The treatment we use for children will depend on many different factors and can be quite complex. The two most important factors are the child’s age and their risk of future cavities. The treatment can range from simply monitoring or “watching” a cavity in a small child (or an older child who will lose the tooth soon) to having to do a silver cap in a child who has large decay on the tooth. The treatment of children’s teeth and more importantly, the child that those teeth are attached to, is much different than treatment for adults. We have to take into consideration the child’s psychological development, ability to cooperate in the chair, and their dietary and hygiene habits. In a nutshell, here are the different treatment options.
Monitor or watching a cavity: This is the most conservative route. There are many reasons we may recommend this option depending on the size and number of the cavities, the child’s age, the child’s brushing and flossing habits, and the child’s development.
White fillings: These plastic fillings are very common and are a good restoration to fix children’s teeth. We may recommend these to fix smaller cavities or to fix cavities in the grooves of the teeth. We don’t place any silver fillings (amalgams) because they contain mercury, which can be bad for your child and the environment.
Silver crowns or caps: These crowns are made of stainless steel (no mercury), and when the cavity grows bigger and has broken through to the sides of the tooth, or will require a baby tooth root canal (pulpotomy), then we will do a crown of some type. These silver crowns last longer than white fillings, and we know that the tooth is protected from getting any more cavities. If a child is younger, needs to have treatment in the surgery center, or has decay on many teeth (at a high risk), we may choose to use a crown to prevent further decay.
White crowns: This newer type of crown is made of zirconia and offer an esthetic option for teeth in the front or back of the mouth instead of silver crowns. These may be an option in a child that only needs a few crowns and is able to sit through the treatment (because they take longer to place than the silver ones). They are sometimes more costly than the silver crowns (depending on your insurance), but many parents like these because of their natural look.
Typically, treatment in the office is completed with nitrous oxide or laughing gas. This gas allows the child to relax, and within five minutes of turning it off, it is completely out of their system. Most children respond well to treatment in the office with laughing gas, and we can accomplish treatment that could otherwise not be done without it. It also reduces the gag reflex to increase your child’s comfort and produce the best dentistry possible.
If we are not able to complete treatment with nitrous oxide alone, then we may recommend oral sedation (for just a few teeth). If the child has more extensive dental needs, has had a fearful experience in the past, has special needs, or has lots of anxiety, we may recommend general anesthesia at Children’s Hospital with pediatric anesthesiologists.
With any decision to treat your child, we always weigh several options to individualize the choice to your child (because all children are different) and we strive to treat your child as we would our own. I only recommend treatment that I would do if it were my daughter in that situation, and when there is a choice between two good options, we let the parents know the options and let them decide.