Many adults have had root canal treamtent before. But do you know children can also have similar treatments for their deciduous teeth?
One of the goals of endodontics is keeping the dentition in a physiologically functional state for the maintenance of good oral and systemic health. Trauma to the developing dentition, when it results in pulp necrosis and incomplete root formation, can lead to a premature loss of permanent or deciduous teeth, which may compromise the dentition and future eruption. Root canal treatment in children is conducted for some reasons most commonly as a result of trauma or dental caries. The quality of
root canal treatment has been linked to maintaining the periapical health of endodontically treated teeth.
When there is trauma or dental decay on the baby teeth it is possible to have a filling done which is a straightforward and direct procedure. Other times, when the cavity is extensive, the dentist might opt for root canal treatment procedure, such as pulpotomy.
The aim of pulpotomy is to remove coronal pulp which has been irreversibly inflamed, leaving behind possibly healthy or reversibly inflamed radicular pulp.
There are a few indications where pulpotomy is deemed a good treatment option for saving the deciduous tooth i.e. when there is caries close to the pulp. Also, if there is no radicular pulp involvement, no history of spontaneous pain and hemorrhage easily controlled during the procedure. Pulpotomy should be carried out when there is no abscess or fistula present. In order to have a high success rate, the tooth needs to have more than 1/2 root length remaining and be without any iatrogenic pulp exposure. Materials of choice for placement within the pulp include Formocresol, Ferric Sulphate (15.5%), Corticosteroids, Glutaraldehyde, MTA, BMP, Ledermix, and Paraformaldehyde. Those materials are used to devitalise the pulp tissues or to regenerate new tissues so the tooth can remain functional within the oral cavity.
It is crucial to have the tooth remaining until the permanent dentition starts to erupt. Deciduous teeth serve the function as a
space retainers within the dental arch. When the bleeding from the root canal is extensive and cannot be stopped within 4 minutes, a pulpectomy is indicated. This procedure removes irreversibly inflamed or necrotic radicular pulp tissue from the root canal system. The dental practitioner will obturate root canals with a filling that will resorb with the same rate as the baby tooth and can be eliminated rapidly if accidently extruded through the apex. This procedure is not standard and can only be carried out when the tooth is diagnosed as irreversible pulpitis, or there is profused hemorrhage following pulpotomy.
The materials used to obturate the canal after cleaning it include CaOH with Iodoform (Vitapex), Iodoform, Camphor, Menthol and Parachlorophenol (KriPaste). These materials have properties that can ensure elimination of bacteria from the canal system, creation of a scaffold for the ingrowth of new tissue and prevent reinfection by creating a bacteria-tight seal.
Depending on severity and experience of the dentist, the endodontic procedure can take only a single visit to the dental office, while others may require two or more visits. One of the main differences between endodontic treatments in children compared to adults is the presence of immature roots. Loss of vitality is a common sequela of dental trauma and can result in arrested root development if this occurs before maturation.
Regenerative endodontic procedures hold the promise of restoring the pulp/dentin complex in teeth with immature roots and necrotic pulps. Still, guardians of the child patient have to understand the situation and be notified about the procedure to avoid any misunderstanding. The rapidly evolving field of regenerative endodontics will undoubtedly reshape the way practitioners approach in root canal treatment in kids.