There are times when it is necessary to remove a tooth. Sometimes a baby tooth has misshapen or long roots that prevent it from falling out as it should, and the tooth must be removed to make way for the permanent tooth to erupt. At other times, a tooth may have so much decay that it puts the surrounding teeth at risk of decay, so the doctor may recommend its removal. Infection, orthodontic correction, or problems with a wisdom tooth can also require removal of a tooth.
When it is determined that a tooth needs to be removed, your child's dentist may extract the tooth during a regular checkup or may request another visit for this procedure. The root of each tooth is encased within the jawbone in a “tooth socket”, and the tooth is held in that socket by a ligament. In order to extract a tooth, the dentist must expand the socket and separate the tooth from the ligament holding it in place. While this procedure is typically very quick, it is important to share with the doctor any concerns or preferences for sedation
Many cavities can be easily fixed using a white filling that mimics the color of the natural tooth. White colored fillings are called composite resins. A composite is a plastic material that contains microscopic filler particles (usually quartz or silica) to give it added strength. It actually bonds to the tooth so that it will stay in place well. White fillings do have their limitations and often teeth with very large cavities with a lot of tooth structure missing are not good candidates for white fillings.
When we place a white filling we first make sure that the tooth is thoroughly numb. White fillings will not bond well to a tooth in the presence of moisture so we use a rubber dam (explained below) to keep moisture (saliva) away from the tooth and to keep all of our materials out of your child’s mouth. We remove the decay and shape the tooth with a dental handpiece. We treat the tooth with some bonding materials and then we add the composite resin (white filling). The composite material is putty-like and we can shape it so that it ends up looking just like the tooth originally did. We shine a bright UV light on the tooth and this light causes the composite to harden very similar to tooth structure. We polish up the filling and the next thing you know we have completed a white tooth colored filling that looks almost exactly like the original tooth!
Unlike small cavities that can usually be restored with white fillings, larger cavities that have destroyed a lot of tooth structure often have to be restored with a stainless steel crown. In addition, teeth with smaller cavities that have weakened enamel in the areas around the cavity often require stainless steel crowns as well. Stainless steel crowns cover the entire tooth and strengthen and protect it. Stainless steel crowns are much less expensive than adult crowns.
Many adults associate their children getting stainless steel crowns with the procedure that a parent may have gone through to get a permanent crown. The procedures are actually very different. Adult permanent crowns are often made of porcelain or gold and have to be custom made in a dental laboratory. They usually require two appointments, one to prepare the tooth for the crown and one to cement the crown. Stainless steel crowns on the other hand are pre-made in various different sizes. We simply find a size that fits your child’s tooth and then we can contour and adapt the crown to fit perfectly and then cement it in place all in one appointment.
The procedure for placing a stainless steel crown is actually pretty quick. After the tooth is numbed we remove the decay and shape the tooth so that we can fit a stainless steel crown over it. We contour the crown so that it fits perfectly and then we cement it on with a dental cement. The stainless steel crown will stay on the baby tooth until the baby tooth falls out at which time the stainless steel crown will still be cemented to the tooth and fall out with the tooth.
Sometimes, a primary tooth is lost before the permanent tooth beneath it is ready to erupt. The most common causes for this are cavities and injuries. If your child loses a tooth prematurely we may recommend a space maintainer. A space maintainer is an appliance that holds open the space left by the lost tooth. The space maintainer helps prevent the nearby teeth from shifting into the vacant space. If this happens, when the permanent tooth is ready to erupt may not have enough room or may erupt in a wrong position. Once the spacer is in place, the eruption of the permanent tooth is monitored and when the time is right, the spacer is removed