Should Children have Crowns?
Understandably crowns are not often made for baby teeth as the teeth themselves will fall out in a few years.
There are however, some circumstances when a crown may be needed for a child, these are:
- If a child has a very badly broken down deciduous (baby) molar tooth
- If they have received treatment to the nerve of a deciduous molar tooth- often called a ‘pulpotomy’ or ‘pulpectomy’.
- If they have severe wear from grinding or erosion or both
- If their teeth have not formed properly- such as in amelogeneis or dentinogeneis imperfecta
- As a temporary measure because they are too young to have a permanent adult crown.
The first two are definitely the most common reasons for children having crowns.
How are Children’s Crowns Different?
Children have pretty limited attention spans, small mouths, buckets of saliva and really don’t want to be at the dentist (like a lot of adults I know!). The idea of an hour appointment to prepare a crown is not at all realistic so a different approach is used.
Children’s crowns are not made in the laboratory like adult crowns and so do not need an impression to be taken or to have a temporary placed.
They are metal crowns and are referred to as ‘stainless steel crowns‘ even though most are made of different metals (nickel chromium). They come ready made in different sizes and the dentist needs to measure the tooth in question to decide which one will fit best.
The child will need to be made numb, all caries removed and the height and sides of tooth reduced a bit to make space for the crown. The crown is adjusted and molded to the tooth, then cemented in.
Success rates for these types of crowns on deciduous molars are very good and most stay in place until the tooth itself falls out.
What about Crowns on Children’s Adult Teeth?
A stainless steel crown may be placed on a child’s adult tooth if the tooth has not yet fully erupted in order to protect it. Long term, an adult crown will be required but before this can be placed it is important that the child’s teeth have stopped growing so the margin (base) of the crown can be placed in the correct place. This is particularly important, as you can imagine, in visible areas of the mouth. Acrylic or ‘Directa’ crowns are temporary white crowns that can be placed in teeth at the front of the child’s mouth. Sometimes simply bonding in white composite filling material will do as a temporary measure.
Placing a crown (or a veneer incidentally) during a growing phrase, will mean the margins, instead of sitting at the gum, will move up as the tooth continues to erupt and the aesthetics will be compromised after just a short period of time. It is for this reason, that cosmetic fixed dentistry – such as veneers, crowns and implants should not be done until teeth maturity, generally at about 17/18 years of age.
When the tooth is fully erupted there is also more height and therefore more retention for placing the adult crown- meaning a better longer lasting crown and the older they get, the more tolerable of longer treatment they tend to become.