If your child needs a crown, the first thing worth knowing is that there’s more than one way to do it. The version that involves numbing and drilling isn’t always the one we use.
At Smiles University Pediatric Dentistry, the approach depends on the tooth, the size of the cavity, and whether the nerve is involved. Some children get a crown with no injection, no drill, and no tooth reduction at all. Others need the more traditional preparation. Here’s how we decide, and what each one looks like from your child’s side of the chair.
Two Ways to Place a Crown
The Hall Technique-No Numbing, No Drilling
For many baby molars with decay between the teeth, we can place a stainless steel crown without touching the cavity at all.
It sounds strange, so here’s the reason: decay is driven by bacteria that need sugar and oxygen. Sealing a crown tightly over the tooth cuts off both. The decay underneath goes dormant. Studies following these teeth for years have found they hold up as well as, and are often better than, conventionally drilled and filled teeth.
What your child experiences:
- No injection. No numb lip to bite afterward.
- No drill. Nothing is removed from the tooth.
- Sometimes we place a small rubber separator between the teeth for a few days first, to make room for the crown. It feels like food is stuck between the teeth.
- The crown is filled with cement and seated over the tooth. Your child bites down to push it into place.
- Total chair time is short, often under 15 minutes.
The one thing to expect: The bite will feel high for a few days to a couple of weeks. This is normal and it self-corrects as the bite settles. Your child may notice it more than you do. It is not a sign that the crown is placed wrong.
When it works: Baby molars, decay that hasn’t reached the nerve, and a child with no pain, no swelling, and no abscess. That describes a large share of the cavities we see.
Conventional Preparation – When the Tooth Needs More
Some teeth genuinely need the traditional approach: front teeth, teeth with decay close to or into the nerve, teeth that already hurt, and zirconia crowns, which require more tooth reduction to fit properly.
In that case:
- Numbing. We use a topical gel first, so the injection itself is easier, and we take our time. Nitrous oxide is typically used to keep the child more comfortable.
- Removing the decay. We clear out the softened, infected tooth structure.
- Treating the nerve, if needed. If decay reaches the pulp, we perform a pulpotomy, removing the affected portion of the nerve tissue and placing a medicated material to keep the tooth healthy. We’ll tell you if this is likely before we start, and confirm afterward.
- Shaping the tooth. We reduce the tooth enough for the crown to seat without sitting too tall in the bite.
- Seating the crown. The crown is cemented, and excess cement is cleaned away.
Your child’s lips and tongue may stay numb for 1 to 3 hours afterward. Watch them during that window. Kids can chew or bite a numb lip without realizing it, and that’s the most common source of soreness after a crown appointment.
Which Crown Will My Child Get?
Depending on the situation, your child will get a specific crown. For example, back teeth (molars) are likely to receive stainless steel for greater durability. It’s also possible that Sprig zirconia crowns can be used on back teeth if appearance matters to the family. For front teeth, we use pre-veneered Kinder Krown or Sprig zirconia crowns.
Stainless steel crowns are silver-colored and nearly impossible to break. Zirconia crowns are white and look far more natural, but they require more tooth reduction and a completely dry field to bond, so they aren’t right for every child or every tooth. We’ll walk you through the tradeoff for your child’s specific case rather than defaulting to one.
Once the crown is placed, your child will need to follow certain aftercare instructions, such as:
- Soft foods for the rest of the day, especially if your child is numb.
- Skipping sticky candy and ice chewing-taffy and caramel can pull at a crown, and ice can chip zirconia.
- Brushing and flossing normally, including around the crown. Flossing matters more than usual here: the crown protects the tooth, but the gum around it still needs cleaning.
- If your child is sore, children’s ibuprofen or acetaminophen at the age-appropriate dose is fine. Most kids need nothing.
- Call us if the gum around the crown swells, the crown feels loose, your child is in real pain rather than passing tenderness, or the high bite from a Hall crown hasn’t settled after a few weeks.
A crown is protecting the tooth your child will keep until it’s naturally ready to come out, often years from now. Our goal is to do that with the least intervention the tooth actually requires. Sometimes that means no needle and no drill. Sometimes it means both. We’ll tell you which before we begin, not after.
About Smiles University Pediatric Dentistry
Smiles University Pediatric Dentistry is home to three board-certified pediatric dentists with more than 40 years of combined experience caring for young patients. We offer both Hall technique and conventional crowns and will recommend the approach best suited to your child’s tooth.
Questions about an upcoming crown appointment, or want a second opinion on one recommended elsewhere? Call us at (512) 321-5437 or schedule online.