When tooth decay occurs it will continue to grow and spread until it is treated. A filling is a procedure in which the decayed part of the tooth is removed and replaced with a tooth-colored material called glass ionomer. You can think of a filling as a minor repair on a wall. If the hole in the wall is small enough it can be repaired with a little spackle. For a larger hole, the entire wall may need to be replaced which is when we would recommend a crown.
Crowns are recommended when a cavity is too large to for a filling. A crown is like a cap that covers the whole tooth. It can be made of stainless steel which is a shiny silver color or it can be made of zirconia which is a tooth-colored material. Zirconia crowns require excellent patient cooperation and often require nerve treatments due to the increased amount of tooth reduction required.
There is a nerve inside each and every one of our teeth. When a cavity becomes large it can start affecting the nerve leading to pain. If left untreated, it will develop into an infection resulting in the tooth needing to be removed. It is important to save baby teeth because they help guide the permanent teeth into place. A pulpotomy or “nerve treatment” involves removing the top portion of the nerve and placing a medicated filling inside the tooth. Placement of a crown is required after a pulpotomy in order to protect the tooth.
We like to save baby teeth if we can because they help guide the adult teeth into position but sometimes baby teeth need to be extracted. Extractions are indicated if the tooth is severely decayed, infected, or for orthodontic reasons. If a tooth is extracted, a space maintainer may be recommended.
If a baby tooth is extracted before the adult tooth is ready to come in, the surrounding teeth can start shifting causing insufficient space for the permanent tooth. A space maintainer is a custom-made appliance that prevents the surrounding teeth from shifting. It’s main purpose is to keep the space to allow the permanent tooth to come into place. It is important to have enough space for the permanent tooth to prevent orthodontic problems later on. Space maintainers are typically worn for 6 months to several years. When we see the permanent tooth starting to come in, the space maintainer can easily be removed.
Silver Diamine Fluoride
Silver Diamine Fluoride (SDF) is a non-invasive liquid medication that slows down cavity progression. The silver has strong antimicrobial properties while the fluoride helps strengthen tooth structure. SDF treatment is quick and painless and applied to the tooth with a small brush. After SDF application, the decayed areas of the tooth will turn dark black. The stains are permanent and will not wash off, however, the spots will be removed when those areas are eventually replaced with a filling or crown. SDF does not get rid of a cavity, it simply slows down the progression of the cavity. SDF can be a good option for a young, uncooperative child who needs to buy a little time before procedures like fillings and crowns can be tolerated.