Restorative Dentistry for Kids: All About Fillings

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Restorative dentistry, in general, is the prevention and treatment of diseases of the teeth to bring them back to their best health. Restorative dentistry for kids includes the repair or replacement of nonfunctional or damaged teeth. Our teeth are not capable of self-healing. And if professional treatment is not done promptly enough, permanent damage to a tooth caused by a crack or cavity can result in its eventual extraction. Having restorative procedures done promptly will allow dental patients to keep their biological teeth. Especially for children, retaining their natural teeth is the best-case scenario for them to have the optimum oral function and proper dental growth.

How does restorative dentistry work?

A restorative dental procedure can be performed by your pediatric dentist to restore your child’s teeth to good health. Treatment is done while your child is awake and he or she can go home soon after the treatment is finished and with a few food and movement restrictions.

Before the pediatric dentist will recommend any restorative procedure for your child’s teeth, the dentist will need to review or take an x-ray of the affected area. On the day of the dental procedure, the dentist will start with the application of a numbing paste or anesthetic medicine on to your child’s gums or the area in the mouth that will be treated. Once it takes effect, the dentist will then give your child sedation medicine through a shot. This sedation medicine, or “sleepy juice” will make your child more relaxed and comfortable. This process will help to completely numb the area and will take away the pain that your child may feel during the restorative procedure.

Generally, each restorative treatment takes about 30 to 45 minutes. However, it may take longer if your child will need several fixes or if sedation is needed.

There is also what we call Interim Therapeutic Restoration (or ITR, for short). Interim Therapeutic Restoration is a restoration placed on a child’s teeth to prevent further tooth decay. ITR is the choice for restoration in uncooperative children, young children, or children with special needs. ITR also avoids the use of sedation or general anesthesia until a child is old enough to cooperate so restorative treatment can be done.

What are the different kinds of dental fillings used for restorative treatments?

Dental fillings are utilized for a tooth that has been drilled out to take away a cavity or tooth decay. After removing the cavity with the use of a dental drill, the cavity is then filled. It is important to note though that dental filling work only on cavities that are not severely damaged or decayed.

The following are the different kinds of fillings used for children’s restorative procedures:

Composite Resin: Composite resins are made from durable plastics. Since composite fillings match your child’s teeth color and offer a similar texture to natural teeth, they are less noticeable and more attractive to use. They are also compatible with dental sealants.

Composite resin has two types. Direct fillings are placed by your child’s dentist using a bright blue light that hardens the soft material. For indirect fillings, your child’s dentist prepares the tooth and still takes an impression of it, from which a mold will be made. Indirect fillings usually require a second visit to your child’s dentist for completion. Composite resins work best in small areas, particularly in the front teeth, or the visible parts of teeth, or in low-stress areas. A pediatric dentist may not recommend a composite filling for a large cavity in a back tooth.

Since they bond directly to the tooth, less drilling is involved. The pediatric dentist does not have to shape the space as much for the filling to hold securely. The bonding process itself holds the composite resin in the tooth. Also, indirect composite fillings and inlays are heat-cured, making the teeth stronger.

Composite resin can be used in combination with other materials, such as glass ionomer, for maximum benefits. However, composite fillings may not be as durable as metal fillings like amalgam.

Glass Ionomer: Glass ionomer is a filling made out of acrylic and a glass component called fluoroaluminosilicate. In a traditional dental filling, the material sets without a bright light. Hybrid composite glass ionomer fillings or those modified with resins are stronger than the traditional ones and require the use of a bright blue light to set. Glass ionomer is used most commonly as cement for inlay fillings. It also is used for fillings in children’s front teeth and its surrounding area, or the roots. Glass ionomer is typically used on kids with a lot of tooth decay, particularly in parts that extend below the gum. It is also used for filling children’s primary teeth and as a liner for other fillings.

It is important to note that the traditional glass ionomer is significantly weaker than composite fillings and will easily wear or fracture as your child grows. Like composite resins, a traditional glass ionomer filling can match the color of your child’s teeth, but its effect is not as good as composite resin. It is the hybrid glass ionomer that offers a more natural tooth color. The hybrid glass ionomer filling needs to be applied in thin layers and each layer must be hardened first with the use of the bright blue light before the next layer can be applied. While this process makes your child’s teeth stronger, it also extends the time of your child’s dental treatment session.

Amalgam: Amalgam is a dental filling made of silver, tin, zinc, copper, and mercury, the latter being almost half of the mixture. This silver-colored filling is primarily used and a practical choice when restoring children’s back teeth. While it is the least expensive type of filling, this kind of filling offers long-lasting benefits, usually at least 10 years. Amalgam fillings are strong and can withstand your child’s chewing. Unlike composite or glass ionomer, amalgam fillings are less sensitive to moisture during the dental procedure.

One obvious disadvantage of amalgam fillings is the color. Amalgam does not match the color of your child’s teeth. Since metal can tarnish over time, the discoloration can be seen between the filling and the treated tooth itself. In using amalgams, it requires the removal of your child’s healthy tooth structure for adequate retention. That means your pediatric dentist may have to remove more of the affected tooth to create a secure pocket and keep the filling in place. Another consideration is its mercury content and its effects. Some kids may even be allergic to mercury. On the other hand, research shows that the amount of mercury exposure from fillings is akin to what people acquire from other sources in the environment.

On your next pediatric dental visit, talk with your child’s dentist about restorative dentistry. Your child’s dentist will surely discuss with you if your child’s teeth will require any restorative procedure and talk to you about the best option for your child’s dental treatment.

Sources:

Fast Facts on Restorative Dentistry, American Academy of Pediatrics Dentistry 2014 https://www.aapd.org/assets/1/7/FastFacts.pdf

Interim Therapeutic Restorations, Dimensions of Dental Hygiene https://dimensionsofdentalhygiene.com/interim-therapeutic-restorations/

Types Of Fillings, Colgate Https://www.colgate.com/en-us/oral-health/procedures/fillings/types-of-fillings

Interim therapeutic restoration in the primary dentition, ResearchGate.net https://www.researchgate.net/publication/308509736_Interim_therapeutic_restoration_in_the_primary_dentition

Restorative Dentistry, Children’s Hospital of Pittsburgh (UPMC) https://www.chp.edu/our-services/dental-services/patient-procedures/restorative

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