Stainless Steel Crowns
The American Academy of Pediatric Dentistry has defined the guidelines for the use of stainless steel crowns:
- If a pulpotomy (nerve treatment) is indicated.
- The tooth has such an area of decay large enough to make the remaining tooth structure insufficient to hold a traditional filling.
- A tooth that has formed incorrectly or has fractured.
Our general dentist said the tooth could be filled.
Dr. Morgan has undergone an additional two years of specialized training to treat primary (baby) teeth. How he treatment plans restorative procedures for your child is based on the guidelines set forth by the American Academy of Pediatric Dentistry. Where indicated, the stainless steel crown is the superior treatment option for your child’s tooth. If a filling is done when a stainless steel crown is indicated, the filling could fail. Your child might need to have the tooth retreated in the future (which might not be covered by your insurance), or extracted. In most cases, the stainless steel crown should last until the tooth comes out naturally.
Are there any crown options that look nicer (white crowns)?
As technology advances, Dr. Morgan hopes to be able to offer your child a more esthetic crown option for their posterior teeth (molars). Currently, white crown are available for primary front teeth, but the materials currently being marketed for restoring the molars are stainless steel crowns with white “facings”. These are far inferior to stainless steel crowns as the white portion of the crowns have been shown to fracture away, leaving a rough surface.
The pulp of a tooth contains the blood supply and nerves. A healthy pulp is ideal, but if it is sick, medicine needs to be placed to maintain the health of the roots of the tooth.
Tooth decay and trauma are the main reasons for a tooth to require pulp therapy. Pulp therapy is often referred to as a "nerve treatment" or "baby root canal”. The two common forms of pulp therapy in primary teeth are the pulpotomy and pulpectomy.
A pulpotomy removes the sick pulp tissue in the pulp chamber only. Once this is removed, medicine is placed to prevent bacterial growth and to calm the remaining nerve tissue. A stainless steel crown is generally placed at this time.
A pulpectomy is required when the entire pulp is involved, including the roots of the baby tooth. During this treatment, the diseased pulp tissue is completely removed from both the crown and root. This procedure is more similar to a “root canal” in adult teeth. The canals are cleaned, disinfected and filled with a resorbable material. Unlike adult root canal filling material, it is important to use a resorbable one for primary teeth in order to avoid any interruption in the adult tooth erupting into place. A stainless steel crown is generally placed at this time.
Resin (white) vs Amalgam (silver) Fillings
Dr. Morgan uses composite resin filling material whenever indicated.
Resin restorations have many advantages over amalgam fillings. Resin restorations require a smaller preparation, which means removing less tooth structure. The material also has a chemical bond component, meaning that it does not rely solely on the shape of the tooth preparation for retention.
Why do children lose their baby teeth?
A baby tooth usually stays in until a permanent tooth underneath pushes it out and takes its place. Unfortunately, some children lose a baby tooth too soon due to an accident or disease. When a tooth is lost too early, Dr. Morgan may recommend a space maintainer to prevent future space loss and dental problems having to do with crowding.
Why all the fuss? Baby teeth eventually fall out on their own!
Baby teeth serve a very important role in saving space for their adult counterparts. Think of it as saving a seat for a friend. They also serve as guides, allowing adult teeth on either side to erupt into the proper position. Early loss of baby teeth without space maintenance may lead to shifting of present and future, unerupted adult teeth. This may increase the need for future orthodontics (braces) or cause a negative change in your child’s bite, discomfort and gum issues from altered eruption or impaction of adult teeth.
What are space maintainers?
Space maintainers hold open the empty space left by a prematurely lost tooth. They steady the remaining teeth, preventing movement until the permanent tooth takes its natural position in the jaw. It’s more affordable-and easier on your child-to keep teeth in normal position with a space maintainer than to move them back in place with orthodontic treatment.
What special care do space maintainers need?
Like braces, space maintainers require a higher level of responsibility when it comes to oral hygiene practices. Daily brushing and flossing is a must, as these appliances may retain food and plaque. Routine dental care is imperative. Also, it is important that your child refrains from all hard, sticky, chewy candies and gum as these have a tendency to dislodge the space maintainer.
What are sealants?
Think of the chewing surface of your child’s molars as the nooks and crannies of an English muffin. This is at the microscopic level, but it’s a good analogy. Sealants protect the grooved and pitted surfaces on the chewing surfaces of back teeth. They are made of a tooth colored resin and are placed on a decay-free tooth to prevent a cavity from forming. Research shows that sealants can help reduce your child’s risk for a cavity by 97%.
How do they work?
The grooves in permanent molars are narrow and deep. This is ideal for cavity-causing bacteria to accumulate and cause disease. Sealants flow into these grooves sealing them off, which helps decrease the risk of decay in the chewing surfaces of the back teeth.
How long do sealants last?
Research shows that sealants can last for many years if properly cared for. If your child has good oral hygiene and avoids biting hard objects (ice, pens, toys, etc.) sealants will last longer. Your child’s sealants will be checked every visit to make sure they are in good condition. Dr. Morgan will discuss touching up and/or replacing them as needed.
What is treatment like?
The application of a sealant is quick and comfortable. It takes only one visit. First, the tooth is cleaned and dried. The tooth is kept dry and free from moisture contamination the entire time. The sealant flows into the grooves of the tooth and is hardened with a blue light. Your child will be able to eat immediately after the appointment.
If my child has sealants, can he still get a cavity?
It is very important that your child maintain very good hygiene by daily brushing and flossing. It is possible to still get a cavity between the teeth from not flossing where a sealant doesn't cover. The same plaque that causes cavities can eat through a sealant if left there for long periods of time. That's why good brushing and regular dental visits are so important to be sure the sealants do their job.
How safe is nitrous oxide/oxygen?
It is perhaps the safest sedative in dentistry. It is mild, easily taken then quickly eliminated from the body.
Are there any lingering effects or special care after nitrous oxide/oxygen?
No. All the nitrous oxide is completly out of your child's system by the time the appointment is over. At the end of the appointment the child is given 100% oxygen to breath for several minutes. After the appointment no special care is required.
Are there special instructions prior to having nitrous oxide/oxygen?
Tell Dr. Morgan about any respiratory condition that makes breathing through the nose difficult for your child. Also tell Dr. Morgan of any medications your child may be taking.
Will nitrous oxide/oxygen work for all children?
Pediatric dentists know that not all children are alike! Some children will not need or benefit from the use of nitrous oxide/oxygen, although most do. Dr. Morgan has undergone comprehensive training to administer nitrous oxide in a safe environment for your child.
What is conscious sedation?
Conscious sedation is a management technique that uses medication to help the child cope with fear and anxiety in order to receive dental care.
Who should be sedated?
Children who have a level of anxiety that prevents good coping skills should be sedated. The very young child that does not understand how to cope in a cooperative fashion for the safe delivery of dental care should be sedated. It is also helpful for some children with special needs.
Why utilize conscious sedation?
Dr. Morgan wants only the highest quality and most predictable dentistry for your child. Conscious sedation aids in allowing a child to cope better with dental treatment. This can help prevent injury to the child from sudden patient movements and promotes a better environment for providing dental care.
Is sedation safe?
Sedation is safe when administered by a trained pediatric dentist who follows the sedation guidelines of the American Academy of Pediatric Dentistry. Dr. Morgan will discuss sedation options and patient monitoring for the protection of your child. As with any type of anesthesia, there are risks that Dr. Morgan will discuss with you.
Will my child be asleep?
Conscious sedation is variable in its effects on children. If your child has a very calm baseline demeanor and/or is a little sleepy to begin with, they may relax so much that they take a nap throughout the procedure. However, this should be not expected, and sometimes patients may still cry or act negatively for treatment. Dr. Morgan is well trained in selecting patients who he feels will have successful conscious sedation appointments.
What special instructions should I follow before the sedation?
In order to alleviate potential anxiety in your child, Dr. Morgan recommends minimal discussion of the dental appointment with your child. Should your child become ill, contact Dr. Morgan to see if it will be necessary to postpone the appointment. It is very important to follow the directions regarding fasting from fluids and foods prior to the sedation appointment.
IV Sedation/General Anesthesia
We are very excited to offer our patients the option of having their treatment done with the benefit of in-office pediatric IV sedation and outpatient General Anesthesia at the Manatee Surgical Center.
Dr. Hector Vila or Dr. George Alvarez (www.pediatricsedation.com), Board Certified Pediatric Anesthesiologists, will be present and perform the sedation. Dr. Morgan will perform all necessary dental treatment.
There are many benefits to having your child’s treatment performed under IV sedation.
- All dental work can be done in one day.
- The child is asleep during the IV sedation. They are not aware of the treatment being done. They go to sleep in their parents arms, and wake up with a parent in the room.
- They do not, generally, need to be numb for treatment. This can eliminate the numb feeling following the procedure, which can last up to 4 hours. Young children do not understand this feeling and can potentially chew the inside of their cheek and lip.
- In some cases, medical insurance will pick up some or all of the costs associated with the anesthesia. Parents will need to contact their medical providers to see if this is a covered expense. Once the appointments are booked, the pediatric anesthesiologist can assist in the paperwork concerning this aspect.
- We can take necessary dental x-rays when they are asleep, which allows us to see if there are more areas affected and treat at the same time. This may result in a change in the original treatment plan given at the child’s examination visit, but can benefit the child by reducing the need for additional future procedures.
Dr. Morgan also has privileges at the Manatee Surgical Center in downtown Bradenton to complete dental treatment while utilizing general anesthesia for patient comfort/safety.
Please refer to the MSC website for more information regarding services offered for your child. http://www.manateesurgicalcenter.com