Common Practices


Sealants are typically placed on molars with deep pits and grooves. These molars are at higher risk for getting cavities because the anatomy of the grooves allows for bacteria and carbohydrates to get packed down into them. Sealing a tooth is analogous to caulking your bathtub, where the grooves are filled in with a hard, white material that leaves the tooth feeling smooth. It is a relatively painless procedure and is recommended according to the anatomy of the tooth, oral hygiene of the child and potential risk factors the child may present at a particular dental examination.


These are the “fillings” which go into the teeth once all of the decay is removed. They are tooth-colored and are bonded to the prepared tooth surface. Silver fillings, or amalgam fillings, are only very rarely used in our office on a case-by-case basis. Different materials have different strengths and weaknesses, and for the overwhelming majority of the time, the tooth-colored fillings will work fine


Periodically, a molar with a more advanced cavity will require what is called a “full-coverage restoration.” In pediatric dentistry, this is done by adapting and fitting a stainless steel crown to fit over the top of the affected tooth. The crown is completed in a single appointment and is designed to last the lifetime of the tooth. Most baby teeth are out of the mouth by 12 or 13 years of age.


Cavities which extend all the way into the nerve of the tooth means a direct communication between the bacteria in the cavity and the blood and nerve supply of the tooth. These teeth may or may not have symptoms prior to the dental treatment. Such a situation requires cleaning out the top nerve supply of the tooth to re-create a sterile environment. A stainless steel crown is then placed on the tooth to maintain an adequate seal. Research has shown us that restoring a pulpotomized tooth with a composite resin restoration tends to have a much weaker prognosis than a crowned tooth in most cases.


In situations where bacteria have extended well into the nerve of the tooth, sometimes a pulpotomy will not remove all of the bacteria or infected tissue. In this scenario, it may be indicated to completely remove the nerve and blood supply of tooth. Some parents will wonder why we should go to such efforts to save baby teeth which will eventually fall out of the mouth. Unfortunately, removing a baby tooth prematurely can have complicated life-lasting effects on the position of the future adult teeth. If a tooth were to come out prematurely for one reason or another, the space created by the missing tooth would likely need to be maintained. Otherwise, neighboring teeth can tip into the newly created space.


A space maintainer maintains space to encourage future adult teeth to erupt into the mouth unobstructed. It is usually needed when a baby molar is lost prematurely. The type of space maintainer needed is dependent on the amount and location of space needed . Single tooth space maintenance is usually maintained with what is called a crown and loop space maintainer. Multiple teeth space maintenance is usually accomplished with a lower lingual arch on the lower jaw or a palatal holding arch on the upper jaw. They are usually designed to remain in the mouth until the adult tooth or teeth erupt into the space being held for them.


Teeth may need to be removed for any number of reasons. Baby teeth that are over-retained, traumatized, abcessed, or potential crowding problems for future adult sometimes need to be removed. Space maintainence may be needed following extractions in some circumstances.