When a baby molar (back tooth) has a large cavity or fracture, the standard of treatment, as recommended by the American Academy of Pediatric Dentistry, is restoring it with a stainless steel crown. Parents often ...
Parents often ask me, “Why do we have to do a crown if it’s a baby tooth? Why can’t we just do a filling instead?”
Here is my answer:
In order for a tooth to hold on to a filling, there must be enough healthy tooth structure to bond to it mechanically. A small, rice-sized cavity can simply be removed and replaced by a filling because there’s plenty of normal tooth left all around. When there’s a larger, oatmeal-sized cavity on an adult tooth, that might not be a big deal because and adult molar is so large and there’s plenty of tooth structure to work with. But an oatmeal-sized cavity on a baby tooth usually means that after the decayed area is removed, a third of the tooth is already gone since the baby tooth is already so small. A filling placed on a tooth without enough healthy tooth structure has no mechanical integrity and will fall out easily. The result is usually more pain, more money, and possibly infection leading to early extraction of the tooth.
Fractured Large Filling on a Baby Tooth
Large cavities on all four molars
A stainless steel crown is made from a composite of strong metals (no mercury though) so it works well even with limited tooth structure. It provides coverage for all surfaces of the baby tooth and once it’s placed, the tooth becomes practically self-maintained even in an environment of poor dental hygiene. This is due to the fact that since the entire tooth is covered, plaque and sugar has no way of getting to the real tooth structure. Even if the child doesn’t brush well, the tooth underneath the crown is protected.
Lower Right Molar Restored with a Stainless Steel Crown
Crowns for baby teeth are much simpler in placement than crowns for adult teeth and therefore are much lower in fees as well (about 80% cheaper). The tooth is first anesthetized. After the dentist removes the decay, she will reduce a thin layer of tooth from all around making the tooth a bit smaller. The crowns are already premade and come in 6 different sizes. Based on the size of the tooth the dentist will pick out an appropriate one and cement it on. When the baby tooth is ready to fall out, the crown will fall out naturally with the baby tooth so it’s not something that parents have to pay special attention to once it’s placed.
Six Sizes Available for Every Tooth
Currently, the most researched and successful molars crowns have been the traditional silver ones. There are, however, non-traditional ones that are more esthetic on the market. One type is stainless steel crowns made with a white covering. The problem with these is that the white coating will usually fracture off after a while (as little as a few weeks) revealing the silver underneath and parents get upset because they had to pay an extra fee to cover the higher cost of the crowns. Another type is molar crowns made with zirconia or acryllic. These crowns are very pretty and sounds promising but because they’re so new on the market, there hasn’t been any credible publications studying their longevity and success rates. Right now, most board certified pediatric dentists are sticking with the traditional ones because they have proven results.