When your child needs dental treatment such as fillings, it is rare that only a single option is available for treatment. The parents’ basic knowledge of the different materials and options in dentistry could benefit the doctor, parent, and ultimately the child.
Scripps Pediatric Dentistry routinely educates San Diego parents on their options and this post summarizes some of those concepts. This is not intended to be taken as medical advise as all must talk to their child’s provider to decide what is best for him/her.
Bonding to enamel and dentin–
Adhesives that micromechanically bond to tooth structure (dentin/enamel) are very commonly used with tooth colored fillings in pediatric dentistry. This filling material is commonly called Resin or Composite (it is essentially a plastic restoration). It can be used to partially (filling) or fully (crown) cover CERTAIN teeth. In pediatric dentistry, large (for example 3 surface) fillings may not be good candidates for composite fillings.
The pro’s include: Very esthetic. Typically less healthy tooth structure needs to be removed. Works well with other resins (like sealants).
The con’s include: More costly to patient. More technique sensitive (takes longer and child’s perfect behavior is more important). Not as strong as silver fillings or crowns.
Amalgam is considered one of dentistry’s most time tested material. Like most dental materials in use now, it has undergone several generations of development and improvement. Today’s amalgam is comprised of several different alloys mixed chair-side to give the ideal outcome. Though certain practices do not use this material, professional organizations including the American Dental Association and American Academy of Pediatric Dentistry have published guidelines and research that support its judicious use. The major area of concern to many remains the presence of mercury, which is a known carcinogen, in all amalgams. However, many quality scientific studies have failed to find support that mercury in amalgam has such effects in humans.
The pro’s include: Less cost effective. Strong (though not necessarily strong enough in certain cases).
The con’s include: Mercury concerns by some. Esthetic. Typically requires more healthy tooth structure removal than composite. Does not bond well with other resins such as sealants.
The use of crowns in children is much different than in adults. Porcelain is rarely ever used in the United States for primary teeth. By far, the most common crown used for molars are called stainless steel crowns (SSC). They are preformed crowns made of a mixture of metals that give it a typical stainless steel shine. They come in many different sizes and your pediatric dentist will select and modify the best fit for the specific tooth. The crown gets cemented to help retention. These crowns are very time tested with excellent compatibility with the oral tissues. Other commonly used crowns used on front teeth include Resin Crowns and SSC’s with Veneered facings.
The pro’s of SSC crowns- Full coverage protection against caries on all surfaces of teeth. Less technique sensitive than fillings. Great long term durability.
The con’s of SSC crowns- Lack of esthetics. Can require re-cementation. More costly than fillings.
The pro’s of resin crowns- Esthetic. Full cover protection on all surfaces of teeth.
The con’s of resin crowns- NOT used on back teeth (molars). Can stain or break. More costly than fillings.
The pro’s of SSC with veneer- More esthetic than SSC.
The con’s of SSC with veneer- More healthy tooth structure removed compared to SSC (at times may force dentist to do an otherwise unnecessary nerve treatment). Veneers can break off.