'Root Canal Treatment' For Children: What Is Pulp Therapy In Pediatric Dentistry? | Ear, Nose, Throat, and Dental problems articles | Body & Health Conditions center

What is pulp?

The pulp is the collection of blood vessels and nerves present at the center of every single tooth. It is responsible for keeping the tooth "alive" by providing nutrition and allowing it to respond to temperature changes.

What is pulp therapy?

Pulp therapy, as the name suggests, refers to the different therapeutic modalities available for the pulp. A number of different options are available to the treating dentist, and the final choice of treatment is dictated by the condition of the tooth, the age of the child, as well as the co-operation that a child provides during treatment. This last factor must not be discounted because there is not much that a dentist can do if the child refuses to open his or her mouth!

When does a child need pulp therapy?

Tooth decay begins as a small blackish discoloration in the outermost layer of the teeth, called the enamel. Once the bacteria causing the decay have made themselves comfortable, they will continue to burrow inwards towards the pulp. The dentin, which is the layer between the enamel and pulp, has some nerve endings and is significantly softer than the enamel.

Once tooth decay reaches the dentin, the patient starts to complain of sensitivity and occasional pain. Once the decay reaches the pulp, the nerve endings start to get irritated and inflamed. The result is pain which can be severe in nature.

The milk teeth have a slightly different anatomy to the permanent teeth. The milk teeth have a much thinner layer of enamel and dentin protecting the pulp, which is why the decay can reach the pulp very rapidly in children with milk teeth. Once tooth decay has reached the pulp, there is no option but to perform pulp therapy to try and save the tooth from extraction.

What are the different options available in pulp therapy for children?

Two main clinical options are available to dentists. One is called a pulpotomy and the other is called a pulpectomy. Both should result in a cessation of the pain that a child is suffering from after the initial appointment itself.

Pulpotomy involves drilling into the tooth until the pulp is reached, and then expanding the access to that region of the tooth. Once sufficient access is gained, a medication is placed into the pulp chamber to desensitize the nerve endings.

A pulpectomy is very similar to what a dentist has to perform during a root canal treatment in an adult. Access is gained to the pulp chamber with a drill and then rotary files are used to clean out the tooth until the root tip is reached. A root canal filling material is used to fill the tooth up to its roots after the symptoms have subsided.

In cases where the tooth has developed an infection, and pus and swelling are present around the tooth, pulpectomy is the only option to try and save the tooth.

Is pulp therapy for children painful?

Pulp therapy for children is not painful, but it can be a bit frightening for children. In most cases, they are already in pain and then must receive anesthesia for the treatment to be carried out. In some cases where the tooth is so badly infected that it dies, the dentist can start the pulp therapy procedure without the use of anesthesia.

Any pain or sensitivity felt by the child is most severe during the first appointment. Once sufficient access has been gained to the pulp chamber, the desensitizing medication ensures that further appointments are painless.

The entire procedure can take two to four appointments. Once again, how cooperative the child is during treatment makes a big difference to the number of appointments needed.

Are there any alternatives to pulp therapy?

The only real alternative to pulp therapy is extracting the tooth. This is possible in older children where the milk teeth are about to be replaced anyway. The successor permanent tooth can be seen clearly in X-rays and an informed decision can be made if it appears that the child is not going to allow multiple appointments to be carried out.

Can pulp therapy in children affect permanent teeth?

Not at all. This is a common misconception that parents worry about. Treating the milk tooth is limited to the length of the tooth itself. Nothing is going to be done beyond that, so the permanent tooth remains undisturbed.

The milk tooth is also filled with a root canal filling material that is completely removed from the body as the milk tooth is being shed. No chemical substance which could harm the permanent tooth is left behind. In fact, if the milk tooth is not treated, the infection can start spreading beyond the roots and actually come in contact with the developing permanent tooth — causing it some damage.

Conclusion

Pulp therapy is also referred to as root canal treatment for children, pulpectomy, or pulpotomy. All of these things refer to treatment modalities dealing with the pulp. Pulp therapy is performed very commonly in children around the world and has been studied extensively in scientific journals over a very long period. They have been found to be very successful in helping relieve symptoms of pain, swelling, and discomfort while saving the milk tooth until it is naturally shed by the body.

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