Children and Tooth Decay

All about tooth decay in children, along with different treatment options.

Prevention of dental problems with a healthy diet, good oral hygiene habits, and regular dental check-ups is the ideal approach to dental health for children (and adults, for that matter). Unfortunately, tooth decay does occur sometimes and has to be treated. There are a variety of ways that tooth decay can be managed in children. For the most part, these treatment options are similar to those available for adults.


A sealant is a protective layer that is placed over the top of a healthy tooth to prevent future decay. Some teeth (usually the molars) have deep grooves that trap food particles and can be difficult to clean thoroughly with brushing. A sealant fills in and covers these grooves with a thin layer of resin (similar to a tooth-colored filling) that prevents food from getting trapped inside and causing tooth decay. A sealant requires little or no drilling, and therefore does not require any anesthetic (numbing).


Once decay has started, it must be removed to prevent toothache and/or loss of the tooth. When decay is relatively small, it can be removed from the tooth and replaced with a filling, just like on a permanent tooth. The filling can be tooth colored (composite resin) or silver.

Pulpotomy and the Stainless Steel Crown

In some cases, tooth decay progresses to the point that it damages the nerve inside the tooth (baby teeth have nerves just like permanent teeth). When this happens, a child can develop a toothache. In order to repair the tooth, the decay must be removed and the nerve must be taken out of the tooth as well. This procedure is called a pulpotomy, and is similar to a root canal in an adult tooth. Contrary to popular belief, this procedure is not particularly painful and feels very similar to having a filling done.

When a pulpotomy is required, the tooth decay is usually extensive and a large portion of the tooth is already missing. In this situation, a stainless steel crown is preferred to a filling. A pre-made crown is cemented on top of the tooth after the decay is removed. The crown will stay on the tooth until it is replaced by the permanent tooth. Although having a metal crown on a tooth may not sound very attractive, children generally don’t mind and get used to it very quickly.

Extraction and Space Maintenance

Sometimes tooth decay is so severe that there is no way to fix the affected tooth. In this situation the only option is to extract the tooth. After an extraction it is often strongly recommended that a device called a space maintainer be placed in the child’s mouth. The space maintainer prevents the remaining teeth from shifting significantly and interfering with the permanent teeth that will come into the mouth later on. Space maintainers come in several forms, but most will involve a metal band that is placed around one or two teeth, with a thin metal wire that holds the space between the teeth. The device is left in place until the permanent tooth is ready to come into the mouth.

It’s important to diagnose and treat dental problems in children quickly. Waiting too long can result in unnecessary discomfort and make successful treatment more difficult. If your child has not been seen by a dentist in the last six months, make an appointment today!