructions.
Other types of medications that your dentist may suggest will require a referral to another office:
- Oral sedation Treatment completed in office where a child drinks a liquid medication and becomes sedated. The child is awake but relaxed to a point that the dentist can provide dental treatment in a safe manner.
- General anesthesia Treatment completed in a hospital operating room where an anesthesiologist will put a child to sleep and Dr. Johnson will complete all the dental treatment at once.
For children who are very nervous, fearful, require very extensive treatment or might have significant underlying health concerns, a referral to a specialist will be made. Oftentimes treatment may be provided while the child is asleep under general anesthesia in a hospital. The type of treatment that the specialist recommends will depend on your child and the procedure or treatment that needs to be performed.