Repairing Children's Teeth

Fillings in Children's Teeth

When dentists talk about restoring a tooth, they are referring to any procedure that returns the tooth to its original shape and function. Fillings and crowns are the most common ways to do this.

Children's primary and permanent teeth sometimes need restoration. There are several reasons this might be needed:

Tooth decay or cavities (dentists call it caries)
Trauma — a broken or cracked tooth
Poor development, so that a tooth may be too small or improperly shaped
Following endodontic therapy (pulpotomy or root canal therapy)
Change in color

Restoring Children's Primary Teeth

You may think it's not necessary to place a filling in a primary (baby) tooth. After all, it eventually will fall out and be replaced by a permanent tooth. However, primary teeth are important for several reasons:

Chewing food
Allowing speech to develop normally
Maintaining space for the permanent teeth
Guiding permanent teeth into position

Also, remember that tooth decay is an infection. If a primary tooth is decaying, this infection may also spread to other teeth, including adult teeth that are developing or already in the mouth. Infection can also affect the child's general health.

A primary tooth can be restored with a filling or a crown. Which one is used depends on how much of the tooth is still healthy.

Primary teeth are more likely than permanent teeth to need a crown if they have a lot of decay. That's partly because primary teeth are smaller. They also have thinner layers of enamel (the outer surface) and dentin (the layer beneath enamel). Large fillings in primary teeth tend not to last as long as crowns. Pre-formed crowns are placed on primary teeth. Pre-formed crowns can be made of many materials, including stainless steel. If the preformed crown is placed on a front tooth it usually has a tooth-colored surface to make it appear more natural. A primary tooth with a filling or crown will still fall out when it is time for the permanent tooth to come in.

Restoring Children's Permanent Teeth

Children's permanent teeth generally are filled in the same way as adults' permanent teeth. The making and fitting of a crown, however, is somewhat different.

Until the early teens, a permanent back tooth that needs a crown typically is covered with a prefabricated stainless steel crown. Some dentists also are now using zirconia porcelain crowns (which are tooth-colored). Either of these types of crowns can be placed in a single visit. Adult crowns usually require two visits.

MORE ABOUT REPAIRING CHILDREN'S TEETH

For children who experience lots of cavities a technique to arrest and prevent them has been developed. It involves the application of a product called Silver Diamine Fluoride (SDF). If a child experiences many cavities, the application of an arresting and preventive treatment such as SDF is important prior to repairing the teeth. The risk for new cavities remains high even after decay is removed and new fillings are put into the teeth. The child who experiences lots of cavities should have a thorough clinical exam that includes a review of medical and medication history, and a full dietary assessment. Individualized interventions to prevent future dental cavities are provided by the dental team. The teeth can then be successfully repaired.

Updated- November 20, 2020

References:

Innes NP, Ricketts D, Chong LY, Keightley AJ, Lamont T, Santamaria RM. Preformed crowns for decayed primary molar teeth. Cochrane Database Syst Rev. 2015 Dec 31;2015(12):CD005512. doi: 10.1002/14651858.CD005512.pub3. PMID: 26718872; PMCID: PMC7387869.
Marinho VC, Sheiham Deceased A, Zaror C. Atraumatic restorative treatment versus conventional restorative treatment for managing dental caries. Cochrane Database Syst Rev. 2017 Dec 28;12(12):CD008072. doi: 10.1002/14651858.CD008072.pub2. PMID: 29284075; PMCID: PMC6486021.
Badar SB, Tabassum S, Khan FR, Ghafoor R. Effectiveness of Hall Technique for Primary Carious Molars: A Systematic Review and Meta-analysis. Int J Clin Pediatr Dent. 2019 Sep-Oct;12(5):445-452. doi: 10.5005/jp-journals-10005-1666. PMID: 32440052; PMCID: PMC7229363.
https://www.aapd.org/globalassets/media/policies_guidelines/bp_restorativedent.pdf (Accessed 10-01-2020)