Any reason not to put a stainless steel crown on my 3-year-old's tooth?
December 8, 2013 10:04 PM Subscribe
We learned from our dentist that our 3-year-old has enamel hypoplasia, serious enough that they want to put a stainless-steel crown on her molar. I tend to trust our dentist, who we've been with for years, but I wonder: should I have any concern about nickel and other metals leeching into the tooth itself, possibly causing sensitivities down the line, as this paper suggests? Or should we just go ahead and do this? Set my mind at ease, MeFi dentists and/or people with teeth!
1. always get a second opinion
2. i'm not a dentist but i have a mouthful of crowns..."sensitivity down the line" is an almost foregone conclusion with crowns - unless you have a root canal. Sooner or later they get dislodged or broken or in the case of stainless crowns, replaced with more traditional porcelain. I occasionally get some sensitivity in crowned teeth, and I know that crowns don't last forever and that at some point i may break one, incur pain as sensitive nerves are exposed and have to go to get a new one...
posted by Salvatorparadise at 10:44 PM on December 8, 2013
2. i'm not a dentist but i have a mouthful of crowns..."sensitivity down the line" is an almost foregone conclusion with crowns - unless you have a root canal. Sooner or later they get dislodged or broken or in the case of stainless crowns, replaced with more traditional porcelain. I occasionally get some sensitivity in crowned teeth, and I know that crowns don't last forever and that at some point i may break one, incur pain as sensitive nerves are exposed and have to go to get a new one...
posted by Salvatorparadise at 10:44 PM on December 8, 2013
Please, go to a dentist who has been practicing for 20-30+ years, and get a second opinion. Go to a dentist with modest office decor and less than ultra new state of the art equipment, that he needs to pay for. Dentistry is an old art. Beware of being oversold.
posted by woman at 10:44 PM on December 8, 2013 [7 favorites]
posted by woman at 10:44 PM on December 8, 2013 [7 favorites]
Sooner or later they get dislodged or broken or in the case of stainless crowns, replaced with more traditional porcelain.
Just wanted to chime in to say that I had stainless steel crowns as a kid. As would be the case with your 3-year-old, the crowns were on baby teeth.
The crowned baby teeth fell out long before I had any problems with the crowns themselves, and I haven't had any unusual issues with my adult molars. I'm prone to cavities now (as I was as a kid) but I'm 27 and still haven't needed crowns or root canals or any kind of extensive work on my adult teeth otherwise.
posted by rue72 at 11:07 PM on December 8, 2013 [4 favorites]
Just wanted to chime in to say that I had stainless steel crowns as a kid. As would be the case with your 3-year-old, the crowns were on baby teeth.
The crowned baby teeth fell out long before I had any problems with the crowns themselves, and I haven't had any unusual issues with my adult molars. I'm prone to cavities now (as I was as a kid) but I'm 27 and still haven't needed crowns or root canals or any kind of extensive work on my adult teeth otherwise.
posted by rue72 at 11:07 PM on December 8, 2013 [4 favorites]
I had the same issue as a child, and had a metal crown put on the baby tooth. It gave me no problem. That was about 40 years ago, though, which is my main point -- dentists have been solving this problem with metal crowns for a long time because it is safe and relatively inexpensive. If you ask around, you'll find lots of adults (especially ones who were premature) who had a metal crown on a baby tooth. It's very common.
posted by Houstonian at 3:52 AM on December 9, 2013 [2 favorites]
posted by Houstonian at 3:52 AM on December 9, 2013 [2 favorites]
Get a second opinion from a Pediatric Dentist who has been fellowship-trained in pediatric dentistry.
By way of example, I live in a fairly small town and in addition to many standard dental offices, there are 2 pediatric dental offices here:
Pediatric Office #1 is a DDS who has had no special training for treating kids but one day just decided to focus on marketing to kids. This dentist will never pass up the opportunity to do procedures on kids whenever it is possible to convince a parent to agree -- such as pulling baby teeth (which should be RARE, not every.single.kid. needs it) as opposed to letting them fall out naturally.
Pediatric Office #2 has 3 fellowship-trained DDS's and they are the ones known locally as being legit, as in, they often will say "This is not immediately necessary, let's wait and see" to the detriment of their own bottom line. They also are the go-to office for treating adults with developmental delays, and are fantastic about making the experience enjoyable for the patient.
I searched this site just now with my zip code, and all of the DDS's from Office #2 came up, but not the person from Office #1. This tells me you want someone approved by the American Academy of Pediatric Dentistry.
posted by hush at 6:43 AM on December 9, 2013 [1 favorite]
By way of example, I live in a fairly small town and in addition to many standard dental offices, there are 2 pediatric dental offices here:
Pediatric Office #1 is a DDS who has had no special training for treating kids but one day just decided to focus on marketing to kids. This dentist will never pass up the opportunity to do procedures on kids whenever it is possible to convince a parent to agree -- such as pulling baby teeth (which should be RARE, not every.single.kid. needs it) as opposed to letting them fall out naturally.
Pediatric Office #2 has 3 fellowship-trained DDS's and they are the ones known locally as being legit, as in, they often will say "This is not immediately necessary, let's wait and see" to the detriment of their own bottom line. They also are the go-to office for treating adults with developmental delays, and are fantastic about making the experience enjoyable for the patient.
I searched this site just now with my zip code, and all of the DDS's from Office #2 came up, but not the person from Office #1. This tells me you want someone approved by the American Academy of Pediatric Dentistry.
posted by hush at 6:43 AM on December 9, 2013 [1 favorite]
That's odd ... Just last night my father, a retired pediatric dentist, mentioned how he had considered himself a specialist in putting crowns into toddlers.
The dental profession has thought long and hard about all of these issues, including metal toxicity.
Get the crowns done, and find something else to worry about.
posted by intermod at 9:02 AM on December 9, 2013 [1 favorite]
The dental profession has thought long and hard about all of these issues, including metal toxicity.
Get the crowns done, and find something else to worry about.
posted by intermod at 9:02 AM on December 9, 2013 [1 favorite]
Here's some recent discussion between dentists about Stainless Steel Crowns (SSC's).
I was saddened to hear that SSCs are routinely used on low-income children on Medicaid whose parents are not informed about other treatment options, and are not allowed to remain in the room with their child. OP, I support your excellent parenting instincts to ask a question like this and to look at the relevant research.
Stainless steel crowns are not the only option. You could also do nothing. You could also use a composite, tooth-colored filling instead. You could put your child under General Anesthesia (GA), or use inhalation sedation with nitrous oxide. The right dentist will not pressure you.
posted by hush at 10:16 AM on December 9, 2013
I was saddened to hear that SSCs are routinely used on low-income children on Medicaid whose parents are not informed about other treatment options, and are not allowed to remain in the room with their child. OP, I support your excellent parenting instincts to ask a question like this and to look at the relevant research.
Stainless steel crowns are not the only option. You could also do nothing. You could also use a composite, tooth-colored filling instead. You could put your child under General Anesthesia (GA), or use inhalation sedation with nitrous oxide. The right dentist will not pressure you.
posted by hush at 10:16 AM on December 9, 2013
Response by poster: By the way, I should have said, our dentist said this might be indicated and that we should talk to a specialist in pediatric dentistry, which we did, and that's who recommended the crowns.
posted by escabeche at 10:20 AM on December 9, 2013 [1 favorite]
posted by escabeche at 10:20 AM on December 9, 2013 [1 favorite]
since you've had 2 opinions on this, i would go with the recommended treatment. I try to use acrylic/composite in my practice, but SSC's are still pretty routine and a bit quicker to do which is an issue with the attention span of the average 3 yr old.
posted by OHenryPacey at 11:09 AM on December 9, 2013 [2 favorites]
posted by OHenryPacey at 11:09 AM on December 9, 2013 [2 favorites]
W/r/t the article, the gist seems to be that the teeth themselves show some uptake of the nickel, so it might serve as a warning for a plan to keep an ssc on a permanent tooth for a long time, but a baby tooth is going to be lost, so unless there is a reaction to the ssc, there should be no long term issue. that's my reading at least (cursory).
posted by OHenryPacey at 12:05 PM on December 9, 2013 [1 favorite]
posted by OHenryPacey at 12:05 PM on December 9, 2013 [1 favorite]
My now-7-year-old has a metal crown on a baby-tooth molar, put on when he was 5. It was recommended and done by a very good pediatric dentist. The reason for doing the crown instead of just extracting the tooth was to maintain the space for the permanent tooth without worrying about putting in a spacer. We've had no problems with the crown or his tooth, and the dentist is confident that it is protecting the development of the permanent tooth as well.
I wouldn't worry about the metal, since it's relatively short term.
posted by Lulu's Pink Converse at 1:00 PM on December 9, 2013
I wouldn't worry about the metal, since it's relatively short term.
posted by Lulu's Pink Converse at 1:00 PM on December 9, 2013
Some more anecdata: I had some metal crowns and metal fillings as a child, and my adult teeth are fine (minus one root canal resulting from a cavity I let get out of control, oops). I don't recall any sensitivities or issues with chewing or anything that resulted from the metals.
posted by Verdandi at 3:19 PM on December 9, 2013
posted by Verdandi at 3:19 PM on December 9, 2013
You've already gotten two professional opinions, including one from a specialist. And these are baby teeth -- they're going to fall out in a few years anyway. Your dentist likely just wants to make sure that the tooth doesn't break apart in the meantime, which would likely be a lot more trouble than this crown would be. It doesn't really matter if the tooth gets a little messed up by the crown, since it's not going to be there for much longer anyway. If it was an adult tooth it might be worth asking about the pros and cons of other crown materials, but in this case I'd say just go for it and don't worry.
posted by Scientist at 4:37 PM on December 9, 2013
posted by Scientist at 4:37 PM on December 9, 2013
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Even with sensitivities in our immediate family line, we went ahead with the right year old.
posted by tilde at 10:28 PM on December 8, 2013