If you have a baby tooth with decay, the usually restorative option is a white filling. If the decay is extensive, a crown may be recommended. There are few options when it comes to crowns for baby teeth. For back baby teeth there really is nothing better than the good ole’ stainless steel crowns. They are relatively easy to do and last till the teeth normally fall out. Since they are in the back, cosmetics is not as much of a concern. They are available for the front teeth and work quite well. However, most people don’t want "silver" in the front. I don’t blame them.
So, are white crowns available for front baby teeth? Yes. There are several types each of which has benefits and drawbacks. A porcelain crown like you do on adult teeth is really not an option for those little baby teeth. The teeth simply are way too small. A Stainless steel crown is good, but looks bad. There is a thing called a NuSmile crown (or other variants) that is basically a stainless steel crown with something white coating the front. It is harder to place and looks a little fake (sort of a harsh white) especially if there is just one there. In addition, the white stuff on the front sometimes chips off. Another white option is a "Strip" crown. This is basically a clear form that is filled with white filling material and placed over the tooth. After light curing, the outer clear shell is removed leaving basically a white filling all around the tooth. This option looks the most natural, but is also the most fragile. It can only be used if there is a good bit of tooth structure remaining after decay removal and crown preperation. One option we use a lot is the "Pedo-Jacket" crown. This is basically a white plastic shell you place in a similar manner to the strip crowns. You can either remove the outer shell like a strip crown or leave it on there, which is the usual method. They look good, but sometimes kids chew through the outer shell which causes problems.
So, in summary, there is no magic bullet. All crowns have some kind of drawback. This is very frustrating for us and for parents. Kids are so rough on their teeth. Again, it should be noted is is very unusual to do porcelain crowns for baby teeth. There are many reasons why they are not ideal. The only time I have done them is for older teenagers with congenitally missing back teeth (with the baby tooth still there at that age) whose only cosmetic option is the porcelain fused to metal crown (those run around $800 or more each) and usually necessitates a pulpal treatment as well due to the small tooth size, and these crowns having a questionable prognosis in baby teeth. Also, it should be noted that there is a NuSmile type crown for back baby teeth, but the white tends to get worn off very easily due to the tight occlusion. We hardly ever do those though many parents ask if there is some kind of white option for those back teeth. Well, not really any good option yet. Maybe some day…
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