People ask why they should treat cavities in primary, or baby teeth when they’re going to fall out anyway. Primary teeth hold the space for their permanent counterparts and help to guide them in to their place. The primary teeth are shaped differently from adult teeth. The pulp, or nerve, is much closer to the surface and the enamel is thinner. Pediatric dentists have designed entirely different shapes for fillings to accommodate these differences. In a modern pediatric dental office, very often the dentist will not even use a drill, or handpiece, at all. Using a high-tech air abrasion unit or a hard-tissue laser enables the pediatric dentist to remove decay gently and conservatively, very often without having to make the tooth “numb” with local anesthesia, much to the relief of parents and children.
Silver colored mercury fillings are passé and are best avoided due to possible health risks. A variety of restorative materials, some especially for children, are available instead. Compomers are tooth colored resins containing glass particles that dissolve microscopically in the mouth, releasing fluoride to protect the surrounding teeth. Miraculously, that fluoride is replaced in the filling, every time the child uses fluoride toothpaste or mouth rinse. Glass ionomers and composite resins are other tooth colored materials which can be used to fill these cavities. All these materials are bonded to the teeth using a safe blue light, making the filling hard and useable immediately. The bonding also helps make new decay between the filling and the tooth less likely than with the old mercury fillings.
Because primary teeth are so small and fragile, a large cavity in a primary tooth often should not just be filled. Special full coverage crowns are available to keep the tooth’s shape and strength. The standard of care is a silver colored nickel-chromium steel crown, but tooth colored facings are sometimes possible. These crowns are prefabricated and come in hundred of shapes and sizes. The pediatric dentist must shave the tooth to the proper size, choose the right crown and cement it. Of course, local anesthesia is necessary for this. Often a tooth that needs a crown will have decay at or near the pulp of the tooth. In this situation, a pulpotomy can be performed to save the tooth before placing the crown, preventing the need for extractions and space maintainers.
Front teeth pose their own special problems. The front teeth of children are often so small and fragile that even the smallest of cavities is near the nerve. Pediatric dentists can provide a perfectly shaped and colored bonded composite crown to protect the tooth until it is ready for the tooth fairy.
Children today are very concerned about the way their teeth look and feel. It is critical to have a pediatric dentist provide the right care for these teeth so that they can help guide the permanent teeth into their proper places.
Children should be seen by a pediatric dentist starting at age two for routine checkups, but they can be seen at any age if there are questions or problems. Dental care in our office generally continues until college graduation.
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Richard A. Gindi DMD is a pediatric dentist with offices in Oakhurst, New Jersey and Brooklyn, New York. He has over 35 years of experience in treating growing children and their teeth.
