When decay has hollowed out a large part of a baby molar, a filling often has too little tooth left to hold onto. A stainless steel crown solves that by covering the whole tooth with a thin, pre-shaped metal cap, which keeps the tooth working until it falls out in the normal way. The silver look takes some parents by surprise, yet on back baby teeth these crowns tend to outlast large fillings.
Large fillings in baby molars often fail
Baby teeth have thinner enamel and larger nerves than adult teeth, and decay spreads through them quickly. Once a cavity reaches across several surfaces of a molar, the walls left behind are thin. A filling in that situation is more likely to crack, leak at the edges or let decay restart underneath, and each repeat visit is another round of treatment for a young child.
A crown wraps around the tooth instead of sitting inside it, so it holds the remaining walls together and seals the decay away from the mouth. Dentists commonly suggest one when a baby molar has:
- decay affecting two or more surfaces
- had pulp treatment (a baby-tooth nerve treatment), which leaves it weaker
- broken down from developmental enamel defects such as molar incisor hypomineralisation
- already had a filling fail
Keeping a baby molar in place until its natural time matters for more than chewing. The tooth holds room for the premolar developing underneath, and losing it years early can let neighbouring teeth drift into the gap, which may then call for a space maintainer.
Two ways the crown can be fitted
The conventional method. The tooth is numbed with local anaesthetic, the decay is removed, the tooth is trimmed slightly so the crown can slide on, and the crown is cemented in place. If the decay has reached the nerve, a pulp treatment is done first.
The Hall technique. For suitable teeth, the dentist fills a crown of the right size with cement and presses it over the tooth without any drilling, decay removal or injection. Sealing the decay off from sugars in the mouth starves the bacteria and slows or stops the cavity. A small rubber spacer is sometimes placed between the teeth at an earlier visit to make room. The bite feels a little high at first and usually settles within a few weeks.
The Hall technique has been studied more closely than many children's dental procedures. In a randomised trial in Scottish general practices, published by Innes and colleagues in BMC Oral Health in 2007, with five-year results in the Journal of Dental Research in 2011, Hall crowns had fewer major failures, such as pain or abscess, than conventional fillings in the same children. It is not suitable for every tooth: signs of infection, an abscess or decay that has already reached the nerve need a different approach, and an X-ray is taken first to check.
Silver or white
| Stainless steel crown | Preformed white (zirconia) crown | |
|---|---|---|
| Look | Silver | Tooth-coloured |
| Where it is mostly used | Back baby molars | Front baby teeth, or back teeth where looks matter more |
| Tooth preparation | Little, or none with the Hall technique | More trimming needed, with local anaesthetic |
| Can it be adjusted to fit? | Yes, the metal can be crimped | No, it must fit as made |
| Track record | Decades of use in children | Newer, with growing evidence |
On a lower back tooth, a silver crown is often barely visible unless a child laughs widely. Many families decide that durability matters more there. For front teeth, a white crown or a tooth-coloured filling is usually preferred.
Stainless steel crowns contain a small amount of nickel. Reactions in children are rare, but tell the dentist if your child has a known nickel allergy.
Life with the crown
Children can eat normally once any numbness has worn off. The gum around a new crown may be a little tender or bleed when brushed for a short time, and gentle, thorough brushing helps it settle. There is nothing to remove later: when the adult tooth below is ready, the baby tooth loosens and falls out with the crown still attached.
A crown protects one tooth, not the rest of the mouth. Twice-daily brushing with fluoride toothpaste, fewer sugary snacks and drinks, and regular check-ups remain the main defence. Fissure sealants can protect the grooves of newly erupted molars, and our article on a child's first filling covers how to prepare a young child for treatment.
Questions parents ask
Will my child need an injection?
Not with the Hall technique. For the conventional method, local anaesthetic is used so the tooth is numb during the procedure.
How long does a crown last?
It is intended to stay until the baby tooth is naturally lost, which may be several years. Occasionally a crown comes loose or wears through; the dentist checks it at each visit.
Is the metal safe?
Stainless steel crowns have been used in children's dentistry for decades. The only common caution is a known nickel allergy.
If your child has a baby molar with a large cavity, a dentist can explain whether a filling, a crown or another option suits that tooth. See our current offers or book with a general dentist at our Melrose Park practice.
This article is general information and not a substitute for personal dental advice.
