With the growing knowledge about the importance of deciduous teeth and emphasis on prevention and management of dental caries in primary teeth, pediatric endodontics has been gaining popularity. The primary objective of pulp therapy in children is to maintain integrity and health of oral tissues.
Goals of pulp therapy in primary teeth:
- To preserve the tooth without significantly compromising the function of the tooth.
- To allow a tooth to remain in the oral cavity in a disease free state
- To maintain arch length by preserving the tooth space
- To prevent the development of abnormal speech patterns and unhealthy oral habits
- To prevent any detrimental psychological effects on the child due to tooth loss
- To maintain child’s esthetics
When do milk teeth require pulp therapy?
Pulp therapy is advised when decay has advanced beyond its repair with a filling. If decay has reached pulp and irreversible pulpitis has set in, pulp therapy is initiated to save the tooth from being extracted. Pulp therapy in children is called pulplectomy. Pulpectomy is just like doing a root canal treatment in your permanent teeth. Pulpectomy can only be considered for primary teeth that have intact roots. Any evidence of root resorption is an indication for extraction. Severe infections or badly damaged teeth associated do not respond well to pulpectomy. Extraction is usually recommended in these cases. Clinical evaluation and radiographic investigations confirm the tooth decay and its level of advancement in the tooth and indicate the need for pulpectomy.
What are the signs and symptoms that indicate a pulpectomy?
Common signs and symptoms that indicate pulpectomy are as follows:
- Pain and swelling around the associated tooth and gums
- Pus discharge can be seen and child may have bad taste
- General malaise and fever
- Swollen or tender lymph nodes
- Discoloration of tooth
However it should be noted that advanced decay may present symptomless sometimes.
What is pulpectomy?
Pulpectomy is complete removal of pulp and infected material from the tooth. Pulpectomy of primary teeth is considered as the best treatment approach to ensure either normal shedding or a long-term survival in instances of retention.
The tooth to be treated is made numb by administering local anesthesia. Use of rubber dam is essential for proper isolation of tooth from contamination. It also helps in providing a clean, dry and sterilizable field. Next, access to the root canals is gained by drilling a hole in the tooth. To achieve optimal preparation, internal anatomy of particular tooth is to be carefully understood by the dentist.Complete removal of pulp is to be achieved through the access point.
Later, canal cleaning and shaping is carried out which is the most important phase of endodontic therapy. Cleaning is best achieved by chemico mechanical preparation which helps in thorough debridement of canals. Depending on the level of inflammation and infection, single visit or multi visit pulpectomy is advised. Once cleaning and shaping of canals is completed, root canals are filled.
The filling materials used for primary teeth root canals
- should be resorbable readily and at the same rate as the primary root
- should be harmless to the periapical tissues and to the underlying permanent tooth bud
- should have disinfecting property
- should be easily inserted into and removed from the canals
- should adhere to the walls
- should not shrink nor dissolve
- should be radiopaque
Most commonly used root canal filling materials in primary teeth are MTA, calcium hydroxide, zinc oxide eugenol paste etc.Guttapercha which is used in adult teeth is contra indicated in primary teeth as guttapercha is not a resorbable material. After the canals are properly obturated with no gross under extension or over extension, the tooth is restored with a stainless steel crown to provide structural integrity to the tooth structure.
With this the infectious process resolves and permits resorption of primary root surfaces and filling materials at the appropriate time to permit normal eruption of permanent teeth.
This procedure alleviates and prevents further pain and swelling.
AFTER CARE :
Child may feel mild discomfort after the procedure. Child should be advised not to chew hard on the treated side for a few days.
Pulpectomy treated tooth should be periodically checked to intercept any problem associated with the tooth. If evidence of any pathology after the treatment is observed, further treatment is performed like extraction and placement of space maintainer.
Occasionally pulpally treated tooth may pose a problem of over retention due to amount of cement used to fix the crown. In such cases, after the normal physiologic resorption of the root, simple removal of the crown is done by the dentist, thus making the permanent tooth to erupt in its own path.