PlayWell Publications

PlayWell Pediatric Blog

Why did my Pediatric Dentist recommend a crown?

March 14, 2023

Teeth can be looked at like a 6-sided dice, where the 6th side has the root of the tooth anchoring it within the jaw bone. The 5 remaining sides are available for chewing, speaking, and smiling, but are also, then, exposed to sugar and sugar bugs, making the tooth susceptible to getting cavities!

When a cavity affects only 1 side of the tooth, like the chewing surface, we usually do a tooth-colored filling (unless it’s REALLY BIG). If a cavity affects 2 surfaces but is still small, we again can often do a filling. However, if a cavity is LARGE and requires restoration of 2 or more surfaces, then a crown which fully covers the tooth should be used. It has the best success rate and is the most cost-effective method over time.

Unlike adult teeth, baby teeth are crowned in just 1 visit. In fact, full coverage crowns can often be done more quickly, and with a less cooperative child than tooth-colored fillings. We use a selection of pre-formed crowns that come in a large variety of sizes. We fit the best crown for the tooth, just like finding the right size shoe for a child. We then make sure the crown is always snug and secure for the greatest stability.

But why do this?

It’s because baby teeth are different from permanent teeth! The roundness of their dimensions, and the thickness/structure of their primary tooth enamel impairs the long-term success rate you might expect from tooth-colored fillings in adults. 

Without getting too technical, fillings fail more often when the cavity is large in proportion to the size of the tooth, and when the filling lacks sufficient natural tooth surface to bond with. Even the smallest 2-surface tooth-colored fillings fail anywhere from 5-10% in 4 years in baby teeth. They often fail by way of new cavities on the same tooth where the tooth and filling meet, or on a totally separate area of the same tooth which then requires a completely new restoration to include the new areas (as seen in Severe Early Childhood Caries - SECC). Bigger fillings fail far more often, commonly by debonding/breaking from the tooth. Crowns on the other hand, only fail if they come off, which virtually never happens!

My best attempt at an analogy is this:

A tooth with a 1-surface cavity is like a laundry basket – it has a hole in the top. Your folded laundry goes in like a “filling”. As long as the basket has 4 sides, your laundry-filling is safe. Even when your kids bounce up and down and take rides in the basket, which is a lot like chewing on a tooth, your laundry will stay put. However, if you lose any sides of the basket, your laundry becomes much less secure. Lose too many sides and there is no way your laundry (or your kids) will stay in place! When I restore a tooth with a crown, it’s like placing the laundry in your basket which is missing a few sides, and then take a larger upside-down laundry basket (crown) and encase your original laundry basket with 4 new sides. Now your child can bounce up and down upon it and you can slide them around the house for a ride. The laundry will stay safe and the original laundry basket (the tooth) won’t break.

Tooth-colored fillings are great and we use them frequently especially when the cavity is small, or when there is only a short time before the tooth will naturally be lost (18-24 months). We use a host of preventive and restorative techniques to make and keep kids healthy. For crowns, we offer both classic stainless steel crowns and tooth-colored crowns.

A kid playing with his toys

Come Smile With US!

The PlayWell Membership Plan has your kiddo covered with the quality pediatric dental care they need and deserve to grow well with bright oral health. Check out our plan perks and give your child the gift of a beaming smile by joining our patient family today!

let's get started