Saturday, June 17, 2006

White Crowns For Baby Teeth

If you have a baby tooth with decay, the usually restorative option is a white filling. If the decay is extensive, a crown may be recommended. There are few options when it comes to crowns for baby teeth. For back baby teeth there really is nothing better than the good ole' stainless steel crowns. They are relatively easy to do and last till the teeth normally fall out. Since they are in the back, cosmetics is not as much of a concern. They are available for the front teeth and work quite well. However, most people don't want "silver" in the front. I don't blame them.

Pedo-Jacket crowns:
So, are white crowns available for front baby teeth? Yes. There are several types each of which has benefits and drawbacks. A porcelain crown like you do on adult teeth is really not an option for those little baby teeth. The teeth simply are way too small. A Stainless steel crown is good, but looks bad. There is a thing called a NuSmile crown (or other variants) that is basically a stainless steel crown with something white coating the front. It is harder to place and looks a little fake (sort of a harsh white) especially if there is just one there. In addition, the white stuff on the front sometimes chips off. Another white option is a "Strip" crown. This is basically a clear form that is filled with white filling material and placed over the tooth. After light curing, the outer clear shell is removed leaving basically a white filling all around the tooth. This option looks the most natural, but is also the most fragile. It can only be used if there is a good bit of tooth structure remaining after decay removal and crown preperation. One option we use a lot is the "Pedo-Jacket" crown. This is basically a white plastic shell you place in a similar manner to the strip crowns. You can either remove the outer shell like a strip crown or leave it on there, which is the usual method. They look good, but sometimes kids chew through the outer shell which causes problems.

So, in summary, there is no magic bullet. All crowns have some kind of drawback. This is very frustrating for us and for parents. Kids are so rough on their teeth. Again, it should be noted is is very unusual to do porcelain crowns for baby teeth. There are many reasons why they are not ideal. The only time I have done them is for older teenagers with congenitally missing back teeth (with the baby tooth still there at that age) whose only cosmetic option is the porcelain fused to metal crown (those run around $800 or more each) and usually necessitates a pulpal treatment as well due to the small tooth size, and these crowns having a questionable prognosis in baby teeth. Also, it should be noted that there is a NuSmile type crown for back baby teeth, but the white tends to get worn off very easily due to the tight occlusion. We hardly ever do those though many parents ask if there is some kind of white option for those back teeth. Well, not really any good option yet. Maybe some day...

Stainless Steel Crowns:









Strip Crowns:











Stainless steel crowns with white coating:

48 comments:

plaza_dental said...

for the strip crows; what would be the production,procedure time and steps?

Dr. Dean Brandon said...

Hmm, I'm, not sure exactly what you're asking, but...

It takes about as long to do either the strip crown, pedo jacket or nusmile. Each type is done differently, but you prep the tooth, (you don't do these like a PFM prep or you'd have no tooth left). You don't need a chamfer or anything too fancy. You just need to remove the decay and make room for the composite. Then you fit the right size crown form, trim it as needed, etch the tooth, bond, place composite in the crown form, place, cure, then remove or "strip" the crown form off. Really it doesn't take too much longer doing one of these than a large composite, but it does take practice to get good at it. It also takes experience to recognize when this is indicated and when it is not. It can get difficult if you have a problem with hemorrhage control or a wiggly patient. Of course, there is no lab fee, but you have to keep a selection of strip crowns in various sizes on hand.

Anonymous said...

We just found out that my 4 year old needs a crown on the bottom-- second tooth from the back. I know it is a back tooth, but I still think it will be visable from the front. Can a stainless steel crown with a white coating be done on this tooth even though it is not right in the front?

Dr. Dean Brandon said...

Well, yes and no. No, there is not a good white crown available, certainly nothing like a porcelain crown that would be used on a permanant tooth. There are some crowns which are actually stainless steel crowns with a white coating of composite or something like that. (similar to the NuSmile ones you see above). They are not perfect, in fact, often the coating gets worn or chipped off, but they are the best we have right now other than the reliable stainless steel ones.

A long time ago we would do a stainless steel crown and cut out a "window" then fill it with white filling material at least in the most visible areas.

leslie said...

About 1 1/2 yrs ago my daughter had her four front teeth covered w/the composite fillings. At first they looked great, but now they are discolored and look awful. Is there anything we can do about that??

Dr. Dean Brandon said...

Restorations often get discolored, stained, worn or get recurrent decay. They might need a crown,new filllings, or sometimes just cleaned or smothed off a little. Plus, as I alluded in the post, kids put a lot of wear on their teeth especially the front ones.

Teresa said...

Can all dentists get the stainless steel crown with white coating? I'm having a hard time finding a dentist that will do it for a tooth other than a front tooth.

Dr. Dean Brandon said...

I just tried some from "dental innovators". They looked ok, but were pretty hard/time consuming to fit. I plan on more time to place these with a higher fee. This is certainly for more cooperative patients. Maybe I'll get better at it with more experience. Still, in our practice we do 99.99% regular Stainless Steel crowns on back teeth. Very few practices would offer or have available these type crowns because they are not as good as the stainless steel ones.

It can be hard to fit them. One reason is that there is a thick layer of white acrylic stuff over the crown making you have to reduce the tooth much further to allow for that layer. We'll see how they hold up over time. We've tried other kinds in the past that have not held up well.

Anonymous said...

Can a stainless steel crown be covered with on the front with white filling?

Dr. Dean Brandon said...

Yes. We used to do that a lot with front teeth, actually cutting away the metal or opening a "window" and then placing composite-we still do that sometimes if a kid comes in with one already there and we want to make it look better without replacing the whole thing. However, it is not generally used on back teeth. If you take a lot away from a back tooth it will weaken the whole thing and the metal margins tend to get ragged and sharp with wear.

Anonymous said...

Okay this may be a silly question. What if the crown is already in the mounth. Is there any way you can fix it with white compositite? Have you ever tried to put a thin layer of composite over an already place stainless steel crown?

Dr. Dean Brandon said...

Not silly at all. As I alluded to above, if there is a stainless steel crown (in the front) we can cut open a window and place white composite there. You can also "patch" a white baby tooth crown with composite filling if it is getting worn, but sometimes you just have to replace the whole thing.

You cannot place anything over a crown in the back or you interfere with the occlusion (the bite)-it's too thick.

Anonymous said...

What do you think about pulling baby teeth rather than putting on crowns.

Anonymous said...

So from your response previously. If a crown is already set in the mouth a window can be cut on the set crown?

Dr. Dean Brandon said...

Removing the front baby teeth is always an option if the teeth are in bad enough shape. I avoid removing back molars (if the teeth are restorable) as often a space maintainer is needed if you remove the teeth too early.

Dr. Dean Brandon said...

I do not cut open posterior (back teeth) crowns to place a composite window.

Anonymous said...

My son's 1st molar was covered with a stainless steel crown. Is there anything that can be done to hide/cover the silver?

Anonymous said...

what do you think of strip crowns? how often do they fail?

Anonymous said...

My daughter is 2, almost 3 (next week is her 3rd b-day). She had 8 cavities the first time we went to a pepediatric dentist (that was recom. by my insur. company).
The dentist gave her a orange drink that made her very sleepy and mean. She took my daughter back to the room and I could hear her raging and screaming for over an hour! She finally filled all of the cavities with white fillings.
From day one that looked weird to me. Kind of yellow and like there was holes in her teeth. I took her back within a couple weeks and the dentist said everything was fine and all of the fillings were in place.
It's been 6 months and I took her back to a general densit for a cleaning (Our insur. changed)
Now this dentsit is saying a lot of her fillings have fallen out (which is what it has looked like very early on and is why I took her back), she has one new cavity and refered us to a pediatric dentist. I called then same one back and said she needed to look at her teeth. We have an apt. today. My question is, shouldn't she have crowned these front teeth? The cavities she has now are in #B,D,E,F and G. The ones she had before were B surface O, E surface L, F surface L, F surface D(?), I surface O, B surface M, F surface M and G surface M.
And are dentist responsible for lost fillings?
Thank you for yor time. Sorry for the length.

Anonymous said...

How long do the "pedo jackets" last and what do you do when the plastic coating gets worn off?? Do you pack cord for the "pedo jackets" and/or strip crowns?

Dr. Dean Brandon said...

Sorry for the delay, I've been out of the country.

As I mentioned, all crowns have drawbacks. I think strip crowns are fine and I do them. They tend to be fragile. Pedo jackets tend to get the outer layer worn off. Of all the crowns, they All have drawbacks and can last a long time (till exfoliation) or get worn in less than a year.

--I do not usually use cord when placing them, but do on occasion. Sounds like you are a dentist or student--I did see a presentation on using "alastic" seperators for crowns to keep the tissue away and control bleeding (of course he removed them after treatment).--worked well for him.

As to the comment before the last comment. Looks like you had "fillings" on the front teeth rather than "crowns" at least that is what you have presented here. It is not uncommon for teeth that have been filled in the past to need crowns if there are problems later on. Sometimes it can be a good idea to be agressive in the first place and put in crowns from the start. (Some parents get uneasy if you mention crowns up front, but..) It is not unusual for fillings on front baby teeth to fail (usually due to recurrent decay), but of all the fillings I see and do, front baby teeth have the most problems. Also, sounds like there was some level of difficulty in patient cooperation the first time---hard on us parents, but tends to make things difficult for the dentist too.

Anonymous said...

My 5 year old has two cavities on back teeth, instead of fillings, the dentist wants to use stainless steel crowns - why not just fill them? I am nervous about the sedation! And what does "soft teeth" mean? when do those back teeth normally fall out?

Dr. Dean Brandon said...

Rather than give a long answer here, I think you might find the answer to much of your questions by looking around the other blog posts here.

Basically: Some baby teeth don't fall out till 12 years old and crowns are indicated for larger cavites rather than fillings because they hold up better.

Anonymous said...

what code do you use for strip crowns ?

Dr. Dean Brandon said...

I think it is prefab resin crown #2930, but I am not sure.

Anonymous said...

My son had an infection on his front tooth, we had it pulled yesterday. He wants his tooth back he is three years old. Is their some kind of replacement tooth that could be put in, until his permanent teeth come in?

Dr. Dean Brandon said...

Yes, see my post (linked on the right part of the page) on "Fake Baby teeth-Pedo Partial".

Anonymous said...

How does stainless steel crowns may affect the stomach? The metal is oxidized, isn't it?

E'meshako said...

My daughter is 2 years old. During a recent doctor visit,, we were told that she needed crowns on two of her front teeth and sealings on some others. How can I be assured that she needs thois procedure right now? Is there anything that I should be aware of following the procedure (continued bleeding, pain). What can I expect? Is it unusual for a two year old to go through this procedure? As silly as it may sound, I do not wan to "traumatize" her for crowns that may no tbe extremely necessary.

Dr. Dean Brandon said...

I see two year olds all the time and yes, some do need treatment. Most kids do well and bounce back from treatment better than adults. Sounds like you are concerned with her ability to tolerate the procedure. You might want to read my posts on kids behavior and sedation. Also, you need to have an understanding of what is being recommended and have a degree of trust in your child's dentist (who I hope is a pediatric dentist)!

E'meshako said...

Thanks doc. I think that I am concerned about her ability to handle the procedure. I will feel more comfortable if I understood the actual procedure--- what to expect (during and afterwards). Is there usually any bleeding or pain? if so, for how long does it last? Is it possible for complications to occur? Please enlighten me.

Anonymous said...

Have you ever used or heard of Kinder Krowns? Do you know if they hold up well on posterior teeth?

Dr. Dean Brandon said...

I have heard of them, but not used them. All the "white" crowns of a similar type we have tried are really pretty unsatisfactory. Some can be done, but results may vary.

Anonymous said...

My son is three years old....he had strip crowns on his front teeth 4months ago. From day one they looked dark to me. He went back 3 weeks later for a check up and I did ask why they looked dark and the Dentist just said it was hard to get a exact match.Three weeks ago I took him back agin and questioned why his two front teeth look so dark. They look like they are a dark grey and it looks like they are getting darker. I brush them dailey....I am afraid the tooth is dying. The dentist just keeps telling me to brush them better. That has nothing to do with the color of the tooth. Is this normal for a strip crown to be so discolored?

Dr. Dean Brandon said...

Darkness can result from the death of a baby tooth. It may also get darker (sort of a yellow) usually from too much plaque that can be cleaned off. As I alluded ot in the post, the outer shell can separate and the whole thing turn a funny color, or the decayed tooth might shine through the composite if it is thin there.

Whatever crown is used, it is still "fake". Nothing is as good as what God made for us.

Anonymous said...

My son is almost three. I recently noticed his 2 front top teeth have decay between them. In addition on both teeth there a faint, narrow and curved discoloration band running verically and curved towards each other. Is this something that can be filled, or are crowns necessary? I have a dentist appointment, but it is later this month.

Dr. Dean Brandon said...

I see 2 and 3 year olds every day with decay (unfortunately), so it IS good to get it checked out. Small cavities need small fillings. Crowns are only recommended if the deday is more extensive. See my post on "decay n a two year" old too.

Anonymous said...

We just found out today that my 4 year old son is going to need 6 teeth extracted. His four front teeth and his two bottom teeth. We were a little disappointed that the first thing she said was that we need to "wiggle" those teeth out because they will be coming out in the next couple of years anyways. Not once did she mention any other options available to us. I was hoping she would offer us some ways on how we can save them. The X-rays showed some decay, but not to the extent that she would rather "save" us money and pull them all out instead of trying to fix them and they can fall out later on there own. I have read your blogs regarding how rough kids can be with their teeth, especially with the strip crowns, nusmile or pedo jacket. But I really would love to have that chance to save his teeth. Although my son just turned 4, he has said he doesn't want to lose them. My husband and I make sure he has plenty of self-esteem, but now it worries me that not having his front teeth may affect him a little bit. Towards the end of the consultation, I basically had to beg the dentist to give me the estimate of costs if we were to fix the front teeth. I am not sure exactly what the procedure was called but they were going to do a therapeutic pulpotemy and resin-4+ w/incis on the four front teeth. What exactly is she going to do (strip crowns, pedo jacket or nusmile)? She again mentioned the fact that I will just be spending a whole lot of money on teeth that may just fall out in a year or less. Should I seek a second opinion? Or go back and tell her that I want her to fix his teeth? I don't feel too confident with this dentist and it brings back some childhood memories where the dentist just pulled teeth because he was doing my parents a favor by saving them few bucks. Any positive advice would help. Thank you.

Dr. Dean Brandon said...

I can't say what they might use. Some teeth are simple too broken down to use anything. Don't feel bad, at least you are trying to address the situation for the health of your child. I'm sure he will be fine.

Anonymous said...

My son have got 3 stainless crowns on the back teeth. I am very worry that other kids will make fun of him. They are noticible when he smiles. Is there something we can do to cover them? he is 4.5 years old and he had two dentist procedures with Iv anestesia. The first time, one of the dentists placed a metal fillings that fell out in 4-6 months, the second time we went to a different dentist and crowns were placed. We are in shock now that he will wear those crowns untill he is 10-12 years old.
Any suggesions you have for us....

Dr. Dean Brandon said...

I understand your concern, but I have never in all my years heard of a child being made fun of in this manner. It may happen but I've never heard a report of such. It's us adults that tend to worry about this and there is really not anything really effective that can be done to change the crown's appearance. The fillings having problems is likely a testament that the crowns were necessary. It is more important that you pick the best solution for the child's health/dental needs.

rridgebacks said...

My 8-year-old grandson had crowns put on all of his back teeth 3-4 years ago, supposedly to keep them healthy. The front teeth with no crowns are in excellent condition, especially since he started using a Sonicare brush for the last two years. Tonight, one of the crowns fell out, and not only does it appear that part of his tooth is inside the crown, but what is left of the tooth is obviously completely rotten. Please tell me this isn't normal, and we're not going to find that all of his teeth are rotten??? I was not happy about the full mouth of crowns at such a young age, am not fond of his dental care provider since meeting him last year, and am now *very* upset, and afraid for the health of what used to be a beautiful set of teeth. I'll be calling another pediatric dentist in the morning to get him in asap, but would like to know if this is the usual result of this type of treatment. Thank you so much!

Dr. Dean Brandon said...

Crowns (any kind of crown), but expecially the white front ones can come off sometimes. Kids are rough on their teeth and there is many times not much left of a decayed tooth once the preparation and caries removal is completed for a crown to hang on to. Usually the crown has either some cement left in it or composite (in the case of front crowns). So it might not be that the tooth "broke off" in the crown. Crowns that are loose and then come off often have leakage where all kinds of stuff can get up under there.

Finally, many kids have less problems with decay as they get older and get in their permanent teeth...Good Luck.

Anonymous said...

My 2 yr old son has decay on his front teeth and our dentist recommended Kinder Krowns. Im concerned about sedation. Can you tell me the benefits of getting this dental work done considering he will lose these teeth anyway? What should be our determining factor when considering having these put on. Do you think it's neccessary?

Dr. Dean Brandon said...

You might benefit from reading my posts on sedation and other related posts, like the one titled "They are just baby teeth, why fix them" and "just got an e-mail bad decay on a 2 year olds teeth". Also, check out a chart of when baby teeth naturally fall out. Upper front teeth begin falling out at 7-8 years of age. Some back teeth stay till age 11 or 12.

Anonymous said...

My daughter just got four stainless steel crowns put on her back teeth about two months ago. They don't seem to bother her at all, but I notice that when I floss they still seem to bleed. I was told this was normal soon after the procedure, but it has been two months. Is this normal? Should I just be more careful when flossing around these teeth? Thanks.

Dr. Dean Brandon said...

Bleeding is usually the result of poor oral hygiene around the crown sometimes due to the difficulty of brushing/flossing around the crowns. Good idea to have the dentist take a look if it doesn't resolve.

Dr. Dean Brandon said...

I am going to limit posts on this subject as we have a whole lot of comments here that pretty much cover the topic. If any further news or info comes out, I'll let you know.