COMMON PEDIATRIC DENTAL PROCEDURES & THEIR BENEFITS AND RISKS
Sealants are a thin coating applied to the pits, fissures, and grooves of the chewing surfaces of molars. Tooth structure is NOT removed; rather sealants are added to the teeth. They can be very effective in preventing cavities since chewing surfaces are the areas where food and bacteria can most easily become trapped. Generally, sealants are highly recommended for permanent molars since they are more difficult to keep clean for younger children and because they will be needed in a healthy condition for decades. However, we sometimes recommend sealing baby teeth in high-risk children as well. Having sealants placed is elective but can save the patient time, money, and the discomfort associated with having a filling placed in the future due to dental caries. While sealants can greatly reduce the risk of getting cavities, the patient may still form cavities due to poor oral hygiene or diet and sealants do not protect against cavities in between teeth or on the smooth surfaces.
Composite resin restoration
These are white colored filling materials. They are used to restore cavities that are small to medium in size on primary teeth and in children who are considered low to moderate risk for cavities. They are a conservative, esthetic treatment option. While most resins hold up over the life span of the baby tooth, it is possible for resins to fail by fracturing or to form more cavities around the margins of the filling. It is recommended for children who are at a higher risk for cavities or who have large cavities that a stainless steel crown be placed so that extra time and money is not spent on retreatment in the future.
Stainless steel crowns (SSCs)
SSCs are the gold standard in treating cavities that are large (wide, deep, or involve multiple surfaces), involve the nerve of the tooth, or in children that are at high risk for having more cavities in the future. They are highly successful in that they are impenetrable by food and bacteria, provide integrity and strength to the compromised tooth, biocompatible with oral tissues, and cemented on using a fluoride-based cement. Although some parents may not like the esthetics of SSCs, they are the best option for reducing the risk of retreatment, and they will eventually fall out when the baby tooth falls out. While very rare, SSCs can be pulled off due to trauma or sticky foods. In most cases, a new SSC can be replaced easily. Generally, when a tooth with a SSC fails, it is most likely due to further degeneration of a compromised nerve (see pulpotomy) and not due to SSC itself.
A pulpotomy is the partial removal of nerve tissue on a baby tooth. I only perform a pulpotomy after much thought and consideration. I only recommend a pulpotomy when I am certain that the bacteria in the cavity has reached nerve. The pulpotomy will hopefully contribute to the longevity of the tooth. The procedure involves removing the top half of the compromised nerve while preserving the healthy, vital bottom half of the nerve in the root. A medicament is place on the nerve to hopefully reduce risk of further infection, and a SSC is placed over the tooth to protect and seal it. With proper case selection and correct technique, a pulpotomy is excellent way to prolong the life span of a tooth, providing the child with increased chewing function and natural space maintenance. Pulpotomies can fail if the disease process progresses to the lower half of the nerve, but can be a healthier and cheaper alternative to premature extraction of a vital baby molar.
Keeping with my conservative values, extraction of a tooth is only recommended in situations with no other sensible alternatives. These situations may include infection of the tooth; pain on a tooth that is loose but cannot be wiggled out by the patient; a baby tooth that is blocking the eruption of a permanent tooth; severe crowding of teeth where extraction of specific baby teeth may alleviate crowding; and a baby tooth with a cavity that is too severe to ignore but not worth restoring due to advanced age of patient. I always encourage children to wiggle out their teeth on their own at home when possible.
There is an assortment of appliances I use to move or hold teeth or to prevent negative habits. These can be discussed in detail on a case-by- case basis. Appliances can be expensive for the parent and cumbersome for some children. Therefore, I always attempt to avoid appliances by trying other options that are less invasive or cheaper before recommending an appliance. All benefits and risks of appliance therapy will be discussed in detail so that the parent can make an informed decision