Fillings | Non-Invasive Dentistry | Stainless Steel Crowns | Strip Crowns | Pulpal Treatment | Extractions | Appliances | Habit Appliances | Preventive Treatment | Emergency Treatment | Nitrous Oxide
Smaller cavities in the primary or baby teeth are often restored with dental fillings. The traditional material is made of silver amalgam and can be used for teeth in the back of the mouth where isolation from fluids may be more challenging. A tooth-colored material called composite is made of resin and powdered glass fillers and provides the esthetics of looking natural. Both types of fillings have great durability and can resist heavy forces.
An alternative material is glass ionomer or resin-modified glass ionomer. Although less durable than resin and amalgam, the silicate glass-powder material has the advantage of slowly releasing fluoride over time. This can help patients who are at high risk because it can provide a great seal while preventing the surroundings from future cavities. They can also be used as sealants and temporary restorations or used with atraumatic restorative techniques.
Silver diamine fluoride (SDF)
SDF is approved to treat dentin sensitivity and is effectively used as a caries-arresting agent when indicated. While the silver ions in SDF acts as an antimicrobial, the fluoride ions act mainly on the tooth structure to promote remineralization and slow down the progression of a cavity or completely arrest it. Thus, the American Academy of Pediatric Dentistry (AAPD) “supports the use of SDF as part of an ongoing caries management plan.”
After the teeth have been dried, a single drop is brushed directly onto the affected tooth structure for at least a minute if possible. It is a quick, non-invasive treatment that often needs reapplication (twice per year or more). Its disadvantage is that SDF permanently stains the cavity a dark-brown or black color. The dark stain indicates that it is arrested but the treatment does not fill the lost tooth structure of a large cavity. Your dentist may place a filling to restore the tooth structure and prevent food from getting stuck.
The benefits of SDF application can outweigh its possible undesirable effects in patients who may present with behavior or medical management challenges, an incipient lesion (the beginning of a cavity in the outer tooth layer called the enamel), or due to parental preference (for example to delay restorative treatment for when a child is older). SDF is not to be used in patients with a silver allergy.
For the anxious pediatric patient, your dentist can apply the atraumatic restorative technique (ART) for smaller cavities in both the primary and permanent teeth. ART allows a restoration to be completed without the use of handpieces and often without the injection of local anesthetics. Instead, hand instruments are used to remove most of the decalcified tooth structure before placing glass ionomer.
When SDF is used with ART, it is called silver modified atraumatic restorative technique (SMART). This technique first treats the cavity with SDF to help arrest the decay before filling the tooth with glass ionomer. Since SDF stains the tooth black, the tooth may appear grey under the filling.
STAINLESS STEEL CROWNS
Preformed metal crowns, also known as stainless steel crowns (SSCs), are the restoration of choice for primary molars that have extensive cavities. The AAPD recommends SSCs for teeth receiving pulpal treatment where the caries extended into the pulp tissues. SSCs are also supported in children who have high caries-risk due to its proven longevity. After the decay is removed, an SSC is fitted then cemented with glass ionomer.
Sometimes an SSC treated tooth can develop an abscess or pimple on the gum by the crown. If so, see your dentist for further evaluation and possible extraction of the crowned primary tooth.
Strip crowns are full coronal restorations composed of a white filling. It is indicated for decayed primary incisor teeth when the cavity is present on multiple surfaces or if there is loss of tooth structure that involves the edge of the tooth. It provides great esthetics but requires cooperative behavior for better results. It is important to avoid biting on the restored incisors to prevent chipping of the restoration.
When the pulpal tissue is involved, various pulpal treatment is available for select cases that allow for restorability. An indirect or direct pulp cap is the placement of a liner or base (usually composed of RMGI or calcium hydroxide) to try and heal the tissue from more irritation. If trauma or caries extends farther, then a partial pulpotomy, full pulpotomy or pulpectomy is completed to clean out the infected tissue. While a pulpotomy may only involve the pulp chamber, a pulpectomy extends into the roots of the tooth.
Unfortunately, when there is a dental abscess, swelling, or loss of too much tooth structure, then the primary tooth is unable to be saved and requires an extraction. Sometimes this may also be the case for permanent teeth if root canal treatment cannot be performed for the patient.
Most of the time, primary teeth can be wiggled out safely at home with clean hands. If however, the adult teeth are ectopic or coming in an abnormal position then your dentist can help extract the primary tooth to allow proper eruption of the permanent teeth or refer the child to an orthodontist if more movement of teeth is required.
Space maintainers are metal appliances that can be used to prevent greater space loss when primary teeth are lost prematurely. This can be a band and loop when a single primary molar in the back of the mouth is missing. A bilateral appliance (such as a nance or lower lingual holding arch) that extends across both sides of the mouth may be indicated when multiple teeth are missing. These such appliances will be cemented on the existing back teeth until the permanent tooth erupts into the adjacent space or possibly until the child is ready to start orthodontic treatment. It is especially important for children to have good home care and an appropriate diet to prevent poor oral health and keep appliances from breaking.
Non-nutritive sucking habits (such as thumb or finger sucking and pacifier use) are a normal part of early development but can become problematic if prolonged. Habits are recommended to be discontinued by age 2. However, when they persist beyond age 4 or 5, there is an unfavorable impact on the growth of the teeth and dentoalveolar structures surrounding the teeth. Such results can also be seen with tongue thrusting, a habit when the tongue rests in the wrong position during swallowing.
At around age 7 when the permanent teeth have erupted, and a child agrees to stop the habit, a habit appliance such as a tongue crib can be offered as an alternative treatment option, especially if patients were unsuccessful at outgrowing the habit on their own. A habit appliance acts by blocking the tongue. With additional home exercises, it can retrain the tongue muscle. It may need to stay in the mouth for at least 12 months to completely break the habit and prevent relapse.
Proper diet and good oral hygiene (such as using the correct amount of fluoride toothpaste under parental supervision and assistance to prevent ingestion of too much fluoride) and regular dental visits starting from when the first tooth erupts or by age 1 is an important practice for maintaining a healthy mouth.
Additional in-office preventive treatments (such as fluoride treatment and sealants) are safe and easy ways to protect natural teeth and help keep cavities away. Even though baby teeth are normally replaced by permanent teeth, it is important for them to fall out naturally for optimal growth and development of the child.
Professionally fitted sports mouthguards can eliminate or reduce unwanted traumatic injuries to the teeth (such as fractures and dislocations) and surrounding tissues during collision and contact sports. You can use a boil-and-bite mouthguard or stock mouthguard purchased from a local medical supply store or pharmacy or speak to your dentist about fabricating a custom-fitted mouthguard to provide optimal protection for your child.
Childhood dental emergencies and injuries are common. Some common causes of a dental emergency can be food impaction (when food gets stuck in or around the teeth), swollen gums, tooth decay, wiggly tooth, tooth eruption, tooth fracture, or dental abscess or infection.
Keep the affected area clean with warm water and check for impacted food. Gentle brushing and dental floss can be used to help dislodge the food as necessary. If the pain persists, swelling occurs in the mouth or face, or a bubble or is seen on the gum by the tooth, contact your dentist as soon as possible.
Trauma or a fall to the face or mouth can lead to a chipped/fractured tooth, displace the tooth (luxation), or even knock the tooth completely out of the socket (avulsion). When an injury occurs with either primary or permanent teeth, it is important to have it evaluated as soon as possible to reduce any pain or sensitivity, prevent damage to any adjacent teeth, and provide treatment in a timely manner. All traumatized teeth, depending on the extent of the injury can lead to possible nerve damage and will need to be monitored over time as well. Soft tissue injury to the mouth (such as the lips, cheeks or tongue) can occur along with dental injuries.
If a primary tooth was avulsed, do NOT re-implant the tooth back into the socket because it can damage the developing adult tooth sitting inside the affected area.
However, if a permanent tooth was avulsed, immediately find the tooth, hold it by its crown portion and rinse gently with water only. If possible, reinsert the tooth facing correctly in the socket and have the child keep it in place by biting on a clean cloth. If you cannot, then transport the tooth safely into a cup of milk (or Hank’s Balanced Salt Solution if available).
While different injuries require different care, the prognosis of the tooth is dependent on time (especially for an avulsed permanent tooth). If ever in doubt, contact your dentist as soon as possible.
If your child is not responding normally, dizzy, vomiting, or unconscious after any trauma to the head, immediately call 911 or take your child to the nearest hospital emergency room.
Mild sedation can be safely achieved for slightly anxious children (and adults) using nitrous oxide, also known as “laughing gas.” It can make them happy and giggly. It can also be called “ice cream air” because of its sweet smell. It is breathed in together with oxygen by wearing a mask over the nose and helps your child feel more relaxed while staying awake. After treatment is completed, 100% oxygen is breathed in and the nitrogen levels are returned to normal with no residual effects.
Higher levels of sedation (with oral or IV conscious sedation, or general anesthesia) may be needed if your child requires extensive treatment, is extremely anxious, is medically compromised or has special needs.