One of the hardest things a pediatric dentist has to tell a parent is, “Your child has cavities.”
Sometimes you already know, and sometimes you are taken off guard; but regardless of the circumstances, these words can often leave a parent feeling guilty and uncertain about what comes next.
If the cavity is small, your pediatric dentist can fix the tooth with a traditional filling. However, if the decay is extensive, it may be necessary to place a crown or “cap” on the tooth. Crowns are placed on teeth that have large areas of decay that could possibly break if a traditional filling material is used to fix it.
Why Use Crowns on Baby Teeth?
One of the first questions that come to mind about pediatric stainless steel crowns is usually:
“Why is it necessary? And, why not just pull the tooth?”
Crowns are often the best treatment plan for decayed or damaged baby teeth for one main reason.
The alternative to using a crown would be extraction, which can lead to complications if a baby tooth is removed too soon such as blockage, misalignment or tipping of baby teeth, or crowding of permanent teeth as they begin to arrive. This could necessitate further treatment including orthodontic care.
Using crowns allows the baby tooth to continue to act as a placeholder until permanent teeth have reached full maturity, while addressing the decayed tooth.
So your child needs crowns, and you are asking, “What choices does my child have?”
Some of the most common options in pediatric dentistry are listed below.
Stainless Steel Crowns
Stainless steel crowns are the most common type of crown used in pediatric dentistry. These are what many people call “silver” crowns. These crowns are covered by most major insurances. They are very durable and are a great option if you aren’t concerned about the cosmetic appearance of baby teeth. On rare occasions, they can cause localized tissue irritation and have been known to be a contributing factor in metal allergies.
Stainless Steel Crowns with White Facings
Stainless steel crowns can be made to look more esthetically pleasing, especially when front teeth need treatment. This type of stainless steel crown is available with a pre-veneered plastic facing. These crowns are more cosmetic in appearance because from the front they look “white” but the reverse side is the portion of silver crown that is non-coated metal. In order for the white facing to adhere to the metal, extra bulk must be added, so these crowns tend to look bulk, thick or rounded. The white facing also has a tendency to chip off easily over time, exposing the silver crown underneath. There are two main reasons the white facings of a stainless steel may chip off: (1) when children grind their teeth, (2) or as a result of regular wear and tear related to chewing forces on back teeth.
Composite Strip Crowns or Resin Crowns
This type of crown is very cosmetic when prepared well by your child’s pediatric dentist. Placing these crowns requires tremendous skill. It also requires the most time to complete. Because of the time required, these crowns can be difficult to place on young, uncooperative children. General anesthesia sedation is often recommended for a cosmetic crown procedure. Strip crowns are entirely made of composite “white” “filling material. This filling material looks very natural– a shade guide may be used to match the crown’s color to the color of your child’s natural teeth. The biggest consequence of composite strip crowns or resin crowns is that they have a tendency to absorb food stains and discolor. It can also attract plaque if brushing and flossing is not done well and recurrent decay may result. Resin crowns are also much weaker than stainless steel crowns so there is an increased risk that a piece or corner of the crown may break off. Most major insurances cover composite strip crowns on front teeth only for baby teeth that require treatment.
How are baby teeth prepared for stainless steel crowns?
1. Your pediatric dentist may recommend using “Laughing gas” and Novocaine for a stainless steel crown procedure. Laughing gas is a very mild form of conscious sedation that helps to manage nervousness or anxiety. Your child is awake during the entire procedure. Novocaine is injected into the gums surrounding the decayed tooth so there is no discomfort during the stainless steel crown procedure.
2. A soft latex sheet called a rubber dam is draped over the mouth to isolate the tooth being treated. This also helps to keep the working area free of any moisture, increasing the dentist’s field of view while preventing the child from swallowing any debris.
3. First, the chewing surface is reduced by about 1.5mm outlining the tooth. Second, the contact area between neighboring teeth is opened to create space for stainless steel crown placement. And third, all decay is removed from the tooth.
4. A crown is chosen, sized, trimmed, and fitted to adapt to the prepared primary tooth. The crown and the tooth are then washed and dried separately.
5. Cement, otherwise known as “tooth glue” is mixed and placed on the insides of the stainless steel crown prior to being fitted on the tooth.
6. The rubber dam is removed and the child is asked to bite hard on the crown so that all the excess cement is removed.
7. The excess cement is cleaned off and the tooth contacts are flossed to finish the procedure.
What do we need to do after a stainless steel crown is placed?
Because we use Novocaine during the crown fitting process, your child should not eat until the anesthetic wears off to avoid biting their lip, cheek, or tongue unknowingly. Once it has gone away, they are free to eat and drink as normal, although the crown may be sensitive. They may feel some discomfort for a day or two after the procedure, which can be handled with over-the-counter pain relievers such as Children’s Tylenol or Children’s Ibuprofen.
Pediatric Stainless Steel Crowns in Quincy, MA
You and your child may be nervous if a stainless steel crown procedure is in order, but at Sprout Kids Dentistry, we know how to create a safe and welcoming environment for you and your little
one. Don’t wait to get the treatment your child needs – call 617-934-6339 or visit us online to schedule your pediatric stainless steel crown appointment today.
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