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Grace Dental Clinic

NABH Accredited On CGHS Panel

Our locations in gurgaon : Call at +9953076985,             Landline : 0124-4832254  for appointment

Sector 31 Location

Grace  Medical and dental Clinic

H.no 1298, Sector 31

Opp. Ajanta Public School, Gurgaon

Call +91-9953076985

landline: 0124-4832254

Opening Hours: 10AM to 9 PM

 

Sector 4 Location

Grace Medical and Dental Clinic 

Shop No.167, Sector 4 market 

behind ICICI bank, Gurgaon

Call +91-9953076985

Opening Hours   5:00 PM to 9:00 PM,  

  
  

 

Kid's Root Canal Treatment

Root Canal Treatment For Children's Teeth

How and why infected baby teeth are saved!

   

 

Root canal treatment for childrens teeth.

Young children can lose primary (baby) teeth and even immature permanent teeth when the pulp, the living tissue inside a tooth, becomes infected. This is often the result of trauma or dental caries (tooth decay) and creates a special problem for the child. The primary teeth provide important guides for the newly developing permanent teeth that will replace them. And injury resulting in loss of young permanent teeth can be even more troublesome, because neither tooth development, nor jaw growth is complete. If teeth are lost prematurely, a malocclusion (“mal” – bad; “occlusion” – bite) can easily result. Tooth replacement techniques such as partial dentures, bridgework and dental implants cannot easily be used in children while everything is changing and growing so rapidly. “Space maintainers,” specially made appliances that can be attached to adjacent teeth or fabricated in a removable “retainer” style, are generally the best choice. Yet many do not restore function, and all require constant monitoring.

For both functional and cosmetic reasons, endodontic (“endo” – inside; “dont” – tooth) or root canal treatment is preferable to tooth loss. It can preserve tooth, jaw and tongue function. It can also prevent speech problems, and abnormal eruption of a permanent successor tooth, or even the loss of a tooth that has no successor.

Tooth eruption process
A Close Look At Tooth Eruption
Baby teeth are lost naturally due to the pressure of the permanent teeth erupting from below. This process is called root resorption. Note the continued development of the permanent crown and root as it erupts. 

What follows is 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. Special endodontic treatment techniques for immature permanent teeth will be covered in a subsequent article.

Different Strokes For Younger Folks

Many things are different when dealing with primary teeth versus permanent teeth. Their survival is shorter and more temporary, but while their shapes, structure and functioning are similar to permanent teeth, they too have differences. Treatment of root canal problems is affected by root resorption, the normal process by which the body absorbs the roots of the baby teeth to allow for eruption of the succeeding permanent teeth. This complicates the diagnosis and, therefore, appropriate treatment.

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Figuring Out What's Wrong

Examination begins with a thorough medical history; a child with systemic (general) disease may need different treatment than a healthy one, and the dentist must consider any implications of the child's condition related to root canal treatment.

The characteristics of pain in a primary tooth are particularly relevant in helping to determine the status of the pulp. In the absence of trauma, pain is most often due to tooth decay reaching the pulp, which contains the nerves within the teeth.

Healthy tooth.
This illustration shows a cross section of a healthy tooth and pulp tissue (nerve tissue) with no tooth decay.
Infected dentin.
Decay is progressing beyond the protective enamel surface of the tooth. Notice how the decay spreads once it extends beyond the enamel surface.
Reactionary dentin.
When decay starts advancing towards the pulp, the pulp attempts to protect itself by adding additional dentin to separate itself from the decay. This is called “reactionary dentin.”
Infected pulp.
When the decay enters the pulp tissue, it becomes infected. This infection could damage the permanent tooth if left untreated.

Symptoms of pain usually accompany pulpal inflammation. However, extensive problems may arise without any history of pain. If possible, a distinction should be determined regarding whether the pain is spontaneous or only occurs when provoked; pain that ceases after removal of the cause is usually reversible and indicative of minor inflammatory change. Pain-provoking stimuli include: thermal, hot and cold; chemical, caused by sweet or acidic foods or beverages; and mechanical irritation, biting, or wobbling a loose tooth. Other common causes include deep tooth decay, faulty restorations (fillings), soreness around a primary tooth that is loose and ready to fall out, or an erupting permanent tooth.

Spontaneous (unprovoked) pain is characterized by constant or throbbing pain that occurs without stimulation and continues long after any causative factor has been removed. Spontaneous toothache is usually associated with extensive degeneration of the pulpal tissues extending into the root canals; this may be followed by swelling of the gum tissues and abscess formation as infection spreads beyond the roots of the teeth and into the surrounding bone.

Radiographs (x-rays) of good quality are essential after the clinical examination. Like permanent teeth, areas of infection appear at the root ends of primary front teeth. In primary molars (back teeth), changes are also most often apparent in the furcations, the areas where roots join each other in multi-rooted teeth. In advanced cases of infection, and where the permanent tooth bud may be in jeopardy, removal of the primary tooth may be necessary.

Mild but chronic pulpal irritation as seen in tooth decay might stimulate the pulp to deposit more dentin (the living tissue of which the body of the tooth is made). This “reactionary” dentin is nature's way of healing the tooth. When looking at radiographs of a child's primary tooth where tooth decay has reached the pulp, advanced pulpal degeneration occurs and extends into the root canals. Interpretation of radiographs of primary teeth is always complicated by the presence of new permanent teeth. Although all decay that penetrates into the pulp causes inflammation, the larger the penetration, the more likely it is to cause death of the pulp tissues.

We'll Get By With A Little Help From Our Friends

Pediatric dentists specialize in the treatment and management of children and adolescents, in growth and development of the teeth and oral structures, and they routinely treat root canal problems affecting primary (baby) teeth. They are particularly adept at figuring out what's wrong with primary teeth. Additionally, endodontists, who have had two to three years of additional training following dental school, specialize in the diagnosis and treatment of pulpal problems. General dentists who have taken additional training may also treat root canal problems of primary teeth.

This additional training is important because there is not always a definitive correlation between symptoms and the state of the tissues of the tooth when dealing with primary teeth. Also, younger patients are often not the best historians and accurate reporters of problems. All of this complicates the diagnosis of pulp health and disease in primary teeth and in immature permanent teeth.

Primary teeth with a history of spontaneous pain are generally candidates for more traditional root canal treatment or extraction. But outside of this situation, there are alternative pulp treatments to prolong the life of primary teeth so that they can perform their necessary functions until they are lost naturally. Another important factor to consider is the proximity of infected baby teeth to their permanent tooth successors. The treatment least likely to damage the permanent tooth should always be chosen. Infected permanent teeth in children may require special management due to problems associated with incomplete root development. Endodontists routinely treat these cases in children and should be included as part of the dental treatment team.

Roughly half of traumatized primary teeth develop transient or permanent discoloration. These colors vary from yellow to dark grey and usually become evident one to three weeks after trauma. Primary teeth with yellow discoloration frequently have radiographic signs of root canal calcification, bone-like deposits that can completely obscure the pulp. Injured primary teeth with dark gray discoloration are reported to have necrotic (dead) tissue in their pulps in 50-80% of cases. Almost all pediatric dentists and endodontists agree that completely knocked out (avulsed) primary front (incisor) teeth should not be replanted because of the possibility of danger to the underlying permanent tooth buds.

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.

 

Contact Us

Grace Dental Clinic, Resi. cum clinic, H.No 1298 Sector 31, Opp. Ajanta public School , Gurgaon

Opening Hours 10:00 AM to 9:00 PM,      +91124- 4832254, 9953076985

 

Grace Dental Clinic, Orthodontic and implant center 

Shop. no 167 Sector 4 Market, Behind ICICI Bank,  Gurgaon-122001

M +91-9953076985,  Drhimanshu@gurgaondentalcare.com

Opening Hours , 5:00PM to 9:00PM,  Sunday Evening Closed   نعمة عيادة الأسنان