Treatment

A sealant is a protective tooth-colored acrylic “coating” that is applied to the deep grooves on the chewing surfaces of the back teeth (premolars and molars). Sealants act as a barrier to food particles, plaque, and acid that can cause cavities in the deep crevices of teeth where brushing and flossing cannot reach.

If the treatment to repair the decay in your child’s tooth is minimal, then the treatment provided can be an esthetic white filling. White fillings are made of composite resin that matches the natural color of your teeth and are an excellent option for small to mid-sized cavities. Because composite fillings actually bond to the tooth via an adhesive, less tooth structure needs to be removed for their placement.

The pulp is the tissue, nerves, and blood vessels that provide oxygen and nutrients to the center chamber and root canals of your child’s teeth. Teeth affected by caries, traumatic injury, or other causes can lead to pulp exposure, inflammation, and pain. Signs of an inflamed or infected pulp include constant or unexplained pain, nighttime pain, sensitivity to hot or cold food temperatures, and swelling around the infected tooth. When this occurs, pulp therapy is performed to maintain the integrity and health of the tooth and its supporting tissues. This is especially important in young permanent teeth with immature roots because the pulp is integral to the normal development of the root.

The two most common forms of pulp therapy are pulpotomy and pulpectomy. A pulpotomy removes the diseased pulp within the crown of the tooth while the pulp in the root canals is not touched. After the diseased portion of the pulp has been removed, an agent is placed in the tooth to prevent bacterial growth and calm the nerve of the tooth. A crown is then placed on the tooth to strengthen it and prevent future fractures. A pulpectomy is indicated when the entire pulp in both the crown and root canals is infected. The diseased pulp is completely removed from the tooth and the canals are then cleansed, disinfected, and filled with a resorbable material (primary tooth) or a non-resorbable material (permanent tooth). A crown is then placed to protect the tooth.

The stainless steel crown (ssc) is an extremely durable restoration with several indications for use:

1. following a pulpotomy/pulpectomy
2. teeth with developmental defects or large cavities involving multiple surfaces where a filling is likely to fail
3. fractured teeth.

In other situations, its use is less clear-cut with high caries risk factors, restoration longevity, and cost effectiveness being considerations in the decision to use the ssc. The ssc is a protective “cap” that covers the entire visible portion of the tooth above the gumline.

An extraction means to have a tooth removed and is done only as a last resort for severe tooth decay and infection. Extractions are also indicated to help facilitate orthodontic tooth alignment when severe crowding is present and when there are problems with wisdom teeth. Primary teeth are essential in maintaining the natural spacing in your child’s jaw for the permanent teeth. If a primary molar is removed prematurely, a space maintainer will be placed.

Space maintainers are used when a primary tooth has been prematurely lost, or extracted, to hold space for the developing permanent tooth. If space is not maintained, teeth on either side of the extraction site can drift into the space and prevent the permanent tooth from erupting into its proper position. The space maintainer will be removed from your child’s mouth once the permanent tooth starts to erupt.