Endodontic Treatment in Children

Endodontic treatment involves the pulp of a tooth. The pulp contains the tooth's nerve. It also contains blood vessels that give the tooth oxygen and nutrients. When the pulp is injured or infected, endodontic treatment is often done to try to save the tooth. Your child may need endodontic treatment if he or she:

Feels pain in a tooth at any time, for no apparent reason
Has a tooth that is very sensitive to temperature changes
Has a broken tooth or one with a deep cavity that exposes pulp

Endodontic treatment can be done in adult (permanent) or baby (primary) teeth. Even though baby teeth eventually will fall out, your dentist will suggest fixing them unless they would normally fall out soon. Baby teeth are important for chewing and speaking. They also hold spaces for the permanent teeth that replace them. If your child loses a baby tooth too soon, neighboring teeth can move into the empty space. This could block the permanent tooth from coming in, or cause it to grow in tilted. There are two kinds of endodontic treatment done on baby teeth. With vital pulp therapy, the tooth's pulp is removed from the crown of the tooth, but not from the root. In non-vital pulp therapy, also called root canal treatment, the pulp is removed from both the crown and the root. If these methods don't work, the tooth will be taken out.

Vital Pulp Therapy for Primary (Baby) Teeth

For vital pulp therapy to work, there must not be any swelling or abscesses. Also, the tooth must not be loose.

There are four types of vital pulp therapy for baby teeth:

A protective base is used when there is decay in the tooth but the pulp is not directly affected. The decay is removed and a protective material is placed in the tooth before placing the filling.
An indirect pulp cap is used when the decay has come very close to the pulp but does not touch it. Most of the decay is removed. A protective dressing is placed over the decay that is close to the pulp. This prevents exposing the pulp. It also stimulates healing. A filling is then placed in the tooth.
A direct pulp cap is used when a small amount of pulp becomes exposed. This can happen during decay removal or because of an injury. Medicine is placed on the exposed pulp to protect it. Direct pulp caps do not work as well in baby teeth as they do in adult teeth.
A vital pulpotomyis done when the top part of the pulp is affected by decay or injured by trauma, but the root part is still healthy. The dentist removes the decay and the infected or injured pulp. The healthy pulp in the roots is left alone. The inside of the tooth is filled with a protective material. The tooth is covered with a stainless steel crown. A vital pulpotomy can be done in baby teeth. It also can be done in adult teeth that haven't finished growing a full-length root. In these adult teeth, vital pulpotomy is usually done as a temporary fix until the tooth has finished growing its root. Vital pulpotomy also might be done as the first step in a complete root canal treatment.

Non-Vital Pulp Therapy for Primary (Baby) Teeth

Non-vital pulp therapy is better known as root canal treatment. This is done when the pulp is too damaged to be saved. The dentist removes all of the pulp from inside the tooth. He or she cleans the inside of the tooth and fills it with a special material. The material will be absorbed when the body starts reabsorbing the root in preparation for the tooth to fall out. A stainless steel crown is placed on the tooth to protect it. If the tooth is in the front of the mouth, the stainless steel can be covered with a tooth-colored facing. Non-vital pulp therapy usually requires more than one visit.

Non-vital pulp therapy usually requires more than one visit.

Primary Teeth: Root Canal Treatment vs. Extraction

Your dentist will give you information so you can decide whether to have a primary tooth taken out, or to have root canal treatment done. This decision depends on:

Which tooth is affected?
When the tooth would naturally fall out?
The amount of damage to the tooth
Whether the problem has affected bone or gum tissue?

REVASCULARIZATION TREATMENT FOR IMMATURE PERMANENT TEETH

Permanent teeth that erupt into the mouth are immature and take several years to fully develop their roots. If the pulp dies or is dying in a recently erupted tooth because of a large cavity or trauma, a technique has been developed to try to make the pulp function again. It involves cleaning out and disinfecting the tooth and applying an antibiotic paste inside the tooth. The bottom of the root is then manipulated with a dental file to encourage a little blood flow and set up the beginning of pulpal revascularization. This technique helps the root to form properly, thereby enabling a stronger tooth.

After Endodontic Treatment

Your child may have some soreness after endodontic treatment. It can be managed with over-the-counter pain relievers for children.

Updated- November 20, 2020

References:

Cohenca N, Paranjpe A, Berg J. Vital pulp therapy. Dent Clin North Am. 2013 Jan;57(1):59-73. doi: 10.1016/j.cden.2012.09.004. Epub 2012 Oct 13. PMID: 23174610.
Cohenca N, Paranjpe A, Berg J. Vital pulp therapy. Dent Clin North Am. 2013 Jan;57(1):59-73. doi: 10.1016/j.cden.2012.09.004. Epub 2012 Oct 13. PMID: 23174610.
Ritwik P. A review of pulp therapy for primary and immature permanent teeth. J Calif Dent Assoc. 2013 Aug;41(8):585-95. PMID: 24073497.