PLACING A CHILD'S FILLING

Young children may have some difficulty with dental treatment. But the visit can be a positive one if the dentist has training and experience with this age group. Here's how a filling is placed.

ANESTHESIA

If the filling will be placed using a standard dental drill, first an anesthetic gel or ointment will be applied directly to a small area of the gum or inner cheek. Once the area is numb, the dentist will inject a local anesthetic. This will numb the teeth and surrounding area during treatment.

If a dental laser is used, local anesthesia is usually not required.

Sometimes young children may not sit still for treatment. Dental fear in children, has been shown to have a direct relationship to decayed permanent teeth. The more fear a child has, the more likely they will not have regular dental visits, which may lead to more cavities. In these cases, the dentist may decide to use nitrous oxide to help them relax. This is a gas that is delivered through a face mask. Other options for sedation include oral medicines, intravenous sedation or even general anesthesia.

DENTAL DAMS

After giving the local anesthesia and any sedation, the dentist will put a dental dam on your child's teeth. This is a piece of latex or similar material that isolates the tooth your dentist is treating. A hole is punched in the dam so the tooth comes up through the hole. The dam protects the rest of the mouth.

Some dams are latex, but there are other materials for children with latex allergies. Some dental dams are scented or flavored.

The dental dam has several advantages:

It protects the cheeks, tongue and lips and keeps them out of the way of the procedure.
It keeps saliva away from the area being treated. Most of the materials that dentists work with are more effective if kept dry. In some cases, saliva can weaken a filling. Use of a dental dam, has been linked to a lower incidence of failed dental fillings.
It prevents the child from accidentally swallowing or choking on anything during the procedure.
It makes many children feel safer to have a dental dam between them and the dentist.

ALL IN ONE ISOLATION SYSTEMS

The use of all in one isolation systems has gained popularity in dental settings. These devices include a suction device, a tongue shield and a bite block. When this is placed in the child’s mouth the tongue is protected from the procedure and the child is able to bite down in an open bite position. During a dental procedure this allows the child to be more relaxed and to protect the tongue and other oral tissues from injury if the child moves during the treatment. The device Is placed after the local anesthetic or sedation is administered.

REMOVING DECAY AND PLACING THE FILLING

Restorations in primary teeth can include partial removal of decay and a composite filling or complete removal of decay and a composite filling. The dentist will assess the child’s tooth and if any pain is present in deciding the best treatment option. Prior to placing fillings your dentist will work with you and your child to determine why cavities are present and how to reduce your child’s risk for additional cavities. Your dentist can provide office fluoride treatment with fluoride varnish or gels as well as recommend home fluoride use such as supplements if you live in a non-fluoridated area or a fluoride daily or weekly rinse.

The dentist uses the standard dental drill (handpiece) or dental laser to remove the decayed part of the tooth and shape the tooth to receive the filling. An amalgam filling can be placed for a large restoration in the prepared hole and is pressed down with a special tool. If a tooth colored composite resin filling will be used, the hole the dentist makes is etched with a weak acid for 15 seconds. This prepares the tooth so the composite resin filling will bond to it.

A composite resin filling must be hardened with a special light. This is usually done in layers. This is one reason composite resin fillings take longer than amalgam ones. Dentists also use other types of tooth colored fillings for baby teeth. These are called glass ionomers. This material also contains fluoride and helps to prevent future cavities in that area.

Once the filling is hardened, your dentist will smooth and polish it. He or she will remove the dental dam and ask your child to bite down gently on a piece of special marking paper. This will show whether the filling has affected the bite (the way the teeth come together). If the bite is not correct, the filling will be reshaped until the bite feels comfortable.

SPECIAL ISSUE: BRACES

Before placing braces, the orthodontist should make sure your child has had a full dental exam. This should include X-rays, to ensure there are no cavities.

The bands should be removed once a year to allow the general dentist to check for cavities.

Braces make it more difficult to keep teeth clean. Your orthodontist needs to be aware of your child's brushing habits. Children who have a more difficult time cleaning food from brackets and wires may need to have more frequent dental exams.

AFTER THE PROCEDURE

Your child should feel little to no discomfort after a filling is placed. Any discomfort usually is caused by irritation of the tooth's pulp or the soft tissue around the tooth. This typically goes away after the first 24 hours. If your child complains of pain after 24 hours, the filling may be too high. Contact your dentist's office. Over-the-counter pain medicines can help relieve discomfort.

After receiving a filling, a child sometimes may accidentally suck, chew or bite on a numbed lip because it feels swollen. This can cause significant injury. The dentist should warn your child not to do this. Don't feed your child until the anesthesia wears off.

Pay attention if your child complains that his or her teeth don't come together right, or that biting "feels funny." The filling may need to be reduced in height. Contact the office to see if the dentist should check the filling.

POTENTIAL LONG-TERM PROBLEMS

A filling can break or crack. This is more likely to happen if the bite is not correct and too much pressure is placed on the filling.

Fillings also can leak. This is more common in composite (plastic) fillings. Leaking can occur if the area is not dry when a composite filling is placed or if the composite is not hardened correctly. As a result, saliva and bacteria can seep under the filling. Leakage can cause sensitivity and further decay.

It's important for your child to visit a dentist regularly. The dentist will check to make sure fillings are still in place and are not leaking. The frequency of visits should be based upon your child's risk of getting cavities. The dentist will assess this risk based on several factors, including your child's:

Number of cavities
Brushing habits
Diet and snacking habits

Last updated May 7, 2021

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