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Dental Health Care: Discolored Primary Teeth

Discoloration of the primary (baby) incisors (front teeth) is most often noticed by parents. This discoloration may be extrinsic or intrinsic. Tooth brushing or a professional cleaning can remove extrinsic discolorations or stains. Intrinsic discoloration occurs within the tooth structure.

Some apple juices and grape juice may cause staining. This type of stain can usually be brushed off the teeth at home. If your child has a tendency to stain, try diluting the juice with water. Once the enamel begins to break down, the staining may be more difficult to remove because it is deep down in the tiny holes created by break down of the enamel. This could progress on to decay. If the teeth appear to be a dull, white color in some spots, discontinue juices completely or dilute the juice with water. Juice is twenty times more decay-causing than milk. Juices should be limited to mealtime only.

Liquid and chewable medicines have a high sugar content and most are colored with dye. A light yellow-brown film may cover the teeth. This occurs most often on the bottom front teeth. Bedtime tooth brushing is especially important when your child is taking liquid or chewable medicine. Tetracycline is the only antibiotic that could cause damage to the developing permanent teeth if given before eight years of age.

Iron in chewable or liquid vitamins may cause staining of the grooves of the primary (baby) molars. This is difficult to remove, but overall is harmless.

You must brush your child's teeth until six years of age. Bedtime brushing is the most important time of day. Staining may occur if plaque remains on teeth for a long period of time. Plaque is made up of cells from the inside of the mouth, bacteria, and food residues. Teeth may appear to be discolored, but a thorough brushing may remove this stain. Do not use toothpaste until two years of age. Baking soda toothpaste seems to be best for stain removal.

Bacteria called chromogenic (colored) bacteria may cause a dark green or brown stain on the teeth. This stain is usually along the gum line. These bacteria are harmless and will one day just disappear. We do not know why they grow in some mouths and not others. A professional cleaning is usually necessary to remove this stain.

Intrinsic discoloration cannot be removed by cleaning the teeth. This occurs because the enamel on the primary teeth did not form in the usual manner. This may be inherited from one or both parents. It does not necessarily mean that the primary teeth will be more susceptible to decay or that the permanent teeth will have the same appearance.

Trauma to a primary incisor (front tooth) may cause discoloration. If the blood vessels deep inside the tooth break, the blood may be absorbed into the tiny tubes that travel from the inside of the tooth to the outer enamel layer. This is similar to a black and blue mark on the skin. Enamel is translucent, so you can see the evidence of the damage. This may resolve without treatment, but your pediatric dentist should be consulted. A procedure to remove the tissue from the inside of the tooth (pulpectomy) may be necessary.

by Jane A. Soxman, DDS

+Jim Du Molin is a leading Internet search expert helping individuals and families connect with the right dentist in their area. Visit his author page.

Stainless Steel Dental Crowns For Children's Molars

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.

dental 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 pediatric 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!

by Jane A. Soxman, DDS

+Jim Du Molin is a leading Internet search expert helping individuals and families connect with the right dentist in their area. Visit his author page.