The stainless steel crown (SSC) is an extremely durable restoration with several clear-cut indications for use in primary teeth including: following a pulpotomy/pulpectomy; for teeth with developmental defects or large carious lesions involving multiple surfaces where an amalgam is likely to fail; and for fractured teeth. In other situations, its use is less clear cut, and caries risk factors, restoration longevity and cost effectiveness are considerations in decisions to use the SSC. The literature on caries risk factors in young children indicates that children at high risk exhibiting anterior tooth decay and/or molar caries may benefit by treatment with stainless steel crowns to protect the remaining at-risk tooth surfaces. Studies evaluating restoration longevity, including the durability and lifespan of SSCs and Class II amalgams demonstrate the superiority of SSCs for both parameters. Children with extensive decay, large lesions or multiple surface lesions in primary molars should be treated with stainless steel crowns. Because of the protection from future decay provided by their feature of full coverage and their increased durability and longevity, strong consideration should be given to the use of SSCs in children who require general anesthesia. Finally, a strong argument for the use of the SSC restoration is its cost effectiveness based on its durability and longevity.