Preformed crowns for managing decayed primary molar teeth

Close-up of fused ceramic corona, three elementsTo stop further damage and restore function of primary molar teeth that are decayed or malformed, a dentist will usually use a filling (a soft material that is placed in the cavity and hardened) to restore the tooth to its original shape. Alternatively the dentist may place a crown over the tooth to cover it. This usually requires an injection in the gum to numb the tooth before trimming it down (conventional technique). These crowns are pre-made (i.e. preformed) in a variety of sizes and can be metal or white, with the correct size being chosen to fit the trimmed down tooth. The Hall Technique is an alternative method for fitting metal crowns, where there is no need for an injection or tooth trimming as the crown is simply pushed over the tooth. Preformed crowns are recommended by specialists in children’s dentistry for the management of baby back teeth (molars) when they are affected by moderate to advanced tooth decay, or where the enamel has malformed during development or the tooth has had to have root canal treatment. Continue reading

Not enough evidence to recommend chlorhexidine treatment to reduce tooth decay in children

tooth decayTooth decay is a very common disease that over time destroys the tooth surface. It has been estimated to affect up to 80% of people in high-income countries and, despite being preventable through oral hygiene and dietary measures and the use of agents such as fluoride that reduce risk of decay, it is likely to remain a problem, especially in low-income countries. Tooth decay can result in pain and infection, and in young children may require treatment in hospital under a general anaesthetic. As well as causing anxiety and pain, this may mean the child or young person missing time at school and their parents or carers having to take time off work, possibly losing income and incurring extra costs. Prevention of tooth decay is simpler and possibly cheaper than waiting until it occurs and then requires extensive treatment. Tooth decay is largely preventable, and a range of things may assist this: twice-daily toothbrushing with a fluoride toothpaste, and reducing both the amount of and number of times per day sugar is eaten. Tooth decay occurs when certain types of bacteria (germs) in the mouth, such as Streptococcus mutans, produce acids from the sugar we eat, which dissolve the hard enamel coating on our teeth. Some studies have shown that the chemical antiseptic treatment chlorhexidine is highly successful at destroying these bacteria and can be used safely at home in the form of a gel, spray, chewing gum, toothpaste or mouthrinse. Alternatively, chlorhexidine can be applied as a varnish to the surface of teeth by a dentist. But what is the evidence that it works to reduce tooth decay in children? Continue reading

Treating tooth decay in baby teeth

pulp treatmentTooth decay in the milk (baby teeth) of children tends to progress rapidly, often reaching the dental nerve (or pulp, the nerves in the centre of the tooth). Dentists normally have to do one of three things:

1. pulp capping – placing a medicament over the exposed tooth pulp
2. pulpotomy – removal of some of the tooth pulp
3. pulpectomy – removal of all of the tooth pulp.

With direct pulp capping and pulpotomy, some of the nerve in the tooth is left and therefore the filling material has to be put into contact with the living pulp tissue. The most common materials used in direct pulp capping are calcium hydroxide, mineral trioxide aggregate, formocresol or an adhesive which allows a filling material to adhere to the tooth. After a pulpectomy, no nerve is left inside the treated tooth, but a filling material is put into the space created by the removal of the pulp and this must not stop the development of the permanent, adult tooth. After a pulpotomy, one of four materials is used to fill the space: ferric sulphate, formocresol, calcium hydroxide or mineral trioxide aggregate. This research investigates the success of these dental nerve treatments in milk teeth. Continue reading