Crowns for Baby Teeth

What is a crown?

A crown, sometimes also called a cap, is a restoration which covers the entire tooth. In enables the tooth to be used for normal biting and chewing. It also improves the appearance and strengthens and protects the tooth underneath. 

Most people are familiar with crowns for adult teeth. With advances in children's dentistry people are becoming more aware  of the importance of saving baby teeth until they fall out naturally. See previous post - Are Baby Teeth Important? (click for link) 

New techniques and materials have led to crowns for baby teeth which have improved appearance and fit.

When do baby teeth require crowns?

• When teeth are severely decayed, worn or fractured and there is not enough tooth surface to adequately hold a filling. 
• Teeth with severe developmental problems of the enamel and dentine may also require crowns. 
• Teeth which have had the nerve removed due to severe decay and infection (see Root Canal Treatment for baby teeth - Pulpectomy) are more brittle and prone to fracture and usually also require a crown.

Advantages of Crowns

• Preserves tooth until it is ready to fall out naturally, maintaining space for adult tooth to come through into.
• Stronger and longer lasting than large fillings.
• Enables normal functioning of tooth for eating and speaking.
• Improves appearance and therefore self-esteem.

What types of crowns can be used for baby teeth?

Crowns for adult teeth are usually made in a dental laboratory after taking an impression mold of the prepared tooth. Crowns for baby teeth can be made in the same way, however, this procedure takes two visits and can be difficult for young children. Therefore, ready made, or pre-formed, crowns are often used.

Pre-formed metal crowns

Ready made metal crowns have been used, mostly for back molar teeth, with a high success rates for many years. They are relatively inexpensive and provide a good fit with minimal tooth preparation and adjustments. They are strong and will last many years, until the tooth is ready to fall out naturally.




However, many people do not like the appearance of the metal. With advances in dental materials, tooth coloured crowns are becoming more popular.

Metal crowns may be modified by replacing the front area with white filling material or by bonding a tooth-coloured facing to the area visible when smiling. The aim is to keep the strength of the metal but improve the appearance. Some metal usually still shows at the edges and on the back of the tooth. Tooth coloured facings sometimes de-bond and fall off. 

Tooth coloured crowns

Strip crowns, also called acid etch crowns, are often used for front teeth. They are made directly in the mouth from composite filling material using a celluloid crown former with the desired shape of the tooth. By choosing the right shade of filling material a very good colour match can be achieved. The durability of a strip crown depends on how much tooth is left and how well the tooth was prepared for the crown. Care must be taken as this type of crown is prone to being broken, loosened or dislodged if too much pressure is applied to the tooth. 

Pre-formed tooth coloured crowns

At Small Bites we are always keeping up with the latest advances in dentistry. We have introduced high quality, pre-formed white crowns made from zirconia for children's teeth. These are imported from the USA and available for both front and back teeth. Zirconia is a hard, tooth-colored material similar to ceramic, but stronger.

The crowns are pre-made to specific sizes and the teeth require a small amount of preparation before the crown is fitted. 

Although more expensive than other crowns they have the appearance of a natural tooth. Only your dentist will know that it is a crown. 

Zirconia crowns give improved fit, tooth shade matching and durability.

If you would like to know more please comment or visit us at Small Bites - exclusive dental care for children in Bangalore.

Fillings for baby teeth

Maybe you have just found out that your child has one or more cavities in their baby teeth?

It is normal for parents to have concerns and questions. 

In this blog, we hope to give some answers and reassurance about fillings for baby teeth.


Children can develop tooth decay soon after their baby teeth come through. Prolonged bottle feeding with sweetened drinks, or frequently falling asleep with a bottle of milk or whilst nursing are the most common causes of decay in babies. Cavities usually do not cause pain in the early stages and young children may be reluctant to open wide to let their parents see or brush their teeth. So, it can come as a surprise to find out that your child has a cavity at a young age. 

Why should we fill baby teeth, won't they fall out later anyway?




Baby teeth are important for normal eating and speech development. A healthy smile is also beneficial for a child's self-esteem once they reach school age. 





Once a cavity has formed it usually progresses resulting in pain and infection. If an abscess on a baby tooth is not properly treated the infection can spread to and affect the developing adult tooth underneath.



Baby teeth also maintain the spaces for permanent teeth to erupt into. Although front baby teeth can start to fall out from around 6 years old, the back teeth need to last until around 12 years old. If baby teeth are lost too early other teeth may tilt or drift into the vacant space, forcing the adult teeth to come through crooked. 

If my child has a cavity what are the treatment options?

Fillings

If the decay is in the enamel or dentine layer only (not close to the nerve of the tooth) the decay can be removed and a filling placed in the cavity. 

Basic procedure:

• Smaller cavities in baby teeth can often be cleaned without using local anaesthetic. If the cavity is deep or the tooth is particularly sensitive, a small injection may be required to numb the tooth. For more information, see this blog post: Questions about local anaesthetic
• The decay is removed and the cavity is washed. There will be some mild vibrations and noise at this stage. A suction tip is used to remove water from the mouth, or your child may spit out when required. 
• The clean cavity is dried by blowing air onto it and then the filling is placed.

At Small Bites, we keep up to date with the latest filling materials and techniques. The two most commonly used filling materials for children’s teeth are:

Glass Ionomer Cement  

• Bonds directly to the tooth surface and so helps prevents leakage around the edge of the filling.
• Releases fluoride which can help prevent further decay.
• It is relatively quick and easy to place and is therefore popular for use with young children where cooperation for treatment is sometimes difficult.
• It  is quite brittle and prone to wear and so it is usually used in areas which are not under a lot of pressure from chewing.
• Reinforced Glass Ionomers have recently been developed which can be used in higher stress areas, such as the biting surfaces of the teeth.
• Glass Ionomer is white in colour but, unlike composite, it does not come in various shades to match the teeth more accurately. It also available in other bright colours for use in back teeth, if children prefer this.

Composite filling

• Composite fillings come in many shades which match and blend in well with the tooth. Therefore, it may be advised for front teeth where appearance is important.
• Composite is stronger and more wear resistant then glass ionomer.

• A blue etching gel, used to prepare the cavity surface, is painted onto the cavity surface and washed off after about 30 seconds. 
• A bonding agent painted onto the cavity surfaces. This adheres the filling material to the tooth.
• Next, the filling is placed in the cavity.
• A blue light is often used to give faster setting of the filling.
• The filling procedure takes a bit longer than for glass ionomer.

Your dentist will check the filling, and polish it, if required. Please follow instructions for looking after your teeth following treatment. It is usually advisable to wait half an hour before eating and drinking and to avoid hard, sticky and chewy foods on the same day. 

Pulpectomy

If the decay has started to affect the area containing the nerve of the tooth (the pulp), a pulpectomy is often required. For more information, see this link: Pulpectomy - Root canal treatment for baby teeth

Crowns

Teeth which are too broken down to adequately hold a filling or which have undergone pulpectomy usually require a crown to strengthen the tooth. This will be covered in a future post.

At Small Bites, the exclusive dental care centre for children in Bangalore, we have plenty of experience with young children and work to put them (and their parents!) at ease. If you have any questions or concerns, please contact us.



Don't forget to read our other posts for advice on preventing dental decay:

It's Never to Early to Start Preventing Tooth Decay
What Causes Dental Cavities?
Top Toothbrushing Tips

Stem Cell Banking from Teeth

Many people are familiar with stem-cell banking from the umbilical cord at birth. Did you know that it is also possible to bank stem-cells bank from baby teeth and young, healthy adult teeth? This recent technology has great potential to enable treatment of diseases and aid healing and repair using an individual’s own stem cells in future years.

What are Stem Cells?

Stem Cells are the “master cells” of the body which have the potential to differentiate into various types of cell, depending on the part of the body. They are also able to self-regenerate or multiply.

There are two main types of human stem cells:

Embryonic Stem Cells are obtained from early embryos. They have the potential to become any type of cell in body. The embryos are usually donated as extra embryos following IVF treatment. However, their use is controversial as collection of the stem cells results in the destruction of the embryo.

Adult Stem Cells are found in various parts of the body. They have the potential to become various types of cells. Bone marrow, umbilical cord blood and dental pulp tissue are good sources of adult stem cells.

      What are the advantages of Dental Pulp Stem Cells?

    Stem cells from teeth are mesenchymal stem cells which have the potential to become many different types of cells in the body.

Dental stem cells are easily collected by extracting the tooth and are found in high concentrations within the tooth pulp.

There are no ethical issues, since the stem cells are harvested from teeth that would fall out naturally or are to be extracted for other reasons.

I have already banked stem cells from my child’s cord blood. Why should I also consider banking dental stem cells?

Banking dental stem cells is complimentary to cord blood banking. The stem cells obtained from the umbilical cord are hematopoietic stem cells which are able to differentiate into all types of blood cells to treat blood diseases. The stem cells from the dental pulp have a much wider range of potential therapeutic uses.

In what treatments are stem cells already being used?

The use of haematopoietic stem cells to treat diseases and conditions of the blood system, such as leukaemia and anaemia, is well established. This demonstrates how powerful stem cell therapies can be. Scientists all over the world are currently researching ways to harness other types of stem cells and use them to learn more about, to diagnose, and to treat various diseases and conditions.

What diseases can potentially be treated using stem cell therapy?

Research has shown that adult stem cells can be taken from one area of the body, transplanted into another area and reprogrammed to grow into a completely different type of tissue. 

Stem cell science is continually moving forward. 

Many potential treatments are currently being tested in animal models and some have already been brought to clinical trials:

•  Type 1 (insulin dependent) diabetes
•  Treatment of spinal cord injuries
•   Neurological diseases e.g. Parkinson’s disease
• Heart disease
• Regeneration of bone, cartilage and other tissues
• Treatment of Autoimmune diseases

Which teeth can be used for stem cell banking?

Baby (milk) teeth

These should be extracted and sent for stem cell banking soon before they are due to fall out.

Healthy adult teeth

When extraction is planned to make space before orthodontic treatment.

Wisdom teeth

These are often extracted due to lack of space.


Teeth with decay are not suitable for stem cell banking.

Teeth from children and young adults usually give a better quality and quantity of stem cells than older teeth.

At Small Bites -  the exclusive dental care centre for children in Indiranagar, Bangalore - we have partnered with Stemade to offer stem-cell banking from baby teeth and young, healthy adult teeth. 

If you have any further questions please contact the practice. (Click Small Bites link above).

Further information is also available on Stemade’s website (click for link).

Fluoride: What parents need to know - Part 2

In Part 1 we discussed the benefits of fluoride and the risks of over-exposure to fluoride.

Fluoride can be useful in strengthening teeth and protecting them from decay, if used in the right way. 

As we discussed in the previous section, there is a risk of dental fluorosis, or mottling of teeth, if children swallow too much fluoride.

In this second part we will look at the uses of fluoride and safety guidelines.

Products which contain fluoride

Fluoride Toothpaste 

This is the most common application of fluoride as it can easily be used regularly at home. Regular use of fluoridated toothpastes has been shown to reduce tooth decay by up to 50%. 

Safety guidelines for using fluoride toothpaste:

• Young children who cannot spit out should use either plain drinking water or a training toothpaste which does not contain fluoride for brushing.
• Children generally learn to spit out from around 5 or 6 years old. At this stage fluoride toothpaste can be introduced with adult supervision.
• It is best to use a lower fluoride toothpaste up to 7 or 8 years old, when children still tend to swallow some paste and their developing teeth could still be at risk of fluorosis.
• The amount of fluoride is usually shown on the toothpaste packet in parts per million (ppm). In India, most adult toothpastes contain 1000 ppm and toothpastes designed for children often contain 500 ppm or less of fluoride. 
• No more than a small pea-sized amount of toothpaste should be used. Instruct your child to spit out after brushing and not to swallow it. 

• Keep toothpaste out of the reach of young children. Swallowing large amounts can cause stomach problems and other health issues. Seek immediate medical attention if a child swallows a large amount of toothpaste. 

Fluoride Mouthwash or Rinses

Mouthwashes are not recommended for children. If a teenager or young adult is at a high risk of cavities, or wearing braces which make their teeth more difficult to clean, their dentist may recommend a fluoride mouth rinse to be used at a different time from brushing. This should of course not be swallowed. Avoid mouthwashes that contain alcohol.

Fluoride Varnish

Fluoride varnishes are useful for children who are at a higher risk of tooth decay. As they contain a very high level of fluoride they can only be used by dentists and applied no more than twice a year. 

The varnish is painted onto teeth and sets quickly, sticking to the tooth surface to minimize swallowing and maximize its effect. If a tooth has very early dental caries in enamel, it can help to stop the decay and prevent it becoming a cavity. Fluoride varnish is also beneficial for sensitive teeth.

Glass Ionomer Fillings

Glass Ionomer is commonly used for fillings and sealants in baby teeth. In addition to being able to adhere directly to tooth surfaces it also releases small amounts of fluoride over an long period of time. The level of fluoride released is too low to cause any health problems but helps to prevent decay and the need for future fillings.

In Summary

When used in a controlled way, the benefits of fluoride outweigh the risks. 

Parents and dentists need to take into account the overall fluoride exposure from all sources when making decisions about the use of products or treatments which contain fluoride. 

In areas with high levels of fluoride in drinking water, fluorosis  (mottling and staining of the teeth) is common. In these areas it is wise to minimise fluoride exposure as much as possible. 

Dental Fluorosis

In areas where the is no significant fluoride in water the appropriate use of some fluoride therapies will be important in preventing decay.

If you need more information and advice, please speak to your dentist.

If you live in Bangalore, you can contact us at Small Bites, Exclusive Dental Care Centre for Children (click for link) where we will be happy to help.