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Restoration


Why Restore Baby Teeth

Neglected baby which develop cavities can and frequently do lead to problems which affect developing permanent teeth. It is very important to maintain the health of the primary (baby) teeth. Primary teeth - or baby teeth - are important for (1) proper chewing and eating, (2) permitting normal development of the jaw bones and muscles, (3) holding space for the permanent teeth and guiding permanent teeth into the correct position. Primary teeth also affect the development of speech sound production and add to a hygienic appearance.

Decayed baby teeth can become abscessed which will result in swelling and pain. An abscessed baby tooth can be life threatening, requiring aggressive antibiotic therapy and in some instances hospitalization.

Early loss of baby teeth can result in shifting of the teeth which can lead to loss of space for the permanent successor tooth followed by abnormal eruption of the permanent teeth. This condition can lead to complicated orthodontic treatment later.

Tooth Colored Restorations

Although tooth colored filling material has been around for a long time it was not until the 1990’s and 2000’s that the materials were widely accepted. Prior to the 1990’s the materials did not have the compressive strength sufficient for use in posterior teeth and they were known to shrink, causing teeth to fracture. Fortunately the materials are greatly improved and the technique for placement is well understood; the problems of shrinkage and compressive strength have been overcome.

The technique for placing a tooth colored (composite) restoration requires meticulous attention to procedure or it may fail prematurely. The tooth must be kept free of saliva during placement or the resin will fail to adhere to the tooth. Composites are placed while still in a soft, dough-like state, but when exposed to light of a certain blue wavelength, they polymerize and harden into a solid state.

Tooth colored fillings are usually treatment planned for teeth that only have a small amount of decay.

Why a Crown?

Although tooth colored fillings are high quality restorations and the material used for some restorative cases, a crown is the more appropriate restoration in cases where a cavity has affected so much tooth structure that the composite filling material cannot be used to repair a tooth. Pediatric Dental training programs stress the importance of the primary teeth. An important function of the baby teeth is to hold adequate space for the adult tooth that will follow each primary tooth. When a child needs to have a primary tooth repaired the Pediatric Dentist draws on his or her training to provide the proper restoration for the involved tooth. The indications for a crown on a primary tooth are:

  • Restoring a tooth with extensive decay – that is decay involving more than one surface of the tooth
  • Restoring a tooth that cannot be adequately restored using a silver or tooth colored filling
  • Restoring a tooth after a pulp therapy because there is an increased danger of fracture of the remaining tooth structure
  • Restoring teeth of very young patients who demonstrate extensive decay knowing the teeth need to be retained for many years before a permanent tooth will erupt
  • Restoring teeth when it is impossible to keep the tooth restoration free of saliva during placement
  • Restoring teeth while the patient is sedated – on occasion it is quicker to prepare and restore a tooth with a pediatric crown than with a tooth colored restoration. It is preferred to complete a sedated patients’ dental care as quickly as possible and return the patient to a non-sedated state

A crown is the best choice for several reasons: (1) it allows the tooth to be restored to the proper form and shape holding adequate space for the permanent tooth which will succeed it; (2) it gives the tooth greater strength to withstand the chewing forces which could cause tooth fracture if it is not protected with a crown.

What Is Pulp (Dental Nerve) Therapy?

The innermost central core of the tooth is known as the pulp of a tooth. The pulp contains nerves, blood vessels, connective tissue and reparative cells. The purpose of pulp therapy in Pediatric Dentistry is to maintain 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", “pulpotomy" or" pulpectomy".

A Pulpotomy removes the dental caries and unsupported portion of the tooth and the diseased pulp tissue within the crown portion of the tooth. Next, medicine is placed into the disinfected pulp chamber to prevent bacterial growth and to calm the remaining nerve tissue. This is followed by a final restoration (usually a 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. A permanent tooth would be filled with a non-resorbable material. Then a final restoration is placed (usually a crown).

Extractions

Permanent teeth are extracted if it is determined that a tooth is non-restorable due to traumatic injury or aggressive decay involving the nerve and blood supply, for orthodontic purposes to make space and removal of third molars (wisdom teeth).

When primary teeth are removed prematurely, that is, prior to them falling out on their own, it may be necessary to place a space maintainer to support the appropriate placement of the developing permanent tooth or teeth.

Space Maintainers

Since primary teeth guide the permanent teeth into place, children who prematurely lose primary teeth may require a space maintainer. A space maintainer is a dental appliance which can be used to hold the space formerly occupied by the primary tooth open. Without a space maintainer the existing teeth on either side of the extracted tooth can tilt toward the empty space blocking the permanent tooth from coming in or result in a tooth coming in crooked. When permanent teeth later drift into the space where a baby tooth was lost early, it can result in YEARS of expensive and extensive orthodontic care.

Kiddie Partial Appliance

Occasionally a child will present with “bottle mouth caries” or have suffered an accident which damages the baby front teeth leaving the anterior teeth non-restorable or missing. In this situation an appliance with false teeth can be fabricated to preserve the child’s smile. This specialized appliance is known as a “kiddie partial”. The kiddie partial is truly an esthetic appliance to restore and preserve the smile until the anterior baby teeth would be naturally lost. A kiddie partial it does not restore the child’s ability to bite into food with the anterior teeth.