- In most children, baby molars stay in the mouth until age 10–12
- Fillings, pulpotomy, pulpectomy and stainless steel crowns
- First check-up: when the first tooth appears, or by age one at the latest
Baby tooth treatment aims to keep decayed baby teeth, including those where the decay has reached the nerve, healthy in the mouth until the day they fall out on their own. Small cavities are filled; decay that has reached the nerve is treated with a pulpotomy or a pulpectomy; and where a large part of the tooth has been lost, a crown that covers the whole tooth is used. Extraction is the last option.
The sentence we hear most often from parents is "It's going to fall out anyway." This page explains why waiting for it to fall out is usually the wrong call, and how to prepare your child for the dental chair.
Why is "it'll fall out anyway" misleading?
The baby front teeth are replaced between the ages of 6 and 8, but in most children the baby molars at the back stay until 10–12. A molar that decays at three still has seven or eight years of chewing ahead of it. Throughout that time, baby teeth:
- do the chewing, and with it support good nutrition;
- help your child pronounce certain sounds correctly;
- hold the place of the adult tooth developing underneath and guide it into position.
Once untreated decay reaches the nerve, the pain, night-time waking and abscesses begin. Infection at the root of a baby tooth can leave a stain or a defect in the enamel of the adult tooth forming just beneath it. And the gap left by a molar extracted early tends to close; in that case a space maintainer is needed.
Which treatment, and when?
| Situation | Treatment | What is done |
|---|---|---|
| Decay well away from the nerve | Filling | The decay is removed and the tooth is filled with fluoride-releasing glass ionomer, compomer or composite |
| Decay has reached the nerve, but the nerve in the roots is healthy | Pulpotomy | Only the nerve in the crown of the tooth is removed; the rest is covered with a medicated material |
| Inflammation has spread into the roots | Pulpectomy | The whole nerve is removed and the canals are filled with a paste that resorbs along with the baby tooth's roots |
| Most of the tooth has been lost | Stainless steel crown | A preformed crown is fitted over the tooth and cemented |
| The tooth cannot be saved or is about to fall out | Extraction | Followed by a space maintainer if needed |
We choose the filling material according to how much longer the tooth has to stay in the mouth. Glass ionomer releases fluoride and is more forgiving in young children, where saliva cannot be fully controlled, but it does not stand up to wear as well as composite. For a tooth that will soon fall out, glass ionomer makes sense; for a molar that will be chewing for years, composite or compomer is the more sensible choice.
What is a root canal treatment on a baby tooth?
What people call a "root canal on a baby tooth" is usually a pulpotomy: only the part of the nerve in the crown is removed, and the nerve in the roots stays in place. A pulpectomy, in which the entire nerve is removed, is closer to an adult root canal treatment, with one important difference: the roots of a baby tooth naturally dissolve as the adult tooth approaches. So the canals are not filled with a permanent material but with a paste that resorbs along with the roots and does not block the path of the tooth underneath. After either procedure the molar is weaker and breaks easily, so we usually recommend completing the treatment with a steel crown.
Why is a stainless steel crown silver?
Steel crowns come in ready-made sizes, are fitted in a single visit without waiting for a laboratory, and stay in place for the rest of the baby tooth's life; when the tooth falls out, the crown comes out with it. Studies show that in baby molars with large cavities they last longer than fillings covering several surfaces of the tooth. The colour surprises most families at first, but because it is on a back tooth it usually does not show when your child smiles. Tooth-coloured crown options are available for front teeth.
How do you prepare your child for the first appointment?
How a child behaves in the chair is shaped largely by what they hear at home. A few suggestions:
- Avoid words such as "it won't hurt", "needle" or "don't be scared"; what they bring to mind is exactly the fear. "We're going to count your teeth and clean them" is enough.
- Do not use the dentist as a threat ("If you eat sweets, I'll take you to the dentist").
- Do not talk about your own bad experiences in front of your child.
- Choose a time when your child is rested and has eaten; for young children this is usually the morning.
We often set aside the first visit for getting to know each other: we show the instruments and explain what we are going to do before we do it. If treatment is needed, we use a local anaesthetic; children usually feel no pain during the procedure. Numbness in the lip and cheek lasts a few hours. During that time, keep an eye on your child so they do not bite their lip, and do not give them food until the numbness has worn off. For very young children, when many teeth need treatment, or when cooperation cannot be established, we discuss treatment under sedation.
When should the first check-up be, and which signs should not wait?
The first check-up should be when the first tooth appears, or by the first birthday at the latest. This visit is more about guidance than treatment: we talk about brushing, night-time bottles and how often your child has sugary drinks. Bring the appointment forward if you notice any of the following at home:
- Chalky white spots along the gum line: the earliest, reversible stage of decay, where fluoride varnish is often enough.
- Brown or black holes, or food constantly getting stuck in the teeth.
- Toothache that wakes your child at night, or a pimple-like bump on the gum.
If there is swelling of the face, a fever, swelling spreading around the eye or difficulty swallowing, do not wait for an appointment: see a dentist the same day — the nearest one if you are not in İzmir — or, at night, go to an emergency department.
What does the cost depend on?
Three things determine the cost: how many teeth need treatment, which procedure each tooth needs, and whether sedation is required. After the examination at our clinic in İzmir we draw up a tooth-by-tooth plan, and you receive a written, itemised quote. Whether insurance contributes to children's dental treatment varies, so check with your own insurer.
Common questions
Does a baby tooth really need a filling?
Sometimes not, if the cavity is small and the tooth will fall out within a few months; we decide by checking on the X-ray how close the tooth underneath is. But in a molar that still has years to go, decay does not stop by itself — it grows and reaches the nerve.
Will my child feel pain during a pulpotomy?
It is done under local anaesthetic, and children usually feel no pain during the procedure; they feel pressure and vibration. For a day or two afterwards there may be mild tenderness when chewing. A painkiller at the right dose for your child's age is usually enough.
Can a steel crown harm the adult tooth coming through underneath?
No. The crown covers only the baby tooth; as the baby tooth's roots dissolve, the tooth loosens and falls out together with the crown, without getting in the way of the adult tooth. If the crown comes off the tooth on its own, have it seen soon, by a local dentist if you are not in İzmir, so the tooth is not left exposed.
What happens if my child cries during treatment?
Crying is very common in young children and is not, on its own, a reason to stop treatment. Even so, we know that a session pushed through by force makes later appointments harder. If cooperation cannot be established, we split the work up, plan short sessions or discuss the sedation option.
What is bottle decay and how can it be prevented?
It is a common type of decay that starts on the upper front teeth in babies who fall asleep with a bottle of milk, fruit juice or a sugary drink. Not putting your baby to sleep with a bottle, switching the night-time bottle to water and brushing with fluoride toothpaste from the first tooth markedly reduce the risk.
Can I stay with my child during the examination?
With young children, a parent is usually by their side. With older children, cooperation sometimes improves when the parent waits outside. We decide this together, based on your child's age and how they respond.
Not sure if this is right for you?
Send us a photo. We will tell you honestly what you need — and what you do not.