By Jane A. Soxman, DDS
Primary (baby) molars with extensive decay, malformed enamel, advanced wear due to grinding, a missing replacement tooth, pulpotomy, or fracture may require coverage with a stainless steel crown in order to provide a durable restoration (filling).
Primary molars are shaped differently than permanent molars. Large amalgam (silver fillings) are not recommended for use in primary molars because they often fracture or crack. A fractured filling may not be evident until it falls out or until the tooth shows signs of abscess (infection). If a filling does fracture, decay may travel to the center of the tooth where the nerve and blood vessels lie. If the infection is caught early enough, a pulpotomy (described later) can be performed. If abscess has occurred, the tooth will often need to be extracted (removed). Early loss of a primary molar can create multiple other problems. Primary molars, and in particular first primary molars with decay on more than one surface, will have the benefit of a much more durable and reliable restoration with a stainless steel crown.
Usually, the crowns are silver, but crowns with tooth-colored facings are available. These may be more pleasing to the eye, but they have drawbacks when compared to the traditional stainless steel crowns. Not only are they more expensive, but the color match and the fit may not be as good. Tooth-colored crowns may appear to be bulky and the acrylic facings can fracture off, leaving exposed metal.
A primary molar may be restored with a stainless steel crown during one appointment. The decay is removed, the tooth is shaped for a crown, the appropriate size crown is selected, and the crown is cemented. The crown must be brushed when brushing the other teeth. Sticky foods such as caramels and taffy can pull the crown off. If this should occur, your dentist can usually replace the same crown in a few minutes.
A pulpotomy is necessary if bacteria have entered the area deep inside the crown of the tooth because of decay or fracture. This area is called the pulp chamber. It contains nerves, blood vessels, and other tissues that are necessary for the tooth to be healthy. A pulpotomy removes the unhealthy tissues only in the crown portion of the tooth. The nerves, blood supply, and tissues in the root(s) are not removed. If the bacteria are not removed, the tooth will abscess. A medicated filling is placed in the pulp chamber after the infected tissues are removed. A stainless steel crown should be placed in order to provide support for the walls of the tooth.
The tooth is once again healthy and in most cases will last until the Tooth Fairy says it's time to go!