Endodontics in Children: What You Need to Know
The presence of a large cavity in a tooth element may require endodontics in children. Many parents are frightened when their pediatric dentist talks about the need for this type of treatment. In this article, we’ll tell you what it is, when it’s necessary, and the different variants depending on the characteristics of the clinical case.
Children’s teeth
In childhood, there are two types of dentition: The temporary or baby teeth and the definitive adult teeth. The characteristics of the dental structures according to the type of tooth and the age of the child make the interventions to be performed vary.
Baby teeth are characterized by having a much larger pulp chamber than adult teeth. For this reason, the soft tissue, where blood vessels and nerves are housed, tends to be affected more quickly in children.
Young permanent teeth also have a greater proportion of pulp. In addition, although they’re already in the mouth, their roots are still forming and finish doing so almost 3 years after eruption.
When is endodontics in children necessary?
Endodontics is the name given to treatments that are performed in the innermost part of the teeth. That is, in the area where the dental pulp is located. This therapy seeks to solve deep conditions of the elements in order to keep them in the mouth.
So, endodontics in children will be indicated to solve inflammation, necrosis, or infection in the pulp of the tooth. This damage usually occurs as a result of very deep and advanced cavities, but can also be caused by dental trauma.
The presence of certain characteristic symptoms are those that indicate the need for treatment in the pulp:
- Sensitivity or pain: This can have different intensities, be constant or occasional, generated spontaneously or with stimuli such as sweets, cold, heat, or biting.
- The presence of a broken or fractured tooth or a large gap caused by cavities.
- The presence of a fistula mouth in the gum or pus in the tooth.
- Swelling of the face, neck, or gums.
Is endodontics necessary when it comes to baby teeth?
Many parents wonder if it’s really necessary to perform endodontics in children, especially when it’s done on a baby tooth. The truth is that there are good reasons to try to keep temporary teeth in the mouth until they can fall out on their own when the time comes. The presence of temporary teeth allows children to develop oral functions such as eating, speaking, and smiling normally. In addition, baby teeth hold the place for and guide the eruption of the definitive elements, which prevents future malocclusions.
Types of endodontics in children
When performing endodontics in children, the pediatric dentist will take into account certain factors to choose the type of intervention to be performed according to the following characteristics:
- The type of tooth affected: Whether it’s a baby tooth or a permanent tooth
- The degree of root formation in permanent teeth
- The time the tooth has left in the mouth
- The severity and type of injury
- The extent of the damage: Whether the problem has affected the bone or the gum
- If the child has medical problems
- The child’s cooperation
Pulp protection
Although this type of intervention isn’t endodontics per se, it’s a therapeutic treatment that’s performed on the pulp tissue. It’s performed in those cases in which the chamber has been slightly exposed when cleaning the tooth or by trauma. Also, when a cavity is very deep but hasn’t managed to damage the nerve or produce symptoms.
When cleaning the teeth, all the affected hard tissue is removed. Special materials that protect the pulp are placed on the teeth before the filling is made. These help the inside of the tooth not to suffer consequences due to the loss of tissues or temperature changes. Then, the rest of the cavity is filled with a filling.
Pulpotomy
Pulpotomy is a type of endodontics that’s performed on children’s baby teeth when the pulp condition is greater. In these cases, the nerve is still alive. The damage is to its most superficial portion and the area of the root remains healthy.
The therapy consists of removing the portion of the pulp that’s in the crown of the tooth without touching the tissue found in the canals. The inside of the canal portion is filled with a protective material and then the tooth is filled with a filling or a stainless steel crown. Because the tooth is alive, local anesthesia is necessary to perform the procedure without pain for the child.
Pulpectomy
A pulpectomy is the removal of all the pulp tissue of the baby teeth, both the coronary and root portion. It’s performed in cases where the entire pulp has been affected.
The dead tissue is removed, and the inside of the tooth is cleaned and then filled with a special paste. The material to be used has the particularity of sealing the canals and avoiding the proliferation of bacteria. The rest of the tooth element is restored with a filling or a stainless steel crown.
Apexogenesis
Apexogenesis is another variant of endodontics in children for cases of permanent teeth that haven’t yet completed the formation of their roots. It’s performed to promote apex closure by sealing the canals and ensuring proper tooth development.
When the pulp of young permanent teeth is affected by trauma or cavities, it’s important to promote apexogenesis. For this, a special material is placed inside the tooth that’s changed and added every so often.
If the damaged permanent tooth has already completed root formation and apex closure, its treatment is performed as a conventional root canal. The dentist will then reconstruct the tooth with fillings or crowns.
Preparing your child for a root canal treatment
As you’ve seen, a root canal treatment in children is a much simpler and faster procedure than in adults. However, it may require the need for x-rays, anesthesia, and a long period of time with the mouth open. Therefore, it’s good to prepare the child for the intervention to avoid fears or unpleasant moments.
Subsequent controls and definitive restoration will also be necessary. So, after the root canal, it’s very important to comply with the indications and return to the dentist to make sure that everything’s going well.
All cited sources were thoroughly reviewed by our team to ensure their quality, reliability, currency, and validity. The bibliography of this article was considered reliable and of academic or scientific accuracy.
- Vivar Alarcon, J. M. (2019). Pulpotomia reporte de un caso clínico.
- Centeno, J. E. O., & Hernández, D. G. (2020). Pulpotomia o Pulpectomia: Éxito clínico y radiográfico en dientes temporales. Revista de Salud Pública, 24(3), 8-17.
- Oliveira-del Rio, J. A., Mendoza-Castro, A. M., & Alvarado-Solórzano, A. M. (2017). Endodoncia en dientes temporales. Pulpotomía. Polo del Conocimiento, 2(6), 1288-1297.
- Guerrero Montes, H. R. (2019). Pulpotomia de dientes temporarios con formocresol (Bachelor’s thesis, Universidad de Guayaquil. Facultad Piloto de Odontología).
- Sarango Sarango, S. A. (2019). Apicoformación con Hidróxido de calcio (Bachelor’s thesis, Universidad de Guayaquil. Facultad Piloto de Odontología).
- Muñiz López, K. I. (2021). Protectores pulpares directos e indirectos (Bachelor’s thesis, Universidad de Guayaquil. Facultad Piloto de Odontología).
- Troilo, L., Kohan, M., Chinen, M., & Santángelo, G. V. (2020). Nuevas tendencias en técnicas de apicoformación utilizando biomateriales. In IV Jornadas de Actualización en Prácticas Odontológicas Integradas PPS-SEPOI (La Plata, 7 de julio de 2020).de la Cruz Navarro, S. P. (2017). Manejo de terapia pulpar, pulpotomía, pulpectomía, apicoformación.
- Caigua, K. L. L., Robles, B. A. S., Eras, S. P. G., & Carrión, D. I. G. (2020). Apicoformación en dientes necróticos. RECIMUNDO, 4(4), 134-143.
- de la Cruz Navarro, S. P. (2017). Manejo de terapia pulpar, pulpotomía, pulpectomía, apicoformación.
- Giani, A., & Cedrés, C. (2017). Avances en protección pulpar directa con materiales bioactivos. Actas Odontológicas, 14(1), 4-13.
