| Endodontic Treatment In Children
Endodontic treatment involves the material 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. If the pulp is affected by traumatic injury, decay or other causes, endodontic treatment is usually the best way to try to save the tooth.
Some of the symptoms that may indicate a need for endodontic treatment are:
- Spontaneous pain from a tooth during the day or night
- A tooth that is highly sensitive to temperature changes
- 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 try to restore them because they are necessary for biting and chewing food, maintaining facial beauty, preventing tongue habits and lastly, they help guide the permanent teeth into their proper positions. If your child loses a primary tooth too soon, neighboring teeth can invade the space. This can block the permanent tooth from coming in, or can cause it to come in tilted.
The type of endodontic treatment required will depend on how seriously the pulp is affected. Your dentist will choose the treatment based on your child's history of pain, his or her examination of your child's teeth, and X-ray results.
There are two categories of pulp therapy: conservative and radical. Conservative pulp therapy (also called vital pulp therapy) preserves the vitality of the tooth's pulp. Radical pulp therapy (also called nonvital pulp therapy, or root-canal treatment) removes the pulp, but maintains tooth function. If the health of a tooth cannot be maintained by either of these methods, the tooth must be extracted.
For conservative pulp therapy to be successful, there must be no swelling or abscesses, and the affected teeth must not be loose. If there is swelling or the tooth is loose, the tooth will have to be extracted. In that case, your dentist will talk to you about methods that will preserve the space until the permanent tooth comes in.
There are four main types of conservative therapy:
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Protective base, used when there is decay in the tooth but the pulp is not affected. The decay is removed and a protective dental material is placed in the tooth before placing the filling.
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Indirect pulp cap, used 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.
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Direct pulp cap, used when a small amount of pulp has been exposed following a traumatic injury. The dentist places medication on the pulp to help with healing. Direct pulp caps have a low success rate in primary teeth, so they are recommended only for permanent teeth.
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Vital pulpotomy, used when the top (crown) portion of the pulp is affected by decay or injured from trauma but the root portion is still healthy. The dentist removes the decay along with the infected or injured pulp. The remaining healthy pulp is left alone. The inside of the tooth is filled with a healing agent, then a filling is placed or the tooth is covered with a stainless steel crown. A vital pulpotomy can be done in baby teeth and immature permanent teeth. In young permanent teeth, it is usually done as a temporary measure before root-canal treatment, which can be done after the tooth's roots have finished growing. Vital pulpotomy also might be done in an emergency when there isn't enough time to do root-canal treatment, or if a child is not old enough to cooperate for the amount of time needed to complete root-canal treatment.
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Radical pulp therapy, better known as root-canal treatment, is done when the pulp in the tooth is inflamed or infected, or if the pulp tissue is breaking down. The dentist removes all of the pulp from inside the tooth, cleans the root canals and fills them with a rubberlike material. A stainless steel crown is usually placed on the tooth. If the tooth is in the front part of the mouth, it will be covered with a crown with a tooth-colored facing.
Whenever possible, root-canal treatment in children is done in one visit, including the placement of a crown.
In some cases, your dentist must decide whether to extract a primary tooth or perform 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 probably would recommend that the tooth be extracted in these cases.
On the other hand, if your child is healthy and extracting the tooth might affect the ability of the permanent tooth to come in properly, your dentist may choose to do root-canal treatment
If a primary tooth is extracted before the permanent tooth is ready to come in, your dentist might insert a space maintainer to keep the space for the permanent tooth. A space maintainer needs teeth on either side to support it, so it may not be possible to have one inserted immediately. Alternatively, your dentist may simply monitor the space to make sure the permanent tooth can come in properly.
Your child may have some soreness after endodontic treatment. This does not last long, and should be helped with over-the-counter pain medication.
A treated tooth can become infected again. If a tooth becomes reinfected, you will notice swelling of the gums or face, pain and fever. If you notice these symptoms, contact your dentist.
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