Dental crowns (caps) for primary (baby teeth) are tooth-shaped coverings cemented to the tooth for the purpose of restoring the tooth to its original shape and function.
In the practice of pediatric dentistry, it often becomes necessary to repair and restore (returning a tooth to its original shape, function, and, often times, appearance) heavily decayed primary teeth (baby teeth with large cavities or structural issues) with the use of dental crowns. In the following article, we will address the following frequently-asked questions regarding crowns in primary teeth:
- What is a dental crown “cap” and when are crowns necessary in primary (baby) teeth?
- Which types of crowns are available for the repair of primary teeth?
- What are the steps of restoring primary teeth with a crown?
- What should I expect after my child’s dental crown procedure?
What is a crown, and when are they necessary in primary teeth?
A dental crown is a tooth-shaped covering cemented to the tooth for the purpose of restoring the tooth to its original shape and function. Crowns are used in pediatric dentistry for various reasons. Crowns are recommended by dentists when it is necessary repair and restore a primary (baby) tooth found to be extensively decayed (has a large cavity), a tooth fractured due to trauma, or a primary tooth which has not developed correctly.
‘Extensive decay’ refers to a tooth which is severely decayed with large cavities found on two or more surfaces. Severely decayed or fractured teeth are beyond the scope of repair by a filling because of the risk of the filling falling out, breaking, or wearing out resulting in the necessity of future dental procedures. Crowns are much more durable than fillings, and usually last until the baby tooth falls out at about age 12.
In addition to repairing a badly decayed tooth, It is very important to repair and restore primary teeth for the following reasons:
- Since the enamel of baby teeth is thinner than that of permanent teeth, decay can spread rapidly between teeth. Crowns can be used not only to save the decayed tooth, but can also help prevent the spread of decay and infection to other areas of the mouth or body.
- Crowns restore a tooth’s shape, size, and function. Since one main function of primary teeth is to hold the spacing for the permanent teeth and help guide the permanent teeth into position, crowns are a very important part of oral health and development.
- Crown restorations aid in the normal development of a child’s jawbone and muscles.
- Crown restorations allow for proper speech development.
- Crown restorations are imperative for the chewing of food.
- Crown restorations cover the entire tooth, and therefore prevent the tooth from further decay.
Which types of crowns are available for the repair of primary teeth?
There are several types of crowns available for the repair and restoration of primary teeth. The four main types are pre-formed stainless steel crowns, “Strip” or acid-etched resin crowns, veneered steel crowns, and zirconia crowns. Each type of crown has it’s advantages and disadvantages and are more useful in some parts of the mouth than others.
Stainless Steel Crowns:
- Are by far the most commonly used crowns in pediatric dentistry—they are tried and true, and have been used in dentistry for over 50 years.
- Are made as metal shells of varying sizes, and can be customized to fit any tooth
- Are perfect for molars (teeth towards the back of the mouth), as they are durable, strong, and resistant to moisture
- Are useful when there is decay between the teeth
- Are easy to place and generally require only one visit to the dentist
- Are cost-effective—stainless steel crowns are the least expensive crowns available.
Strip crowns (also known as ‘acid-etched resin’ or ‘composite strip’) :
- Consist of a clear shell which is filled with tooth-colored composite (filling) material and fitted over the tooth
- Once the composite material ‘sets’, the plastic covering is removed, leaving behind the tooth-colored material
- Are an aesthetically (cosmetically pleasing) option, and are often used for front teeth
- Are a moderately-priced option
Veneered Steel Crowns (also known as porcelain-fused-to-metal or resin veneer crowns):
- Consist of stainless steel/nickel crown with a tooth-colored material bonded to the front, top, and sides
- Are durable
- Are aesthetically pleasing—perfect for anterior teeth
- Are a great choice for anterior (front) tooth restorations
- Are also available for posterior (back) tooth restorations
- Are protective against moisture
- Require more tooth reduction than other crown preparations
- May cause allergic reaction in children with metal allergies
- Are made of a hard tooth-colored material similar to ceramic
- Like stainless steel crowns, zirconia crowns are pre-made to specific sizes
- Are metal free
- Are virtually indestructible—stronger and more durable than natural enamel
- Are arguably the most aesthetically-pleasing of all crowns
- Are resistant to plaque accumulation and decay
- Are biologically-inert—do not initiate an allergic response when introduced to biological tissue
- Can be produced in one visit if the dental office has the software and hardware available to do so
What are the steps to restoring primary teeth with a crown?
In most every dental crown procedure, there are a few universal steps. First the dentist will numb the area around the tooth to be restored, put a dental dam in place, as well as remove decay and shape the tooth to fit the crown. Unlike crowns for adults, which often require several visits to the dentist, most crowns for children can be placed in a single procedure. Below are the steps for most every pediatric crown procedure:
- First, the dentist will numb the area with a numbing gel. The gel is applied around to the gums and cheeks around the tooth receiving the crown.
- Next, the dentist will inject a local anesthetic to completely numb the tooth.
- Since some children experience anxiety when seeing a dentist, sometimes the child may be consciously sedated (relaxed, yet completely aware of all that is going on) by one of the following methods:
- Nitrous Oxide (laughing gas): Nitrous Oxide is a gas which is mixed with oxygen and delivered through a small mask which is placed over the nose of the child. The effects are very mild, and allow the child to be relaxed while being fully alert. Some potential issues with Nitrous Oxide include the mask feeling uncomfortable or anxiety-producing to the child. In addition, since the mask placed over the nose requires the child breathe through the nose, a child with nasal congestion may need another type of sedation.
- Medicine in the form of a syrup or pill: Different sedatives (medicines used to cause relaxation) may be administered if for some reason a child is unable to tolerate the Nitrous Oxide mask, or is highly agitated.
- An injection with a sedative medicine: This type of sedation is rare, but may be necessary in some circumstances.
- Intravenous sedation: In situations where there is need for major restoration involving many teeth, an intravenous (medicine for relaxation through an i.v.) sedation may be used.
- Then, the dentist will place the dental dam. The dental dam is a small piece of latex or similar material used to isolate the tooth being treated. A small hole perforated hole is placed over the tooth and secured with a metal apparatus. Dental Dams provide the following benefits:
- It protects the child’s cheeks, tongue and gums.
- It keeps the tooth isolated and dry during the procedure. For a crown restoration to be successful, it is imperative the area be kept dry. A vacuum source is used to control moisture in the mouth beneath the dam.
- The dental dam can help a child feel safe and protected during the procedure as it provides a literal and figurative barrier between the child and the dentist, and encourages cooperation with the dentist by the child.
- The dental dam prevents a child from accidentally swallowing or aspirating (breathing in) any loose material during the procedure.
- As the procedure continues, the dentist will first remove any decay using a special drill called a handpiece. The handpiece is also used to shape the tooth for optimal placement of the crown. It is very important the crown fit snugly over the tooth.
- Finally, the crown will be placed. Depending on the type of crown, the procedure may vary slightly.
- For stainless steel crowns, the dentist will chose the best sized crown to fit the tooth. The crown will be polished and filled with cement. The crown will then be pressed into place over the tooth. Once the crown is placed on the tooth, the dentist will remove any extra cement or debris and will rinse the child’s mouth.
- For strip crowns, the dentist will fill a tooth-shaped plastic shell with composite (tooth-colored material), and will then use a special light to cure (harden) the composite. The shell will then be removed leaving a tooth-colored crown in place.
What should I expect after my child’s dental crown procedure?
It is normal for your child to experience some discomfort caused by irritation of the tooth’s pulp or soft tissue around the tooth for up to 24 hours after the procedure. Over the counter medicines such as acetaminophen or ibuprofen will help with the discomfort. It is important to contact your child’s dentist should the pain last longer than 24 hours.
It is very important to discourage eating until your child’s numbness has completely worn off. This prevents accidental bites of the lip and/or cheek, which can cause significant injury.
Sometimes a child may bite, chew, or suck on the numb areas of the mouth without realizing how hard they are biting. This can cause severe damage. Please pay attention and discourage your child from chewing, sucking, or biting the numb areas.
If a child mentions the tooth feels ‘funny’ or has trouble biting or chewing, please contact your dentist’s office immediately as the tooth may need a bit more adjusting to achieve the ideal bite.
Finally, it is imperative to encourage brushing, flossing and rinsing at least twice a day to prevent healthy teeth from potential decay. A child prone to tooth decay may need dental checkups up to four times a year. Keep your child in ideal oral health by discouraging sugary foods and drinks, encouraging regular brushing, flossing, and rinsing, and by regular dental exams.