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!
