A pediatric crown is a pre-formed cap placed over a primary tooth to restore its shape, size, and function. The primary purpose of this dental restoration is to preserve the compromised tooth until it naturally falls out to make way for the permanent tooth. Protecting the baby tooth ensures proper chewing and speech development while also maintaining the necessary space for the underlying adult tooth to erupt correctly. This restorative treatment is recommended when the tooth has sustained damage too extensive for a simple filling to repair effectively.
When Are Crowns Necessary and How Frequently Are They Used?
The use of crowns on primary teeth is a common practice in pediatric dentistry, standard for significant dental issues in children. They are typically required when tooth decay is so widespread that it involves multiple surfaces of the tooth, leaving insufficient healthy tooth structure to support a traditional filling material. In these cases, a crown provides full coverage and protection, sealing the tooth from further decay and bacterial invasion.
Crowns are also necessary after a pulpotomy, which is a procedure similar to a root canal for a primary tooth, where the nerve tissue in the crown portion of the tooth is treated. Following this internal therapy, the remaining tooth structure is weakened, and a crown is needed to reinforce it and prevent fracture. Other clinical situations include teeth that have fractured due to trauma or those with developmental defects, such as enamel hypoplasia, where the tooth is structurally weak from the start.
Because severe decay is not uncommon (nearly half of children experience tooth decay by age 19), the need for crowns is a regular occurrence in pediatric practice. Dentists prefer to use a crown to save a primary tooth rather than extracting it prematurely, which could lead to space loss and future orthodontic complications.
Material Options for Pediatric Crowns
Pediatric crowns are primarily available in two material types, each offering distinct advantages based on the tooth’s location and parent preference. Stainless steel crowns (SSCs) are the standard for full-coverage restorations on primary molars due to their durability and ease of placement. These crowns are made from a strong, silver-colored metal alloy that can withstand the intense chewing forces exerted on back teeth.
SSCs are cost-effective and require minimal tooth preparation, allowing for a quicker and less invasive, single-visit procedure, which is often preferable for younger patients. Their primary drawback is their metallic appearance, which is why they are typically reserved for posterior teeth that are not highly visible. For a more natural look, aesthetic crowns are available, most notably those made from zirconia.
Zirconia crowns are crafted from a durable ceramic material that is tooth-colored, providing an aesthetic result that blends with the child’s natural smile. These crowns are biocompatible and are frequently chosen for anterior (front) teeth or for back teeth when cosmetic appearance is a priority. While highly durable, zirconia crowns are more expensive and generally require more tooth structure to be removed for proper placement compared to stainless steel options.
What Happens During Crown Placement?
The process of placing a pediatric crown is generally completed in a single visit, unlike the multi-appointment process sometimes required for permanent crowns. The procedure begins with the administration of a local anesthetic to numb the tooth and the surrounding gum tissue, ensuring the child remains comfortable throughout the process. The pediatric dentist then thoroughly removes all decay and debris from the compromised tooth.
Once the tooth is clean, the dentist carefully shapes the tooth (crown preparation) by reducing a small amount of enamel. This shaping is performed to create a surface that allows the pre-sized crown to seat correctly without interfering with the child’s bite. The crown is then selected from a variety of prefabricated sizes to find the most accurate fit for the prepared tooth.
The dentist checks the fit of the crown to ensure it snaps securely into place and that the child’s bite aligns properly. After confirming the fit, a specialized dental cement is applied to the inside of the crown, and it is permanently sealed onto the tooth. This direct placement technique minimizes the time the child spends in the chair, and the crown immediately provides the necessary protection and restoration of function.
Maintenance and Longevity of Primary Tooth Crowns
The crown is designed to remain on the baby tooth until the permanent tooth naturally erupts, which can be a period of several years, typically between ages 5 and 12. Maintaining the crown is straightforward and largely involves following a regular, thorough oral hygiene routine. Parents should ensure their child brushes the crowned tooth twice daily, paying close attention to the gumline where the crown meets the natural tooth structure.
Flossing around the crowned tooth is also important to remove food particles and plaque, preventing new decay from forming at the margins of the restoration. While the crowns are durable, parents should encourage children to avoid excessively hard or sticky foods, such as hard candies or taffy, which could potentially loosen or dislodge the crown. A crown that feels loose or comes off should prompt an immediate call to the dentist to have it re-cemented or replaced.
The body’s natural process of root resorption, where the baby tooth root slowly dissolves, will eventually cause the crowned tooth to become loose. When the tooth is ready to exfoliate, the crown will simply fall out with the baby tooth, just as any healthy primary tooth would.