Why have a root canal treatment on a baby tooth and not extract the tooth?

April 30, 2018


Why have a root canal treatment on a baby tooth and not extract the tooth?
Q: Should I remove the baby tooth or extract the tooth?
A: Always try to save the deciduous teeth to ensure that the adult teeth underneath will erupt in the proper position.
Root canal treatment or extraction - this is the question.

When your kid’s tooth is damaged, decayed or infected and the child complains of toothache, may it be pain upon mastication (chewing), dentin sensitivity (sharpshooting pain in response to hot or cold beverages), pain upon direct pressure applied or constant, throbbing pain, you bring your child to a dentist and expect a tooth extraction. That is what usually comes to your mind, without question, because you think that it is the only cure and that eventually it will be replaced with a permanent tooth. However, recent practices of pediatric dentists, aims to do as much as possible in order to avoid baby tooth extraction and try to save it through root canal therapy.

When the soft tissue (pulp) inside the root canal, providing the blood and nerve supply, is damaged through a decay or injury, an infection will progress leading to the development of abscess which collects pus and leads to inflammation and pain. If not treated and addressed properly, extensive damage and tooth loss will occur.

Root canal treatment also called endodontic treatment is a procedure performed by an endodontist - a dentist who specializes in endodontic therapy, aiming to relieve pain, repair and save infected teeth. The procedure is usually performed and completed in two appointments. During the first appointment, the endodontist will review your child’s medical history and co-existing systemic diseases, clinically examine your child’s tooth and will obtain an xray of your child’s tooth for a more precise visualization of the inside of the tooth and below the gumline. The dentist will determine the extent of the damage and the spread of infection. Then, a local anesthetic is administered to numb the tooth, a dental dam is placed as a sheet to isolate the tooth and prevent contamination, a small opening is created on the crown of the tooth to access to remove the diseased pulp, to drain the pus and abscess and to disinfect the root canal. The root canal is then filled with gutta-percha (a bio-compatible rubber-like root canal filling) for complete sealing. During the final visit, the tooth is checked if the infection has cleared, a crown is placed on the tooth and the tooth is assessed for restoration of full function.

Apparently, the most common notion most people have regarding root canal treatment is that it is a procedure performed to save infected adult permanent tooth and not baby teeth. Thus, this would lead us to question the reason why would there be a need to save the baby tooth and spend money on RCT. Some people say that the baby tooth will just fall off with time, even if it is a healthy one, and be replaced with adult permanent tooth.

It is true the root canal treatment is usually performed to save the infected permanent tooth.  It is recommended by dentists over baby tooth tooth extraction because the premature loss of baby tooth can distort the speech development of the kids and can interfere with the normal chewing and eating. Furthermore, when a baby tooth is extracted, the remaining baby teeth will try to shift unevenly and disproportionately which may cause crooked alignment, overlapping teeth, diastema (gap between central incisors), underbites and overbites. This misalignment will occur not only in the mixed dentition but in the permanent teeth as well. Shifted baby teeth will stop the normal eruption of the adult teeth underneath and will cause a delayed eruption in the wrong place of the dental arch. This will eventually affect the shape of your smile and the dental work you will need to carry out may be extensive and costly. 

If by any reason the baby tooth needs to be extracted then a space maintainer should be placed in the gap. This will assure that there is no movement, overeruption or shifting in the adjacent and oposing teeth. Permanent teeth that are underneath will be able to erupt on time and in the right position.

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