Primary teeth are very small, and any tooth decay on a primary tooth is a concern. If decay proceeds into the dental nerve, the tooth needs to be treated with a nerve treatment. If the decay is just into the nerve, a partial treatment, or pulpotomy is performed. If the tooth is infected (tooth abscess), a complete nerve treatment, or pulpectomy, is needed.
Since the enamel of primary teeth is very thin, decay can progress into the dental nerve much more easily than in permanent teeth. When decay projects just into the nerve there are bacteria that enter the outer surface of the nerve chamber. If these bacteria continue to penetrate into the whole nerve the tooth will abscess.
A pulpotomy is a procedure where the nerve in the crown (part of the tooth above the gum line) is removed and a sedative filling material is placed into the nerve chamber. This keeps the remaining nerve tissue intact and vital.
After the nerve treatment, the tooth needs to be restored with full coverage -- either a composite or stainless steel dental crown. If the tooth is not protected, it may fracture and need to be removed.
If the decay has progressed into the dental nerve far enough, the tooth will abscess. When this occurs, the tooth will need a Pulpectomy or be removed and a space maintainer placed. An abscessed primary tooth may have no discomfort due to the fact that the bone holding the roots is a spongy bone that is porous. When there is an infection in the primary tooth, the abscess can drain through the bone and gums into the mouth with no pressure buildup. On the other hand, a permanent tooth lies in the dense cortical bone; and if a tooth abscesses there will be a pressure buildup and significant discomfort. The treatment is similar to a root canal on a permanent tooth, but is accomplished in one visit. The nerve chambers of the tooth are cleaned, irrigated, dried and filled with a resorbable paste filler. The tooth is then restored with a composite or stainless steel crown.
Stainless Steel Crown
When a primary tooth has extensive decay, a conventional dental filling is not adequate as there is not enough tooth structure to support the dental restoration. This can be due to treatment of the tooth with a pulpotomy or pulpectomy, or due to the number of surfaces of the tooth that are involved with decay. A stainless steel crown is a prefabricated form that is fit and trimmed by the dentist to cover and protect the tooth. This type of restoration will protect the primary tooth from fracture and will keep it intact until it is time for it to exfoliate.
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