Cavities, Fillings & Crowns

Pediatric Fillings, Stainless Steel & Zirconia Crowns in Vero Beach, FL

When your child has a cavity, the right answer depends on a lot of things - how big the cavity is, which tooth it’s in, whether it’s a baby tooth or a permanent tooth, and your child’s age and ability to cooperate. At Nickel Pediatric Dentistry, Dr. Andrew Nickel - a board-certified pediatric dentist (ABPD Diplomate) - uses the smallest, gentlest restoration that will solve the problem. That means tooth-colored fillings for most early cavities, and a thoughtful conversation about crowns when the decay is more advanced.

This page covers the choices, when each one fits, and the question parents most often ask: *does my child really need a crown on a tooth that’s going to fall out anyway?*

Why Cavities Are Different in Kids

Children’s teeth aren’t just smaller adult teeth. The enamel is thinner, the pulp chamber is larger and closer to the surface, and decay can progress noticeably faster than it does in an adult tooth. A small cavity at a six-month visit can easily become a much bigger problem by the next visit if it isn’t addressed. That’s part of why we image when there’s a clinical reason and check carefully at every cleaning - catching cavities early often means a smaller, simpler restoration.

When we *can* avoid drilling entirely - through Silver Diamine Fluoride, Curodont, or other minimally invasive options - we do. When traditional restoration is the right call, the choice comes down to fillings vs. crowns.

Tooth-Colored Fillings - The Most Common Restoration

For most cavities - small to moderate decay that hasn’t reached the nerve - a tooth-colored composite filling is the right answer. The decayed portion of the tooth is removed, the area is cleaned, and a tooth-colored composite resin is shaped and bonded into place. The result blends naturally into the surrounding tooth.

When tooth-colored fillings fit:

• Early to moderate cavities in baby teeth or permanent teeth
• Both back molars and visible front teeth (the composite material matches enamel color)
• Children who can comfortably tolerate a short awake procedure with local anesthetic and (often) nitrous oxide

What to expect: local anesthetic numbs the area, the actual filling typically takes 15-30 minutes, and your child can usually eat normally as soon as the numbness wears off.

When a Crown Is the Right Answer

Crowns sound like a big deal - and the parent question we hear most is *does my child really need a crown on a tooth that’s going to fall out anyway?* The honest answer is: only when the decay is extensive enough that a filling won’t hold up. When that’s true, here’s why a crown matters even on a baby tooth:

• Baby molars don’t fall out until ages 10-12. A back baby molar restored at age 4 needs to last 6-8 more years. A large filling in a heavily decayed tooth often fractures or fails before then - and a failed filling means a more difficult re-treatment, an infection risk, or an extraction.
• Crowns seal the entire tooth. Where a large filling has multiple margins where bacteria can re-enter, a crown encases the tooth fully. The AAPD specifically recommends crowns for extensively decayed primary teeth and after pulpal therapy.
• Saving the tooth saves orthodontic complications. Losing a baby tooth too early can let the surrounding teeth drift, leaving the permanent tooth without enough space when it tries to come in. A crown that preserves the tooth until natural exfoliation prevents that downstream problem.

When we recommend a crown, it’s because we genuinely believe the alternative - a large filling that may fail, or extraction with a space maintainer - is a worse path. We’ll always explain our reasoning.

Pediatric Crown Options

Three options come up most often for kids. Each one fits a specific situation.

Stainless Steel Crowns (SSC)

The traditional, AAPD-recommended choice for back baby molars with significant decay or after pulpal therapy. Stainless steel crowns are pre-formed, durable, sealed completely, and last reliably until the baby tooth is naturally ready to come out. They’re particularly well-suited for very young children (under age 4) because the success rate of SSC restorations significantly exceeds large fillings in this age group.

Tradeoff: they look silver. For a back molar, most parents are happy to trade aesthetics for a reliable, long-lasting restoration. For a visible tooth, we’d typically choose a different option.

The Hall Crown Technique is a no-drill way to place a stainless steel crown - read about it on our minimally invasive dentistry page.

Zirconia (White) Crowns

A tooth-colored alternative to stainless steel - pre-formed crowns made of strong ceramic that match natural tooth color. Zirconia crowns are an option for both back molars and front teeth when aesthetics matter to the family. They’re harder to place than stainless steel (require more tooth preparation) but offer significantly better appearance.

When zirconia fits:

• Visible teeth where appearance is important to the family
• Back molars when parents prefer a tooth-colored option
• Older children where the tooth has more time to remain in place

We’ll discuss whether SSC or zirconia is the better choice for your specific child and tooth.

Anterior Strip Crowns

For decay or trauma on front baby teeth, strip crowns are tooth-colored composite crowns shaped using a clear plastic form and cured in place. They’re not pre-formed - Dr. Nickel builds the restoration directly onto your child’s tooth, which means the cosmetic result can be matched precisely. Read more on our minimally invasive dentistry page.

What the Procedure Looks Like

For most filling and crown procedures:

• Local anesthetic numbs the area completely. Your child will feel pressure but not pain.
• Nitrous oxide (“laughing gas”) is available for kids who would benefit from extra calm. For more anxious children, very young children, or extensive treatment, we may discuss deeper sedation options.
• Time: a single filling typically takes 15-30 minutes. A crown placement is usually 30-60 minutes; the Hall Crown technique typically takes two appointments.
• Aftercare: soft foods for the first day if your child is sore, normal brushing and flossing, and a follow-up at the next routine cleaning to check the restoration.

Cost and Insurance

Most dental insurance plans cover both fillings and crowns when they’re medically necessary - typically at 70-80% of the contracted rate after the deductible. Crowns generally have higher allowable amounts than fillings, but the difference is usually less than parents fear once insurance applies. We verify your specific benefits before any procedure and walk through any expected out-of-pocket cost. For more, see our financial information page.