REZA M. MADANI, DMD, FAGD
In severe cases of enamel fluorosis, the appearance of the teeth is marred by discoloration or brown markings. The enamel may be pitted, rough, and hard to clean. In mild cases of fluorosis, the tiny white specks or streaks are often unnoticeable.
Baby teeth that have large caries (cavities) and some degree of pain occasionally require that the "coronal" (top) portion of that tooth's nerve be removed before a filling or a crown (preferably) is placed. The main goal of this procedure is to preserve the baby tooth, since baby teeth help to maintain adequate room for the permanent teeth. Pulpotomies have published success rates that range from 60% to 90% and represent a good and reliable way to save a badly decayed baby tooth.
Recent controversy regarding the use of Stainless Steel Crowns (SSCs) in some states have led some parents to question dental care providers more thoroughly on their use and on other alternatives. SSCs have been used in dentistry for over 50 years for primary and permanent dentition. For primary teeth, SSCs are usually placed on teeth that have extensive caries (where two or more surfaces are extensively involved), or teeth that have pulp treatment (such as pulpotomy or pulpectomy). We also use them in teeth that will remain in the mouth for a considerably long period of time; where other materials will not last long enough. SSCs become loose and come out of the mouth just like normal primary teeth. They work just like normal teeth do, and require the same care. Alternatives to Stainless Steel Crowns do exist, particularly for front teeth.
Usually these can be one of the following:
- A prefabricated SSC that has a white facing bonded to it on the front (Commonly we use the Nu-Smile brand: www.nusmilecrowns.com)
- A white cap fabricated with a white filling material (Usually we call these strip crowns).
- A normal SSC that we modify by building a window in the front of it, which we later fill with a white filling material.