Restorative Dentistry

Restorative dentistry is the prevention and treatment of diseases of the teeth in order to restore or bring them back to their best health. Restorative dentistry also includes the repair or replacement of damaged or defective teeth. Procedures that can be considered restorative dentistry include:

• pulpotomy, or treatment of the nerve
• silver stainless steel crowns
• silver or white fillings in a tooth or teeth
• extractions (removing teeth)   
• space maintainers

Before any work is done, your dentist may take an x-ray of the treatment area, or review your child’s x-rays if they have been taken very recently. The treatment will begin with the dentist using something like a Q-tip® to apply a small amount of flavored “jelly” on the gums (a topical numbing medicine) and the area being restored. Once the area is numb, the dentist will give your child an injection (shot) of numbing medication, which we call “sleepy juice.”  This medicine will make your child comfortable and without pain during the restorative treatment. The dentist will wait until the area is completely numb before beginning any restorative dentistry. For certain procedures, such as a pulpotomy or tooth extraction, your dentist may discuss using sedation to keep your child calm and comfortable. 
(See separate instruction sheets on Procedural Sedation and Anesthesia in Dentistry.)

Pulpotomy
A pulpotomy, or nerve treatment, is done when there is a large amount of decay (such as a deep cavity), when there is pain from an infected tooth, or when the decay is very close to touching the pulp, or nerve, of the tooth. If not treated properly and promptly, your child could develop a serious infection or lose the tooth. A special drill is used to clean out the cavity and the top part of the nerve. The pulp is then sterilized, and a medicine is put over the empty space to control bleeding. The entire nerve or a part of it may be removed, depending upon the amount of decay. Likely, a stainless steel crown will be fitted over the remaining part of the tooth. The crown will be placed over the tooth at the same appointment.

Stainless Steel Crowns
Primary (baby teeth) molars that are not formed properly, have a lot of decay or fractures (cracks), or have undergone a pulpotomy may require a silver stainless steel crown in order to cover the remaining tooth. Crowns also are used when a very wide and/or deep cavity has done so much damage to the tooth that it needs to be protected in order to save it. The procedure can be done right after a pulpotomy, at the same appointment. Once the area is numbed, the tooth or teeth being restored will be ground down using a special dental drill. The amount the dentist must drill depends upon how much damage the decay has caused. The dentist then will fit the stainless steel crown over the top of the remaining tooth to keep it protected. A special glue is used to keep it from slipping off. The stainless steel crown is shaped like a normal tooth and will fall out when the permanent tooth comes in, just as a normal tooth would. It takes about 30 minutes to take the x-ray and place the crown over the remaining tooth.

Silver or White Fillings
A filling is used to fill in an area of a tooth that has been drilled out to remove decay (a cavity). Cavities that require a filling usually are not cavities with deep decay. To fill a cavity, the dentist will begin by using a special dental drill to clean out the decayed area of the tooth. The decay then is removed and the inside of the tooth is cleaned. Silver fillings called “amalgam” or white fillings called "composite" can be used to fill the area.

Extractions
A child might need an extraction (pulling a tooth) for several reasons. An extraction might be needed if your child has a severe infection or a very large cavity. Extractions also may be done if your child has spacing problems, such as crowding, or if space needs to be made for orthodontics (braces). An extraction usually takes about 20 minutes. Your child will have some restrictions going home. Your dentist will give you specific instructions before you leave.

Space Maintainers
When a baby tooth is lost early, or if a tooth never appears, a space maintainer is used to “save” a place for the permanent tooth (adult tooth). If the space is not maintained, the teeth on either side of the missing tooth can move and prevent the permanent tooth from ever erupting (coming in). Also, without a space maintainer, teeth crowding can occur and be very difficult to treat. A space maintainer is made of stainless steel and looks like a silver band and loop. Spacers are temporary and will be removed once the new tooth or teeth erupt, or the teeth around it become loose.

Once you check in at the registration desk, you and your child will be called to the dental exam room. For young children, one parent or guardian will be allowed to stay in the procedure room with the child. In certain cases when sedation is required for a procedure, you or a guardian may be asked to sign a release form.

The most important role of a parent or guardian is to help your child stay calm and relaxed before the procedure. The best way to help your child stay calm is for you to stay calm.

• You may bring along a “comfort” item — such as a favorite stuffed animal or “blankie”— for your child to hold before and after the procedure.
• One parent or guardian may stay with your child during the procedure. If you choose not to stay in the room, one parent or guardian should remain in the family waiting area during the procedure in case the family needs to be reached.

Following restorative dentistry:

• You may give your child Tylenol® or Motrin® if he or she is experiencing minor discomfort, pain or swelling. 
• Your child may experience some drooling, or say his or her mouth and lips feel “big and fat.”  This is caused by the numbing medicine. It is perfectly normal and will go away after a few hours.
• Limit your child’s eating to cool and soft foods for 3 hours after the procedure so that he or she does not bite the inside of the mouth or lip as the numbing medication wears off.
• Have your child continue to brush and floss as usual after the procedure.
• Your child may resume normal activities right away unless sedation or anesthesia were used during the procedure. (See separate instruction sheets on Procedural Sedation and Anesthesia in Dentistry.)
• If your child received a stainless steel crown, he or she should avoid sticky foods and candy until the crowns fall out naturally, usually around the age of 10 to 12 years old.

There rarely are symptoms of concern after restorative dental procedures. If your child’s gums are sensitive, Tylenol® or Motrin® will help with any discomfort. If your child experiences the following for more than 24 hours, you should call your dentist:

• fever
• severe bleeding of the gums
• severe pain that does not go away after 24 hours
• biting down on the lips due to numbness

If your child has any of these symptoms, you should call the Dental Clinic at 412-692-5440 immediately. If you are calling during the evening or on a weekend, please call the hospital at 412-692-5325 and ask for the dental resident on call.

If your child has any special needs or health issues that you feel the doctor needs to know about, please call Children's Dental Clinic at 412-692-5440. It is important to notify us in advance about any special needs your child might have.