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Crowns and Fillings

Composite (White) Fillings

Why use composite (tooth-colored) restorations? Composite fillings are made to blend in with the teeth color for an esthetic look. When applied correctly, they can be bonded directly to the tooth without as much loss of the natural tooth structure. Although, more esthetically pleasing, composite fillings do fail at a much faster rate than Amalgam Fillings. They are not good for children with questionable oral hygiene and who are at high risk for future cavities.

Amalgam (Silver) Fillings

Why use amalgam (silver) restorations? Amalgam fillings are often preferred due to their preparation and adaptation. They adapt readily to cavity walls and are extremely durable to wear and tear. They also provide a block to micro-leakage, securing the cavity site and keeping it free of moisture and cavity causing agents. These are good restorations for situations where oral hygiene is questionable and/or strength is needed.

Pulpal Therapy

What is pulpal therapy? Nerve therapy in the baby teeth (primary teeth) is not unlike root canal therapy in an adult (permanent) tooth. The aim of both procedures is to prevent extraction of a decayed tooth. In primary teeth, however, treating the pulp is considered less complicated. In brief, when tooth decay becomes deep and reaches the nerve tissue, also known as the pulp, the dentist must remove the affected tissue so that the tooth does not cause your child future discomfort or infection. A pulpotomy involves the removal of diseased nerve tissue (pulp) from the crown of the tooth, while the healthy tissue in the root is left alone. After the top part of the pulp is removed, restoration can be performed.

The pulp of a tooth is the inner, central core of the tooth. The pulp contains nerves, blood vessels, connective tissue and reparative cells. The purpose of pulp therapy in Pediatric Dentistry is to maintain the vitality of 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”, “pulpectomy” or “pulpotomy”. The two common forms of pulp therapy in children’s teeth are the pulpotomy and pulpectomy.

A pulpotomy removes the diseased pulp tissue within the crown portion of the tooth. Next, an agent is placed to prevent bacterial growth and to calm the remaining nerve tissue. This is followed by a final restoration (usually a stainless steel 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. Then, a final restoration is placed. A permanent tooth would be filled with a non-resorbing material.

Restoring a tooth after pulpal therapy:

Quite often when a tooth has decayed to this extent, a large restoration is necessary to replace lost tooth structure. A stainless steel crown is always recommended for teeth that have undergone pulpal therapy to improve strength and durability of the treated tooth and give the tooth the best chance for success.

Stainless Steel Crowns

What are stainless steel crowns? Stainless steel crowns are silver colored “caps” used to restore teeth that are too badly decayed to hold fillings or need pulpal treatment. These caps are extremely durable and are easy to maintain. Very seldom does this restoration fail or need to be redone. These “caps” will come off when the baby tooth is ready to fall out.