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Root Canal Treatment For Children's Teeth

How and why infected baby teeth are saved!

By Dr. Joe H. Camp

This article is endorsed by the
American Association of Endodontics.


Root Canal Treatment Options For Primary Teeth

The treatment of primary and young permanent teeth is quite safe and predictable, backed by a large body of research detailing the best clinical techniques and practices. With sound clinical techniques and some rather extraordinary compounds, a lot can be done to save baby teeth. As always, treatment is based on assessment and diagnosis, and, especially in the case of primary teeth, may be decided by the state of the tooth at the time of examination.

The treatment of primary and young permanent teeth is quite safe and predictable.

What follows is a summary of the state-of-the art treatment techniques for the various stages of pulpal involvement for baby teeth with trauma and decay:

Indirect pulp treatment works best for teeth with deep decay approaching and/or barely exposing the pulp, where removing all the decayed parts of the tooth would expose it. Instead, as much soft decay is removed as possible, leaving only harder remnants without penetrating into the pulp. Then applying an antibacterial agent and restoring the tooth to seal it prevents further infection. In this procedure, outer layers of infected dentin are removed and a layer of lining cements are placed over the exposed dentin. These materials reduce the acidity caused by decay and sterilize the surrounding infected dentin. By allowing inflammation to subside, reactionary/reparative dentin is deposited by the pulp to further protect itself. A temporary filling is then placed in the tooth to ensure comfort and healing. A more permanent filling is placed after 10-12 weeks. When properly applied, this procedure has proven 90% successful over three-year periods.

Direct Pulp Capping is recommended for “small incidental exposures of the pulp when there is no decay.” Here, the dentist will essentially “cap” the exposure directly using similar materials as mentioned above, to create a dentin “bridge” to seal the exposure.

Managing Root Canal Treatment for Your Child

  1. Find a pediatric dentist, endodontist or general dentist who shows trust and empathy.
  2. Get a full explanation of the situation with all the risks, benefits and treatment alternatives, adequate for your comfort level.
  3. Try not to appear anxious; if you are worried, your child will be worried.
  4. Painless dentistry involves local anesthesia to numb the uncomfortable tooth. This not only relieves your child's pain but also allows your dentist to concentrate on doing the best possible job.
  5. Your dentist will place a “rubber dam” on the tooth, or group of teeth. This will allow isolation of the tooth from the mouth so that the root canal treatment can be performed in a dry, uncontaminated environment for best possible results.
  6. A successful root canal treatment will be followed by an appropriate restoration to seal the tooth to prevent further decay and leakage.
  7. Periodic visits will be necessary for follow up and monitoring to assess the effectiveness of the root canal treatment.

Pulpotomy is literally a “partial pulp removal,” a tried and tested technique, and is successful in 90% of cases. It is used to treat pulp exposures, a result of decay in primary teeth, when the inflammation/infection is confined to the coronal (inside the crown) area of the pulp. The procedure includes removal of the coronal portion of the pulp, preserving the vitality of the remaining root areas of the pulp. Success is based on the dentist's determination of whether the remaining pulp is healthy or reversibly inflamed. Effective control of infection is also crucial; it includes complete removal of inflamed pulp tissue, appropriate wound dressing, and effective sealing of the tooth during and after treatment.

Dentists use medicines and preparations to stabilize vital tissue and prevent it from becoming infected. This allows the remaining vital or living tissues of the pulp to survive so that the tooth can function normally until lost naturally. One of the newer compounds developed in the mid-nineties, MTA (Mineral Trioxide Aggregate), has remarkable properties. It is biocompatible with living tissues, and promotes healing; it has cement-like properties and therefore seals the root canals, preventing leakage and the spread of infection. Most importantly, it can encourage dentin formation so that the tooth can heal itself.

Pulpectomy involves complete removal of all the pulp tissue because it is infected. If a child has tooth pain, particularly if there has been accompanying swelling of the gum tissues or cheek, this will need to be managed first. A small opening is drilled in the biting surface of the tooth to drain infection and/or a course of antibiotics is given. This will set the stage for the removal of infected tissue from the root canal/s completely. This procedure resembles traditional root canal treatment, with removal of all the infected tissue from the root canals; disinfecting, cleaning, shaping and filling the canals to seal them. The sealant material must be absorbable so that the body can absorb the roots normally, allowing the primary tooth to be lost and replaced by its permanent successor. The materials most commonly used are zinc oxide/eugenol paste, or iodoform paste and calcium hydroxide. Some researchers have reported a mixture of calcium hydroxide and iodoform as nearly perfect — it is easy to apply, absorbs at a slightly faster rate than the roots, is non-toxic to successor teeth and is radio-opaque, which means it is visible on radiographs (x-rays).

Upon completion of root canal treatment for primary teeth, the restoration of choice for a back tooth is a stainless steel crown and, for a front tooth, a composite tooth-colored resin.

This has been a guide to understanding what to look for in your child and what can be done to save baby teeth until they are ready to be lost naturally. Pediatric dentists, along with endodontists and general dentists are an exceptional resource for any additional questions you may have. Special endodontic treatment techniques for immature permanent teeth will be covered in a subsequent article.