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Tooth decay is extremely prevalent in children of all ages. There are a number of treatment options available depending upon the severity of the affected tooth. Here is what you need to know.

Are fillings in primary teeth necessary? Aren’t they going to fall out anyway?

Primary teeth are of utmost importance in your child’s mouth. They help your child chew properly and guide the development of your child's speech. The tooth buds of permanent teeth are already present in the gums below your child’s primary teeth, so the primary teeth maintain the space in the jaw for the permanent teeth. Research shows that extensive decay in primary teeth may cause a higher risk of caries in permanent teeth as well.

Primary teeth start shedding at about six years of age.  This process can continue up until 12 or 13 years of age. Primary teeth differ from permanent teeth in their anatomy. The enamel layer is thinner and the pulp or nerve tissue is larger and more vascular. Because of these anatomical differences, the progress from a shallow cavity to a deep cavity involving the nerve tissue and hence needing more extensive treatment is faster as compared to permanent teeth.

For all these reasons, dental treatment is a must at the very first sign of decay in your child’s teeth.

Tooth decay is preventable and avoidable, but if it does occur then treatment must be carried out immediately. Treatment of tooth decay depends on the age of the child and extent of the decay and whether the tooth is primary or permanent. The first sign of decay may be white spots, which can be treated with an application of fluoride varnish to aid in the remineralization of the decayed part.

Fillings in shallow tooth decay

In case a shallow cavity is present, the dentist will recommend a dental filling. The dentist will drill out the decayed part of the tooth and fill the prepared cavity with a variety of different filling options. The decision to use either a silver filling, a composite resin filling or a glass ionomer filling depends on certain clinical factors and should be left to the dentist.

The decay may be removed using a drill or a hand instrument. This is usually a painless procedure. In the case of sensitivity, the dentist may use local anesthesia or other sedation techniques like nitrous oxide gas.

The use of silver dental fillings is declining due to the presence of mercury and this is banned in some European countries as well. They are still used in some parts of the world as they are cheaper than tooth-colored composite fillings and take less time to put in.

Fillings for deep cavities in teeth

For deeper cavities involving the pulp or nerve tissue, a pulpotomy or a pulpectomy may be required. This is similar to a root canal in adults but is suitable for primary teeth. The child may already be in pain at this stage and these procedures will relieve the pain. In case the age of the child is such that the shedding date of the tooth is fast approaching or if the tooth is shaking, then such a tooth may be removed.

In case of a deep cavity in a young permanent tooth in a child, a proper root canal procedure should be carried out. These procedures require local anesthesia or sedation techniques. In some rare cases when multiple teeth need such procedures, general anesthesia may also be recommended.

Is it difficult for children to get dental fillings?

When you take your child to the dentist for fillings, you must be very calm and try not to transfer your anxiety to your child. Provide very basic information to the child and allow the dentist to win the child’s confidence in a playful manner. In most cases, your child’s bravery will surprise you. In case a large number of fillings are needed, allow the dentist to decide how many fillings will be done in one sitting.

Dental fillings are safe, and a great way to control caries in your child. They can be done in both primary and permanent teeth. In case fillings come out or decay recurs, new fillings may be required.

Stainless steel crowns for children

A primary tooth which is badly broken down and may not hold a dental filling reliably can be treated with a stainless steel crown. This is more common post-pulpectomy or in teeth with multiple fillings on different surfaces. These are pre-made crowns which are available in approximate sizes for different teeth. They cover the entire tooth like a cap. They are fit and cemented in place in one single sitting.

They are long lasting and studies show that they are more fruitful than metal fillings in children. They also increase the success of pulpectomy procedures and reduce the need for retreatment. They are mostly advised for the primary molars and have good strength to bear the chewing pressure.

Are stainless steel crowns safe for children?

They are perfectly safe to be used in children and very rarely need to be refit or remade. They stay in the mouth till the primary tooth sheds. Use of ceramic and gold crowns is extremely rare in children. Tooth-colored alternatives are advised for front teeth.

In case a child has a missing tooth, then a stainless steel crown may be placed on the adjacent tooth with an attached space maintainer which sits on the gums in the area of the missing tooth, hence maintaining the space for the permanent tooth bud below.

Stainless steel crowns though commonly used for primary teeth may also be placed for young permanent teeth, and at a later age are replaced with porcelain crowns.

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