Dentaltown May 2013 - (Page 24)

second opinion column Stainless-Steel » ThePrimary Molars Crown for Overuse? No, I say underuse. by Joel Berg, DDS, MS Second opinions are common in health care, whether a doctor is sorting out a difficult case or a patient is not sure what to do next. In the context of our magazine, the first opinion will always belong to the reader. This feature will allow fellow dental professionals to share their opinions on various topics, providing you with a “second opinion.” Perhaps some of these observations will change your mind, while others will solidify your position. In the end, our goal is to create discussion and debate to enrich our profession. – Thomas Giacobbi, DDS, FAGD, Editorial Director, Dentaltown Magazine The stainless-steel crown is an important restorative tool in caring for the oral health of children. Although our focus in providing the best oral health care for children is clearly on prevention, unfortunately there are many children who do not seek or obtain oral health preventive care at an early enough age to prevent what can be devastating disease at an early stage of their lives. All who care for children’s oral health see many cases of early childhood caries present at the first visit to a dentist. Children as young as 18 months present to pediatric dental centers all over the country each day with severe early childhood caries in need of treatment to avert progression of significant infection. Further, some children initially present with disease only after the infection has spread beyond the teeth causing facial swelling and a potentially life-threatening condition. These children often need to be hospitalized, placed on intravenous antibiotics and must have an incision and drainage performed, along with extraction of the offending tooth, to avoid a dangerous situation. Of course I support medicinal therapeutic methods (these are rapidly evolving but not all fully tested) of halting disease progression and treating the infection. Though, most commonly, presentation is at too late of a stage and the literature supports restorative treatment to eliminate the decayed tooth structure and to preserve the health of the teeth in these very young children. Most children with early childhood caries do initially present (although late after the initiation of caries disease) early enough to manage their disease progression via restorative techniques. Given the pre-cooperative state of these very young children and the lack of cognitive skills to cooperate for a restorative procedure, we must be carefully astute in planning the right care for the child, providing the best care which will be definitive and avert progression of disease. We want any restorative treatment performed on a child to last the life of the primary tooth, to sustain the health of the tooth in the mouth and to provide the appropriate maintenance of space to allow the natural transition into the permanent dentition several years later. Based upon the anatomy of primary molars, with the convergence of the buccal and lingual surfaces toward the occlusal surface (from the proximal perspective), and therefore having a small occlusal table, it becomes challenging to place on intra-coronal restoration when the decay has spread even a small amount beyond ideal size in the proximal aspect of the tooth. Therefore, restorations placed with amalgam, composite or glass ionomer must be of ideal size, or perhaps slightly larger, to be retained properly and last the life of the tooth. The scientific literature has shown the strong support for the placement of stainless-steel crowns in the event that restorative materials would extend beyond the ideal size, not allowing retention of the restoration, to avoid leakage after the placement of the restoration and subsequent infection. A stainless-steel crown is easy to place once trained to do so, fits well in a primary molar and provides halting progression of caries to allow the tooth to be retained in the mouth until natural exfoliation, and in a healthy state. Unfortunately, we often see placement of large intracoronal restorations in primary molars, which should have had stainless-steel crowns. Large intra-coronal restorations can break, causing leakage and subsequent infection. If not placed properly, there is immediate leakage and subsequent infection, which can be very dangerous for the child’s overall health. Stainless-steel crowns require proper local anesthesia, rubber dam isolation and adequate tooth preparation followed by adequate fitting of the crown, which comes in six stock sizes. After fitting, the crown snaps over the buccal bulge of the molar and is retained mechanically along with the adhesive glass continued on page 26 24 MAY 2013 » dentaltown.com http://www.dentaltown.com

Table of Contents for the Digital Edition of Dentaltown May 2013

Dentaltown.com Highlights
Howard Speaks: Is Dentistry Getting Too Easy?
Professional Courtesy: High Tide for High Tech
Continuing Education Update
Industry News
Second Opinion: The Stainless-Steel Crown for Primary Molars
Special Second Opinion: Prevent a Tulsa Repeat
Simple Two-implant CT Guided Case
Does Your Staff Ask for Referrals?
Your 2013 Website Optimization Starts Today
I Attended Your CE and All I Got Was This Crappy Notebook
Dentaltown Research: CAD/CAM
New Products
DIY Finance, Part VI: Red Flags and Scams
Employee Working Interviews: They’re Legal, Aren’t They?
The Sleeping Giant in Your Practice
What’s on My Tray? Prep and Impression, Crown and Bridge
Continuing Education: Articaine and Paresthesia in Dental Anesthesia: Neurotoxicity or Procedural Trauma?
Concentric Circles Dentaltown’s annual focus on the charitable side of dentistry
All the Things Money Can’t Buy
Taking on Pro-bono Cases
Doing Good and Doing Well
Global Dental Relief
Giving Thanks, One Smile at a Time
Big Help on a Local Level
Oral Health America
You Should Know: Climb for a Cause
In This Issue: Where Should Prevention Begin?
Perio Reports
Ad Index
Profile in Oral Health Prada or Prevention: A Look at Public Health and Oral Health
Dentally Incorrect

Dentaltown May 2013