Complex Dental Treatment
Some types of treatment that may be advised for children with tooth decay:
- Pulpotomy
This may be necessary for badly decayed teeth when caries (tooth decay) extends into the pulp.
The pulp is the tissue inside the tooth which contains nerve and blood vessels.
When tooth decay is deep, bacteria contaminates the pulp causing inflammation and sometimes pain.
When this happens, it is necessary to remove the inflamed tissue.
This treatment is called a pulpotomy.
In this procedure, the decay and the inflamed pulp tissue in the crown portion of the tooth is removed, a dressing is placed over the remaining pulp and the tooth is restored with a stainless steel crown (back teeth) or a strip crown (front teeth).
A pulpotomy may be necessary when there is a large cavity, pain on eating or pain with hot or cold.
- Pulpectomy
Spontaneous pain or toothache at night indicates irreversible inflammation and a pulpectomy may be necessary.
This is where the entire pulp is removed.
The root canals are cleaned and disinfected, and a medicated filling material is placed in the canals.
The tooth is restored with a stainless steel crown (back teeth) or a strip crown (front teeth).
Signs that this treatment may necessary include spontaneous pain, pain waking the child at night, abscess, redness or swelling on the gum around the tooth.
Sometimes it is not possible to save the tooth with pulp therapy and an extraction becomes necessary.
- Extractions
Sometimes it is necessary to extract teeth, for example if a tooth can not be restored, or is vertically fractured.
Local anaesthetic will be given for post operative pain relief.
This means that the area of extraction and the child’s lip will be numb.
Care must be taken to watch that the child does not bite or scratch their lip before the anaesthetic wears off.
A dissolvable suture (stitch) may be placed which will fall out by itself in a few days.
- Space Maintainers
One of the functions of baby teeth is to hold space for the following permanent teeth. When baby back teeth are lost prematurely, teeth behind tend to drift forward reducing the amount of space available for the permanent tooth which is supposed to replace the baby tooth at around age 10 to 12.
To avoid this loss of space, a space maintainer may be placed.
Any space maintainers placed will need to be removed when the permanent tooth starts to erupt, or the baby tooth becomes loose.
There will be a small fee when this occurs.
- Stainless Steel Crowns – Decayed teeth
When large amounts of tooth structure are lost due to caries, a stainless steel crown is usually placed to restore the tooth.
This is because large white fillings are prone to failure and the tooth then is likely to abscess.
Primary molar teeth would normally fall out around age 10 –12 years, so a SS crown gives the tooth the best chance of surviving until it is due to fall out, without requiring any further treatment.
- Stainless Steel Crowns – Hypoplastic teeth
The enamel on some children’s molar teeth forms imperfectly.
This is known as hypoplastic or hypomineralized enamel.
These are often treated with stainless steel crowns.
Because the enamel is defective, it is very difficult to get normal fillings to bond, so restorations in hypoplastic or hypomineralized teeth are prone to failure and other areas of the same tooth can also fracture at a later date.
This means that the child is subjected to multiple treatments on the same tooth.
Placing a stainless steel crown means that the tooth is treated once.
The 6 year old molars are important teeth for jaw development and development of the occlusion (bite).
These teeth are then later permanently crowned or may be extracted for orthodontic reasons.
- Anterior Composite Resin Crowns / Strip Crowns
Badly decayed front teeth and those fractured due to trauma may be restored with composite resin crowns, provided there is sufficient enamel left to be a foundation for the restoration.
These are tooth colored restorations that restore the size and shape of decayed / fractured primary incisors.
Although these give a good aesthetic result, these restorations are not as strong as normal healthy tooth structure, and may fracture more easily particularly if traumatized again eg in a fall, or on biting very hard foods or objects.
- Fissure Seals
Routinely done on 6 year old molars with deep grooves, fissure seals prevent bacteria getting into hard to clean fissures and prevent needing a filling at a later stage.
One material often used for this is slightly pink in colour and will release fluoride for ongoing cavity protection.
In primary teeth, a white material is also used.
