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Pediatric Treatments for Baby Teeth
Space Maintainers
When there is a premature loss of a primary baby tooth, it is necessary to place a space maintainer.
Each primary tooth has a permanent tooth that will come in after it falls out. Normally the permanent tooth is right below the primary tooth and comes into mouth soon after the primary tooth exfoliates. If a primary tooth comes out early and nothing is done to keep the teeth in position, the teeth adjacent to the lost tooth will start to tip and drift into the open space. This will cause the available space to get smaller and the new tooth that will erupt later will not have adequate room.
If a primary molar is lost at age 5 or 6, the permanent tooth will not come in until age 11 or 12. A space maintainer is an appliance that is fixed or removable and is made of acrylic or metal. A fixed space maintainer comes in two varieties: unilateral (band and loop) or bilateral (lingual or palatal arch). The band is fit on the tooth behind the missing tooth, and a wire is attached near the gum line connecting to the tooth in front of the space. This prevents any shifting in either direction of the adjacent teeth. The removable space maintainer is similar to an acrylic retainer that is used after braces to hold the teeth position. There are indications for each type.
Why Fix Baby Teeth?
The primary (baby) teeth are important for eating, proper chewing and swallowing of food, and good speech. Proper care of the primary teeth also keep your child's smile beautiful. Decay on primary teeth can progress quickly, as they are small and have a thin layer of the enamel, the harder, more cavity resistant part of the tooth. The front upper and lower primary teeth fall out at about 6 years old. The back teeth, three in each quarter, fall out at about 12 years of age.
If there is decay on primary teeth that will be in the mouth for a reasonable amount of time, they should be restored. Decay can progress into the nerve of a primary tooth in 12 months or less. This can cause pain and may even cause the teeth to become infected. An infected primary tooth needs either a nerve treatment or to be removed. If a tooth is removed, a space maintainer is placed to prevent tooth shifting (see Space Maintainers). Also, decay between the teeth will make the tooth narrower as the tooth breaks down, and will allow the teeth to drift together, losing space for the permanent teeth. A few millimeters of tooth loss can occur and may cause additional crowding of the permanent teeth as they erupt. The proper oral hygiene and preventive care in the dental office and at home will go a long way in keeping your child's smile intact and beautiful.
Amalgam -- Rationale for Use
Dental amalgam has been used for over 150 years. Gold restorations are the only restorations used longer than amalgam. Dental amalgam is a combination of mixing mercury and a metallic powder composed of silver, tin, copper and zinc. Dental amalgam is one of the most predictable and cost-effective dental restorations there is. It lasts longer than any restoration other than gold. There is less sensitivity after placing an amalgam restoration, and treatment time in the chair is significantly less than other restorations. Its only drawback is its gray color.
Today, dental amalgam is used in many situations. It is used for fillings on children and adults. Teeth that have large fillings in a stress-bearing area are well served by amalgam fillings. Also, small restorations are easily restored by amalgam. Amalgam restorations are also used for bases for building up a tooth prior to a crown. If a patient has poor oral hygiene, amalgam restorations last longer. Cost of amalgam fillings are approximately 50 percent less than a comparative white filling. An amalgam is not used in front teeth where aesthetics is important, and where there is not adequate tooth structure and full coverage, or when a crown is needed.
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