For anterior (front) primary or permanent teeth, a tooth colored (compomer or composite) restoration is performed.
For posterior primary or permanent teeth, an amalgam (silver) or tooth colored (compomer or composite) restoration is utilized.
Tooth colored restorations are somewhat more costly than amalgam (silver) restorations. The white filling materials are more expensive and technique sensitive. Some insurance companies only allow a tooth colored restoration for a posterior tooth to be reimbursed at a lesser (amalgam) fee.
Stainless Steel Crowns
Stainless steel crowns are prefabricated and used to restore primary anterior and posterior teeth and permanent molars. They are indicated with large tooth decay with considerable missing tooth structure, decalcification, multi-surface decay on primary molars, developmental defects (hypoplasia/hypocalcification), and following pulpotomies or pulpectomies. That weakens tooth structure and makes them susceptible to fracture.
The stainless steel crown is considered an ideal restoration for primary molars, as they are very durable, rarely come off (are cemented with a dental cement), and cannot get recurrent decay as the crown completely covers the tooth. For primary anterior teeth, which receive a stainless steel crown, we do place Kindercrowns, which have an attached composite (tooth colored) facing for excellent esthetics.
Pulpotomy/Pulpectomy (Baby Root Canal)
If decay has processed deep enough to affect the pulp (nerve) of a primary molar or young permanent molar, a pulpotomy is performed. The nerve tissue in the pulp chamber (crown segment) is cleaned out and the remaining vital tissue in the root canals is preserved. An agent is placed in the pulp chamber to prevent bacterial growth followed by a resorbable material for a primary molar. A permanent molar receives a material in the pulp chamber which maintains pulp-vitality and allows continued and full root development.
A pulpectomy for an anterior tooth is required when the entire pulp is involved (due to trauma and/or infection). The diseased nerve tissue is completely removed from the crown and root. The canals are cleaned, disinfected and for a primary, filled with a resorbable material. A permanent anterior tooth receives a non-restorable material.
Sometimes when a primary molar is non restorable (due to infection and/or large decay with insufficient tooth structure), we may recommend a space maintainer. The purpose of a space maintainer is to preserve the space for the developing permanent tooth under the primary tooth, which is removed.
A space maintainer may be prefabricated and completed in one visit or may involve several appointments (setting orthodontic bands, impressions and seating the appliance).
Along with appropriate use of fluorides, sealants have made a major impact on efforts to reduce tooth decay. The grooves and pits on back teeth are very difficult to keep clean and free from bacteria and food. A sealant covers and protects the grooves and pits on the chewing surfaces. Sealant material is a resin and is used on permanent molars and premolars and susceptible primary molars. Sealants may last several years, but need to be checked during regular periodic exams. Chewing hard items (crunching ice, popcorn seeds, chewing on fingers/pens) may wear the sealant and decrease their lifespan.
Do I stay with my child during the visit?
We invite you to be present with your child during the first visit to our practice and for any preventive care appointments scheduled every six months. These visits should compromise the overwhelming majority of visits to our office. During other visits, which involve treatment, we request you allow our staff to accompany your child. We will do our utmost to make the appointment pleasant and successful. We utilize a tell-show-do approach where we describe the procedures we are doing in terms kids can understand. We commonly utilize nitrous oxide minor sedation for the comfort of our patients. We also have flat screen monitors in our treatment operatories, which allow children to watch their favorite movie during treatment. We are honored with the privilege of treating your child and appreciate the trust and confidence you have placed with us. As one of our favorite Disney characters, Peter Pan says, “All it takes is faith, trust and a little pixie dust”.