Restorative Pediatric Dentistry in NYC

Cavities are one of the most common childhood dental conditions — and when they are caught early, treatment is straightforward, effective, and completely manageable even for young or anxious children.

At Bright Healthy Smiles, we use tooth-colored composite resin for children’s dental fillings. Upper East Side parents rarely want visible silver amalgam, and we agree for clinical reasons too: composite bonds directly to the tooth, which means we remove less healthy tooth structure to place it. The result looks natural, feels natural, and blends completely with the surrounding teeth.

Our approach to fillings is minimally invasive by design:

• We follow a conservative, biological philosophy that prioritizes preservation
• We use CariVu cavity detection and low-radiation digital X-rays to find decay at its earliest, smallest stage
• We treat only what needs treatment — nothing more

For children who feel anxious about fillings, we offer nitrous oxide and other comfort options to keep the appointment easy. Most kids cavity treatment at our Manhattan office is complete in a single short visit, with your child back to school or the playground the same day.

Common questions about fillings are answered in the FAQ section below.

If your child’s dentist has mentioned a “root canal for a baby tooth,” the procedure they are likely referring to is a pulpotomy — and it is far less intimidating than it sounds.

A pulpotomy is performed when tooth decay has reached the pulp — the soft inner tissue of the tooth that contains nerves and blood vessels. Rather than removing the entire root system as with an adult root canal, a pulpotomy removes only the affected pulp tissue in the crown portion of the tooth, leaving the root structure intact. The remaining space is filled with a medicated material, and the tooth is then capped with a crown to protect it.

The goal of kids root canal treatment at our NYC office is to preserve the primary tooth so it continues to hold space and support normal biting and chewing until the permanent tooth is ready to come in. Extracting a baby tooth early creates a cascade of issues — shifting, crowding, and potential orthodontic intervention — that are all avoidable with the right restorative care.

A pulpotomy is performed under local anesthetic, and sedation is available for children who need it. Recovery is typically smooth, and most children return to normal activity the same day. A crown is placed at the same appointment or shortly after to protect the treated tooth.

When a baby tooth is significantly decayed, cracked, or weakened after a root canal procedure, a dental crown provides the protection and structural support that allows the tooth to function normally until it falls out naturally.

Holding onto primary teeth matters more than many parents realize. Baby teeth hold space for the permanent teeth developing underneath them. When a primary tooth is lost too early — whether to extraction or decay — neighboring teeth can shift into the space, crowding out the incoming permanent tooth and creating orthodontic problems that are more complex and costly to address later.

We offer two types of crowns for primary teeth:

• Stainless steel crowns — the most durable and cost-effective option, typically used on back molars where strength is the primary concern
• Tooth-colored zirconia crowns — a white crown that blends with the natural tooth, ideal for front teeth or families who prefer a more aesthetic result

Crown placement is completed in a single appointment. We use local anesthetic to ensure your child feels nothing during the procedure, and sedation is available for children who need additional comfort. Our team will explain exactly which type of crown we recommend and why — and we will never recommend a crown without a clear clinical reason.

Extraction is always a last resort at Bright Healthy Smiles. Our clinical philosophy prioritizes keeping natural teeth whenever doing so is in the child’s best long-term interest. But when a tooth is too severely decayed to restore, is causing a dental abscess or infection, or is blocking the eruption of a permanent tooth, removal becomes the most conservative — and most compassionate — choice.

The most common reasons a child might need a tooth extracted include:

• Severe decay that has progressed beyond what a filling or crown can effectively treat
• An abscess or infection that threatens surrounding teeth or bone
• A primary tooth that is retained and preventing the permanent tooth from erupting
• Dental trauma resulting in an unrestorable fracture
• Orthodontic preparation — creating space for proper alignment

We use local anesthesia for every extraction, and our team is experienced in making tooth extractions for kids at our Manhattan office as calm and efficient as possible. Nitrous oxide is available for children who feel nervous, and IV sedation or general anesthesia can be arranged through Dr. Sanjay Tewari, our in-house board-certified pediatric anesthesiologist, for children with extensive needs.

Following an extraction of a primary tooth, we discuss whether a space maintainer is appropriate. This small device holds the gap open so the permanent tooth can erupt into the correct position — a simple measure that prevents significant orthodontic complications later. Learn more on our Dental Space Maintainers page.

Thoughtful treatment and compassionate care help children return to smiling, eating, and living comfortably.