Crown
When damage or decay is too extensive to repair with a dental filling, a crown is used to completely cover the outside of a damaged tooth. Crowns are used to restore strength and function to primary teeth and are often recommended after a pulpotomy. Crown material varies and includes stainless steel and zirconia.
Composite White Fillings
Composite fillings are made with tooth-colored material to blend naturally with the rest of your child’s tooth. After removing areas of decay, the composite material is applied and hardened.
Pulp Treatment
The pulp of a tooth is rich in blood vessels and nerves, and when it becomes damaged it can cause pain. When this happens in baby teeth, we can often perform a pulpotomy to remove decay and the affected portion of the pulp. The coronal pulp chamber is cleaned, and sealed to eliminate pain and restore function. A pulpotomy is often confused with a root canal, but the procedures are not the same.
Extractions
When restorative solutions are not an option, a tooth may need to be extracted. Primary (aka baby) teeth do not have large roots, and extraction can often be done under local anesthesia and nitrous oxide sedation. A space maintainer may be placed to ensure there is enough room for the secondary tooth to erupt, preventing future orthodontic problems.
Silver Diamine Fluoride (SDF)
Why would a dentist recommend silver diamine fluoride (SDF) for my child?
SDF can stop cavities from growing. The treatment is quick, comfortable and affordable. Because SDF can keep decay from getting worse, fixing the teeth can possibly be put off until a child is older and consequently would typically have an easier time sitting through treatment. Sometimes SDF is the only treatment needed if the cavity is very small.
What is silver diamine fluoride?
SDF is a colorless liquid made up of fluoride and silver ions. It kills the bacteria that cause cavities. SDF is an antimicrobial agent that can stop cavities from growing by making the tooth harder, and limiting the growth of bacteria that causes tooth decay.
What is the treatment like?
SDF is painted on a cavity with a small brush. Treating a cavity takes about two minutes. Best of all, the application does not hurt and requires no drilling or injection of anesthetic. The treatment has a metallic taste and can sometimes cause a mild irritation to the gums that will resolve by itself in a couple of days.
Is silver diamine fluoride safe?
Very safe, according to the evidence-based clinical guidelines of the American Academy of Pediatric Dentistry. SDF has been used in Japan for over 40 years and in Australia and China for over 10 years. Most important, it can postpone or even prevent the need for sedation or general anesthesia, especially for very young patients.
You should not be treated with silver diamine fluoride if:
- You are allergic to silver.
- Cavities are so large that they involve the nerve of the tooth.
- There are open sores or ulcers in your child’s mouth.
Does it work to stop tooth decay?
Yes. Based on clinical trials, SDF works to stop cavities from growing in 70 to 90 percent of treated teeth (or as many as nine out of 10 teeth). Teeth treated with SDF need to be checked by a dentist at least every six months to make sure the tooth decay has not progressed.
Is it true SDF turns teeth black?
Cavities treated with SDF turn black, the teeth do not. This color change is permanent, lasting the life of the tooth. If the cavities are on the back teeth, it is barely noticeable. If the cavities are on the front teeth, it can be very noticeable. If SDF touches the lips or skin, perhaps if a patient moves too much during treatment, it will leave a dark stain for a few days.
Why treat cavities in baby teeth?
Cavities on children’s teeth can grow very fast and cause pain and infection. The factors that started the cavities in the first place can cause decay in other teeth, and as cavities get larger, the nerve of the tooth can become infected and lead to serious infections in the body.
Baby teeth hold space for the proper placement of the permanent teeth. If a baby tooth is lost too early, it can lead to space loss and crowding in the permanent dentition.
What can I do at home to prevent cavities?
For the treatment to work its best:
- Keep your child’s teeth clean by brushing with fluoride toothpaste after breakfast and before bed.
- Cut down how much and how often your child has foods and drinks with sugar in them.
- Visit your pediatric dentist at least every six months.
Important things you should know about this treatment are:
- If patients move too much, and the liquid touches their lips or skin, there could be a dark stain for a few days.
- SDF may need to be re-applied for the effects to continue.
How to prepare for your restorative treatment visit
Restorative treatment can be daunting for children and parents. Often children have many questions before dental appointments and giving them an idea of what to expect can significantly ease anxiety. We use non-threatening terminology to explain everything that will happen during their appointment and encourage you to share this information with your child before you arrive at our office.
What to expect
When your child is coming into our office for restorative treatment, we want them to feel comfortable. At check in, your child will pick out a movie or show on Disney+ to watch throughout the procedure.
For most children, we recommend using nitrous oxide which they breathe through their nose for the duration of the appointment. This helps reduce nervousness, gag reflex, and restlessness, but it does not induce sleep. Once your child is comfortable in our chair with the nitrous mask (astronaut nose) on, we will explain what we are doing and show them many of the tools and materials involved in a nonthreatening manner.
We allow one parent in the room during treatment, and we do not allow siblings in the room to help limit distractions and allow us to solely focus on your child undergoing treatment.
Local anesthetic
To keep your child comfortable while completing treatment on their teeth, we often use local anesthetic. Before injection, we use a medical grade topical numbing cream to numb the area. This cream will typically sit on their gums for 3-5 minutes before injection. We avoid using words like shot and needle when referring to local anesthetics and instead call the injection sleepy juice. We do our best to ensure your child never sees the syringe, and they typically don’t know they have received a shot. Terminology is very important when preparing your child for these appointments and can greatly reduce stress and helps ensure a successful outcome.
During treatment
While your child’s tooth is going to sleep we show them many of the tools we will be using and explain how things work. To help your child’s mouth stay open for us we use a mouth prop (tooth pillow). This sits between their teeth, allowing them to rest on it. Next, we often place a rubber dam (rubber raincoat) over the treatment area. It is a balloon-like material with a hole for their tooth to go through. It keeps everything out of their mouth and helps retract their cheeks and tongue from the area. This allows our doctors to see well and work quickly and effectively. Several different hand pieces may be used to remove decay during the treatment. Instead of using the word drill, we use words like whistle toothbrush and bumpy toothbrush.
Completion of treatment
After treatment, we will turn the nitrous to zero and allow your child to breathe oxygen for approximately 5 minutes. The effects of the nitrous end as it leaves their system. After their appointment, your child will receive a prize. Please keep in mind that your child’s mouth will typically retain numbness for 1-2 hours after their appointment. Remind your child not to pinch, chew, suck, or play with his or her lips and tongue while numb. Softer foods that don’t require chewing are recommended until numbness goes away.