To crown or not to crown?

After visiting the dentist, you may walk away with a large treatment plan for your cleft child, including stainless steel crowns.

You may be asking yourself, what are stainless steel crowns?

Stainless steel crowns, sometimes referred to as “caps” or “silver crowns,” are strong, durable, and cost-effective ways to protect baby teeth. Baby teeth are so important to protect because they serve as space-holders for permanent, adult teeth. If baby teeth are removed too soon, your child is at risk for permanent, adult teeth coming in at the wrong locations in the mouth.  This leads to an improper bite and tilting of teeth, which leads to improper function. 

They are usually indicated when your child has a high-cavity risk or a large cavity in the tooth. The reason a filling cannot just be done on these teeth is because of the size of the cavity. If a crown is being recommended by your dentist, that means a simple filling could potentially break just due to the size. A crown covers the entire tooth and protects the tooth structure underneath it.

What puts a child at a high-cavity risk?

To put it simply, having a cleft lip and/or palate already puts your child at a high-cavity risk.¹

• The reasons are not entirely clear, but much research shows that because of the tooth malformations and malpositioning of teeth that result from a cleft, the plaque buildup is much greater in cleft patients. Naturally, through chewing and saliva flow, plaque is wiped away from the teeth, but teeth in different positions because of the cleft may be more difficult to clean. 
• The nasal discharge from the opening in the palate also makes it difficult to keep teeth clean.
• Hypoplastic lesions, or weakened enamel, is more prevalent in cleft patients. If the enamel is weak, the child is more susceptible to cavities.²
• Lastly, it’s been found that cleft patients partake in a more sugary diet than non-cleft patients. 

OK, if I do the crown, what are my options?

There are 4 options for the type of crown to get. Which one to choose depends on esthetics, function, and finances.

Stainless Steel Crown

• Durable
• Strong
• Long lifespan
  
• Cost-effective
• Not suitable if child has metal allergies

Stainless Steel Crown with White Facing

• Has a tooth-color on the front of the crown
• More bulky to add white color
• Tend to chip over time

Composite Strip Crowns

• Entirely tooth-colored
• Takes longer to put on than a stainless steel crown
• Because it takes longer, sedation is recommended
• Over time, discolors
• Significantly weaker than stainless steel crowns

Zirconia Crowns

• Entirely tooth-colored
• Smooth and shiny
• Do not stain
• Extremely strong
• More expensive

Moving Forward

Just because your child has a cleft and is at higher risk for developing cavities does not mean all of the teeth should have crowns. Unless his/her dentist is recommending crowns, do not voluntarily get them. 

It does mean more care should be taken to prevent cavities from occurring, at least with the parts you can control. 

What this includes:³ 

1. Less sugary snacks
2. Always clean any appliances in the child’s mouth at least twice a day
3. Have regular dental examinations
4. Fluoride supplements in non-fluoridated areas
5. Practice good oral hygiene by brushing twice a day!

Thank you for reading! I hope this helps answers some questions and makes these crowns seem less scary. At the end of the day, they are good for your child and will help ensure proper positioning when those adult teeth do come in.

 

1. Britton, K.F.M., Welbury, R.R. Dental caries prevalence in children with cleft lip/palate aged between 6 months and 6 years in the West of Scotland. Eur Arch Paediatr Dent 11, 236–241 (2010). https://doi.org/10.1007/BF03262754

2. Shashni R, Goyal A, Gauba K, Utreja AK, Ray P, Jena AK. Comparison of risk indicators of dental caries in children with and without cleft lip and palate deformities. Contemp Clin Dent. 2015;6(1):58–62. doi:10.4103/0976-237X.149293

3. Preventing caries in cleft lip/palate. Br Dent J 202, 61 (2007) doi:10.1038/bdj.2007.59