Treatment for Dental Decay and Abscesses

Treatment options for dental decay or abscesses can vary depending on the preferences of the parent, child, and dentist, and the type of dental issues existing in the mouth. Dr. Rau strives to give options to parents so they may choose an appropriate option for their children. It is rare, but at times, we cannot provide options.

An early form of decay is often a white or brown spot on the tooth. These areas are not technically cavities and may often be actively monitored by your dentist. There are newer options of resin infiltration or remineralization techniques. Please speak to Dr. Rau or Dr. Nguyen if you are interested in these techniques.

• White or silver fillings (restorations)
  The most common way of filling a cavity after it has been cleaned out (prepared) is to use a white filling (resin or composite restoration). Dr. Rau uses this technique most frequently. White fillings are very aesthetic but are not as durable as other restorations. Most studies show that they are replaced at a much higher frequency than silver (amalgam) restorations or crowns. Silver fillings (amalgam) are a very stable restoration that lasts longer, but they are less esthetic. Dr. Rau will use these in posterior teeth (molars) on patients who do not want to replace the fillings regularly or patients who cannot tolerate normal dental clinic settings.
  
  
• Stainless Steel Crowns
  Stainless steel crowns are a great option for children with really large cavities or a very high cavity rate. These crowns reduce the need for re-treatment. They often act to maintain the space for an adult tooth when there is a large amount of tooth loss. Stainless steel crowns are twice as likely to stay in place in comparison to white (zirconia) crowns. A stainless steel crown is more expensive than a filling, but children’s crowns are not priced the same as adult crowns since they are prefabricated. Most insurances will cover stainless steel crowns for children at the same percentage they would a filling.
  
  
• White-faced stainless steel crowns or zirconia crowns
  These crowns are often used in esthetic areas such as the front teeth. Front teeth that need crowns have lost a lot of tooth structure from decay or fractures. Most of the time, these white-faced crowns are placed in the operating room under general anesthesia. White crowns (zirconia) are more aesthetic. However, they cannot be bent to fit the tooth. Due to this limitation, white crowns have more limited applications.
  
  
• Pulpotomies
  When a baby tooth has a very large cavity or has a large fracture, dentists will often recommend a pulpotomy. The pulp of the tooth is a skin-like material inside the tooth that has nerves, blood vessels, and tooth-building tissue. A pulpotomy (or removal of pulp) helps to maintain the baby tooth for a longer period of time. After a pulpotomy, the tooth is usually covered with a crown. These are often referred to as baby nerve treatments of baby root canals.
  
  
• Extractions
  When a tooth is abscessed or is too badly decayed to restore, Dr. Rau or Dr. Nguyen will often recommend that the tooth be removed. Another reason for an extraction is when the adult tooth is already in the mouth, and the baby tooth is still present; then the baby tooth needs to be removed. Sometimes, people will refer to this as pulling a tooth. We usually tell a patient that we will wiggle the tooth out for them. Often, when a baby tooth is removed, we recommend some way to maintain the space for the adult tooth that is meant to be in that space in the future. In addition, an orthodontist may request that we remove teeth so that they may proceed with treatment.
  
  
• Silver Diamine Fluoride
  Silver diamine fluoride is often referred to as SDF. This is a medication that kills the bacteria that cause decay and stops the progression of decay for a time. Studies show that placing SDF every 3 months is very effective at halting the progression of decay. A major drawback to SDF is that it turns the decay black.
  
  The uses of silver diamine fluoride vary widely. We often use SDF to stop decay on teeth that are close to falling out. We use it on young children to buy time for them to grow up and cooperate normally in a clinical setting. At times, we will use SDF to decrease sensitivity on teeth and allow them to heal.