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Getting root canal treatment for a young child can seem quite difficult and maybe even unnecessary. Here is everything you need to know about getting an RCT done for a child, why it's done, and what you can expect from it.

Root canal treatment can seem like a tough procedure to go through for adults, but what about children who have yet to get any one of their permanent teeth? Can they undergo root canal treatment and do they actually need to?

The answer to both these questions is yes. Children can and often actually do need root canal treatment in multiple teeth due to poor oral hygiene and habits that lead to rapid tooth decay [1]. Root canal treatment in children does differ a little from what is conventionally done in adults.

Root canal treatment in children

When we talk about RCT in children we mean their milk teeth (deciduous teeth), which will fall out at a certain age. If the child is old enough to have permanent teeth and needs root canal treatment in one of those teeth, then the procedure is absolutely the same as that followed in adults [2].

The most common reason for a child needing root canal treatment is decay. This could be due to not brushing at all, poor brushing technique, food habits that lead to the development of decay, or sleeping with a milk bottle in case of toddlers [3].

The protective layer of enamel is very thin in milk teeth and that is why decay can quickly progress to involve the nerve. Once that happens it can become very painful very quickly. It is also not at all uncommon for a child to need root canal treatment in multiple teeth at the same time [4].

How is root canal treatment done in children?

The most important thing for a dentist to be actually able to perform root canal treatment on a child is to have a cooperative patient. The dentist may have to spend some time explaining the procedure to the child in the simplest manner possible, use some behavior management techniques, and then proceeding in a manner that is slower than in adults [5].

The treatment has to be performed under local anesthesia in most cases. In a small number of cases, the tooth is already dead and so there is no need to administer anesthesia to the patient at all [6].

The steps followed are pretty similar to a root canal performed in a permanent tooth. Some amount of drilling is done in the tooth to gain access to the pulp (the area where the nerve endings are). A medicine to devitalize the pulp will be placed for a few days [7].

The second appointment involves cleaning of the inside of the tooth including the roots. The dentist may choose to fill the tooth and roots with a filling material at the same appointment or do that a separate time.

The filling material used for children is different than that used in adults. Since the milk teeth in children are going to fall out, the root canal filling material is such that is gets destroyed along the destruction of the milk tooth [8]. This ensures that nothing is left behind when the milk tooth falls out.

What is the success rate of root canal treatment in children?

The success rate of root canal treatment in children is pretty similar to that seen in adults, at least theoretically speaking [9]. In practice, dentists often find that re-infection in milk teeth can be more frequent than that seen in permanent teeth.

The reason behind this could be down to a difficulty in isolating the tooth during treatment, the likelihood of poor oral hygiene habits in children, and poor food habits which increase the amount of disease-causing micro-organisms in the mouth.

Is a crown needed after root canal treatment in children?

Yes. A crown is needed after root canal treatment in children to ensure that the final filling is protected and there is no food lodgment in the area. The kind of crowns placed on the milk tooth is also different from the adult teeth. As a general rule of thumb, caps are always needed after root canal treatment.

Stainless steel crowns are preferred for use in milk teeth. These are pre-fabricated crowns which are adapted to the tooth by the dentist in the clinic. Milk teeth that have been root canal treated have a much better chance of success if they are protected with a stainless steel crown afterward [10].

Why not just extract the milk tooth? It is going to fall out anyway.

This is one of the most common arguments that dentists hear when it comes to performing root canal treatment in children. Yes, performing an extraction is always an option but it should not be the first consideration. Milk teeth stay in the mouth until about the age of 10 to 12 in children. They perform important functions, like helping chew food and guiding the permanent teeth in the right direction.

Removing milk teeth can also lead to a loss of space in the jaw for the erupting permanent teeth increasing the chances of needing braces down the line. 

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