What Happens During Restorative Procedures?
Before any work is done, your dentist may take an x-ray of the treatment area, or review your child’s x-rays if they have been taken very recently. The treatment will begin with the dentist using something like a Q-tip® to apply a small amount of flavored “jelly” on the gums (a topical numbing medicine) and the area being restored. Once the area is numb, the dentist will give your child an injection (shot) of numbing medication, which we call “sleepy juice.” This medicine will make your child comfortable and without pain during the restorative treatment. The dentist will wait until the area is completely numb before beginning any restorative dentistry. For certain procedures, such as a pulpotomy or tooth extraction, your dentist may discuss using sedation to keep your child calm and comfortable. (See separate instruction sheets on Procedural Sedation and Anesthesia in Dentistry.)
Pulpotomy A pulpotomy, or nerve treatment, is done when there is a large amount of decay (such as a deep cavity), when there is pain from an infected tooth, or when the decay is very close to touching the pulp, or nerve, of the tooth. If not treated properly and promptly, your child could develop a serious infection or lose the tooth. A special drill is used to clean out the cavity and the top part of the nerve. The pulp is then sterilized, and a medicine is put over the empty space to control bleeding. The entire nerve or a part of it may be removed, depending upon the amount of decay. Likely, a stainless steel crown will be fitted over the remaining part of the tooth. The crown will be placed over the tooth at the same appointment. Stainless Steel Crowns Primary (baby teeth) molars that are not formed properly, have a lot of decay or fractures (cracks), or have undergone a pulpotomy may require a silver stainless steel crown in order to cover the remaining tooth. Crowns also are used when a very wide and/or deep cavity has done so much damage to the tooth that it needs to be protected in order to save it. The procedure can be done right after a pulpotomy, at the same appointment.
Once the area is numbed, the tooth or teeth being restored will be ground down using a special dental drill. The amount the dentist must drill depends upon how much damage the decay has caused. The dentist then will fit the stainless steel crown over the top of the remaining tooth to keep it protected. A special glue is used to keep it from slipping off. The stainless steel crown is shaped like a normal tooth and will fall out when the permanent tooth comes in, just as a normal tooth would. It takes about 30 minutes to take the x-ray and place the crown over the remaining tooth. Silver or White Fillings A filling is used to fill in an area of a tooth that has been drilled out to remove decay (a cavity).
Cavities that require a filling usually are not cavities with deep decay. To fill a cavity, the dentist will begin by using a special dental drill to clean out the decayed area of the tooth. The decay then is removed and the inside of the tooth is cleaned. Silver fillings called “amalgam” or white fillings called "composite" can be used to fill the area. Extractions A child might need an extraction (pulling a tooth) for several reasons. An extraction might be needed if your child has a severe infection or a very large cavity. Extractions also may be done if your child has spacing problems, such as crowding, or if space needs to be made for orthodontics (braces). An extraction usually takes about 20 minutes. Your child will have some restrictions going home. Your dentist will give you specific instructions before you leave.
Space Maintainers When a baby tooth is lost early, or if a tooth never appears, a space maintainer is used to “save” a place for the permanent tooth (adult tooth). If the space is not maintained, the teeth on either side of the missing tooth can move and prevent the permanent tooth from ever erupting (coming in). Also, without a space maintainer, teeth crowding can occur and be very difficult to treat. A space maintainer is made of stainless steel and looks like a silver band and loop. Spacers are temporary and will be removed once the new tooth or teeth erupt, or the teeth around it become loose.