Endodontic Treatment In Children
Posted April 20, 2007on:
Endodontic treatment involves the nerves and blood vessels in the center of the tooth, called the pulp. The pulp contains the tooth’s nerve, as well as blood vessels that supply the tooth with oxygen and nutrients. When the pulp is affected by traumatic injury, decay or other causes, endodontic treatment is usually the best way to try to save the tooth.
Symptoms that may indicate a need for endodontic treatment include:
1. Pain from a tooth during the day or night for no apparent reason
2. A tooth that is highly sensitive to temperature changes
3. Sensitivity from a broken tooth with exposed pulp
Endodontic treatment can be done in permanent or baby (primary) teeth. Even though baby teeth eventually will fall out, your dentist will suggest repairing them unless they are going to fall out soon. Primary teeth are needed for chewing and speaking, as well as to hold proper spacing for the permanent teeth that will eventually replace them. If your child loses a primary tooth too soon, neighboring teeth can invade the space, blocking the permanent tooth from coming in, or cause it to grow in tilted.
The type of endodontic treatment required depends on how seriously the pulp is affected. Treatment is based on your child’s history of pain, examination of the teeth and X-ray results.
There are two categories of pulp therapy, depending on whether the pulp is healthy enough to be saved. Vital pulp therapy preserves and protects the tooth’s pulp. Nonvital pulp therapy, also called root canal treatment, removes the remnants of a diseased pulp, but maintains the tooth and its functions. If the health of a tooth cannot be maintained by either of these methods, the tooth must be extracted.
Vital Pulp Therapy for Primary (Baby) Teeth
For vital pulp therapy to be successful, there must not be any swelling or abscesses, and the affected teeth must not be loose. If there is swelling or the tooth is loose because of an abscess, it will have to be treated with root canal therapy or extracted unless it is going to fall out soon. If the tooth needs to be extracted, your dentist will talk to you about other methods to preserve the space until the permanent tooth comes in.
There are four main types of vital pulp therapy for primary teeth:
1. Protective base — When there is decay in the tooth but the pulp is not directly affected, the decay is removed and a protective material is placed in the tooth before placing the filling.
Indirect pulp cap — When the decay has come very close to the pulp but does not reach it, most of the infected parts of the tooth are removed and a protective dressing is placed over the slight amount of remaining decay. This prevents exposing the pulp and stimulates healing. A filling is then placed in the tooth.
2. Direct pulp cap — When a small amount of pulp becomes exposed during removal of decay or following a traumatic injury, medication is placed directly on the exposed but healthy pulp to prevent further damage. Direct pulp caps have a lower success rate in primary teeth than in permanent teeth, so they are recommended less often for primary teeth.
3. Vital pulpotomy — When the top part of the pulp is affected by decay or injured by trauma, but the root part is still healthy, the dentist removes the decay along with the infected or injured part of the pulp. The remaining healthy pulp in the roots is left alone. The inside of the tooth is filled with a therapeutic material, and the tooth is covered with a stainless steel crown. The stainless steel crown is needed because a tooth that has been treated by vital pulpotomy is more likely to fracture. A vital pulpotomy can be done in baby teeth and immature permanent teeth that haven’t yet finished growing a full-length root. In young permanent teeth, vital pulpotomy is usually done as a temporary measure until the tooth has finished growing its root. Vital pulpotomy also might be done as the first step in a complete root canal treatment.
Non-Vital Pulp Therapy for Primary (Baby) Teeth
Non-vital pulp therapy, better known as root canal treatment, is done when the pulp in the tooth is too damaged by decay or trauma to be saved. The dentist removes all of the pulp from inside all parts of the tooth, cleans the root canals and fills them with a specially formulated material. The material is designed to be absorbed while the body naturally reabsorbing the root in preparation for the tooth falling out to be replaced by a permanent tooth. A stainless steel crown is placed on the tooth to keep it from fracturing. If the tooth is in the front part of the mouth, the stainless steel can be covered with a tooth-colored facing.
Non-vital pulp therapy usually requires more than one visit.
Primary Teeth: Root Canal Treatment Versus Extraction
Your dentist will give you information so you can decide whether to extract a primary tooth and place a space maintainer if needed to preserve spacing or perform root canal treatment. Factors that affect this decision include:
1. Which tooth is affected
2. How much longer it is needed
3. The amount of damage
4. Whether the problem has affected neighboring bone and gum tissues
5. Whether the tooth can be repaired adequately after completing the root canal treatment
If your child has serious medical problems, — for example, he or she is undergoing chemotherapy or has congenital heart disease — any infection can be a serious matter. Because there is always a small chance that a tooth can become infected again after root canal treatment, your dentist would most likely recommend that the tooth be removed.
If your child is healthy and removing the tooth might affect your child’s ability to eat or speak properly, or the permanent tooth’s ability to come in properly, your dentist may encourage root canal treatment.
After Endodontic Treatment
Your child may have some soreness after endodontic treatment and between visits if more than one visit is needed. The discomfort is short-term, and can be managed with over-the-counter pediatric pain medications.