Crowns and Nerve Treatment on Baby Teeth: Why Bother if They Fall Out?

"A crown? On a baby tooth? But she's only four!" Many parents are surprised when a dentist suggests nerve treatment or a crown for a tooth that will one day fall out. It is a fair reaction. Here is why it is often the kindest and most practical choice for a child, and what the alternatives are.

Baby molars have a long job to do

The back baby teeth (molars) usually stay in the mouth until around age 10 to 12. For a four- or five-year-old, that can mean six years or more of chewing. During that time these teeth:

• Let your child chew comfortably and eat a varied diet.
• Hold space for the adult teeth growing underneath. If a baby molar is lost early, the neighbouring teeth can drift into the gap and leave too little room later.
• Keep the mouth healthy. A decayed, infected tooth can be a constant source of pain and germs.

Why a baby tooth may need nerve treatment

Enamel on baby teeth is thinner than on adult teeth, so decay can reach the pulp (the soft inner part with the nerve and blood vessels) quite quickly. Once decay reaches or comes very close to the pulp, a filling alone is often not enough.

In a pulpotomy, sometimes called a "baby root canal", the dentist removes the inflamed part of the pulp in the crown of the tooth, places a soothing medicated material, and seals the tooth. The healthy pulp in the roots is left in place, and the tooth can usually carry on doing its job until it falls out naturally. If the infection has spread further, a more involved treatment called a pulpectomy may be considered, or the tooth may be better removed. An X-ray helps the dentist decide.

Why a crown often follows

After nerve treatment, or when a molar is badly broken down by decay, the tooth is weaker and a large filling may crack or fall out. A crown is a cap that covers the whole tooth and protects it.

• Stainless-steel crowns are the most common choice for baby molars. They are strong, long-lasting and usually fitted in one visit. They look silver, which children often don't mind, and some even show them off.
• Tooth-coloured crowns are also available for some teeth. They look more natural, but they may need more of the tooth to be shaped and are not suitable for every situation. Ask your dentist about the pros and cons for your child.

The crown falls out together with the baby tooth when the adult tooth is ready.

What the visit involves

• Numbing first. A numbing gel is applied, then a gentle local anaesthetic, so the tooth is comfortable. Some children are treated with the STA computer-controlled anaesthesia system, which delivers the anaesthetic slowly and steadily.
• Gentle, step-by-step care. We explain each step in simple words, show it first, and allow breaks.
• Nitrous oxide ("laughing gas") may be an option for anxious children. It helps them feel relaxed while staying awake.
• Afterwards, the lip and cheek stay numb for a few hours. Watch that your child doesn't bite or chew them, and offer soft food once the numbness wears off. The gum around a new crown can feel a little sore for a day or two.

For very young children or those needing a lot of treatment, your dentist may discuss sedation or general anaesthesia.

What happens if it's left?

A tooth with decay into the nerve rarely gets better on its own. Often it leads to:

• Pain, which may come at night or when eating.
• An abscess, a gum boil or swelling, sometimes with fever.
• Damage to the adult tooth underneath, which can develop with marks or weak spots if infection sits around it.
• An emergency extraction later, in a child who is now in pain and frightened.

Facial swelling with fever needs urgent attention.

The alternative: extraction and a space maintainer

Sometimes removing the tooth is the better choice, for example when it is too badly damaged to save or close to falling out anyway. If a baby molar is removed years early, your dentist may recommend a space maintainer to hold the gap open for the adult tooth. Both paths are reasonable in the right situation, and your dentist should explain why one suits your child better.