How deep the decay is decides the treatment. Small cavities get a filling, decay too extensive for a filling gets a crown, decay reaching the nerve needs a pulpotomy, and early or hard-to-treat lesions can often be arrested with silver diamine fluoride instead.
Parents usually assume the choice is about the child's age or how well they sit in the chair. Those matter for how treatment is delivered, but not for what is needed. The deciding factors are how far the decay has traveled into the tooth, how much healthy tooth structure is left to hold a restoration, whether the nerve is involved, and how long that tooth still needs to stay in the mouth before it naturally falls out.
That last point is the one unique to pediatric dentistry. A baby molar that will not exfoliate until age eleven is a tooth worth restoring properly. The same tooth in a child who will lose it in eight months is a different decision entirely, because restorative treatment exists to keep that tooth healthy and in place until it is ready to go.
Because baby teeth hold the path that permanent teeth follow when they erupt later. Untreated decay in a primary tooth causes pain, can lead to infection or tooth loss, and can damage the developing adult tooth sitting underneath it. Our own numbers on this are worth repeating: on average, kids between the ages of 2 and 11 have 1.6 decayed baby teeth, and 51% of children between 5 and 11 have at least one cavity. This is common, and it is fixable.
A filling replaces the decayed portion of a tooth. Your child's dentist removes the decay and packs the space with a restorative material that restores the tooth's shape and function. It is the fastest, simplest, and most affordable way to treat a cavity, and it is the right answer whenever enough sound tooth remains around it to hold the filling in place and take a chewing load.
A crown covers the whole tooth instead of patching part of it. When decay or an injury has taken too much structure for a filling to survive — a large multi-surface cavity, a fractured molar, or a tooth that has already had nerve treatment — a pediatric crown is what keeps the tooth functional for years rather than months. Crowns are made specifically for small teeth, and they are the more durable option precisely because they take the biting force off a weakened tooth and distribute it across a cap.
The practical difference for your family is longevity, not comfort. Both procedures are done in one visit and both are routine. A filling placed in a tooth that really needed a crown tends to fail, and a failed restoration usually means a second appointment and deeper treatment. When we recommend a crown, that is the reason.
Silver diamine fluoride is a non-invasive alternative to a filling: no drill, no shot, and just a few minutes of chair time while the dentist paints a liquid onto the affected tooth. It seals and strengthens the tooth and stops the decay from progressing. SDF shines in three situations — a very young child who cannot yet tolerate a traditional restoration, a child with several lesions who needs decay stabilized while treatment is sequenced, and a tooth close to falling out on its own where a full restoration is hard to justify.
The trade-off is honest and worth knowing before you agree to it: silver diamine fluoride stains the arrested decay black. On a back molar that is invisible. On a front tooth it is not, and many families choose a filling there for that reason alone.
If decay reaches the pulp — the nerve and blood supply inside the tooth — cleaning out the cavity is no longer enough. A pulpotomy, sometimes called a baby root canal, removes the infected pulp tissue from the crown of the tooth, disinfects it, and seals it, usually finishing with a crown to protect what remains. Done in one visit, it stops the infection and relieves the toothache that brought you in.
Extraction is the last resort, not a shortcut. We restore a tooth whenever restoring it is possible. But when a tooth is too damaged to save, removing it eliminates the pain and prevents the infection from spreading — and if it comes out well before it would have naturally, a space maintainer holds the gap so the neighboring teeth do not drift into it.
Sudden pain, facial swelling, or a tooth broken in an accident is not a wait-and-see situation. Call us the same day. Our team will help you judge the severity over the phone, walk you through what to do at home, and get your child seen; the details are on our emergency dentistry page, and if a tooth has been knocked out completely, our guide on what to do when your child knocks out a tooth covers the first thirty minutes.
This is the question most parents actually want answered, and the honest response is that comfort is a separate decision from the restoration itself. Local anesthetic handles the tooth. For children who are anxious, very young, or simply have a hard time sitting still, sedation options handle everything else — and we offer free nitrous oxide with your child's treatment, so cost is not a reason to skip it.
If dread is the real obstacle, come in before the appointment. A complimentary meet-and-greet lets your child tour the office, meet the team, and have their teeth counted with nothing else on the schedule. And if you are holding a treatment plan from another office that you are not sure about, bring it by — we offer complimentary second opinions.
Aftercare is usually simpler than parents brace for, but it differs by procedure and it helps to know what normal looks like before you leave the office.
After a filling or a crown, the main thing to manage is the numbness rather than the tooth. Local anesthetic can linger for a couple of hours, and the risk in that window is a child biting the inside of a numb cheek or lip without feeling it, so stick to soft foods and keep an eye on them until sensation returns. Mild sensitivity to cold for a few days is normal. Sharp pain when biting down is not, and it usually means the restoration needs a small adjustment — call us rather than waiting it out.
After a pulpotomy, expect the tooth to feel tender for a day or two and treat it with whatever pain reliever your pediatrician recommends at your child's weight. The tooth is typically covered with a crown at the same appointment, so it can be used normally once the numbness wears off. After an extraction, the priority is the clot: no straws, no vigorous rinsing, and soft foods for the rest of the day. Some oozing on the first day is expected; steady bleeding, a fever, or increasing swelling on day two warrants a call.
Silver diamine fluoride has essentially no recovery at all — your child can eat and drink normally right away. What it does need is follow-up, because SDF arrests decay rather than removing it. The treated tooth gets re-checked at the next cleaning, and sometimes gets a second application or a restoration later, once your child is ready for one.
Very early demineralization — a white spot that has not yet broken through the enamel surface — can sometimes be remineralized with fluoride and better home care. Once decay has created an actual hole in the tooth, it cannot heal on its own and needs treatment to stop it from spreading.
A well-placed pediatric crown is designed to last until the tooth naturally exfoliates, which is often several years. That is the point of the crown: it takes the chewing load off a weakened tooth so the tooth can finish its job on schedule.
No. There is no drilling and no injection — the dentist paints the liquid on and the application takes only a few minutes. The main consideration is cosmetic, since the treated decay turns black.
Not usually. Treatment is typically sequenced by urgency, starting with anything causing pain or approaching the nerve, and grouped so your child spends as little time in the chair per visit as possible. Silver diamine fluoride is sometimes used early in that sequence to stabilize the other lesions while the plan is carried out.
If your child has a spot you are watching, a tooth that hurts, or a treatment plan you would like a second opinion on, call (760) 634-KIDS. Our office at 135 Saxony Road, Suite 200 in Encinitas is open Monday through Thursday from 9am to 5pm and Friday from 8am to 4pm.
