Many adults have had root canal treamtent before. But do you know children can also have similar treatments for their deciduous teeth?
One of the goals of endodontics is keeping the dentition in a physiologically functional state for the maintenance of oral and systemic health. Trauma to the developing dentition, when it results in pulp necrosis and incomplete root formation, can lead to a premature loss of permanent or deciduous teeth, which may compromise the dentition.
Root canal treatment is conducted in children for some reasons most commonly as a result of trauma or, less often, dental caries. The quality of root canal treatment has been linked to the success, and periapical health of endodontic ally treated teeth on several occasions.
Other times, when the cavity is extensive, the dentist might opt for root canal treatment procedures, such as pulpotomy. The aim of pulpotomy is to remove coronal pulp which has been irreversibly inflamed, leaving behind possibly healthy or reversibly inflamed radicular pulp.
There are a few indications where pulpotomy is deemed a good treatment option to save the deciduous tooth. When there is caries close to the pulp. Where there is no radicular pulp involvement, no history of spontaneous pain and hemorrhage easily controlled during the procedure. Only carry out pulpotomy when there is no abscess or fistula present.
For this treatment to have a high success rate, the tooth needs to have more than 1/2 root length remaining and without any iatrogenic pulp exposure.
Materials of choice for placement within the pulp include Formocresol, Ferric Sulphate (15.5%), Corticosteroids, Glutaraldehyde, MTA, BMP, Ledermix, and Paraformaldehyde. Those materials are used to devitalise the pulp tissues or to regenerate new tissues so that the tooth can remain functional within the oral cavity. It is crucial to have the tooth remain until the permanent dentition starts to erupt. As we know, deciduous tooth serves the function as a space retainer within the dental arch.
When the bleeding from the root canal is extensive and cannot be stopped within 4 minutes, Pulpectomy is done. This procedure removes irreversibly inflamed or necrotic radicular pulp tissue and gently clean root canal system.
The dental practitioner will obturate root canals with a filling that will resorb the same rate as tooth and eliminated rapidly if accidently extruded the apex. This procedure is not standard and only carried out when the tooth is diagnosed as irreversible pulpitis, or there is a profused hemorrhage following pulpotomy.
The materials used to obturate the canal after cleaning it include CaOH with Iodoform (Vitapex), Iodoform, Camphor, Menthol & Parachlorophenol (KriPaste). These materials have properties that can ensure elimination of bacteria from the canal system, creation of a scaffold for the ingrowth of new tissue and prevent reinfection by creating a bacteria-tight seal.
Depending on severity and experience of the dentist, some can take only a single visit to the dental office to have the procedure completed, while some cases may require 2 visits.
One of the main differences between endodontic treatments in children compared to adults is the prevalence of immature roots. Loss of vitality is a common sequela of dental trauma and can result in arrested root development if this occurs before maturation.
Regenerative endodontic procedures hold the promise of restoring the pulp/dentin complex in teeth with immature roots and necrotic pulps. Still, guardians of the child patient have to understand the situation and be notified about the procedure to avoid any misunderstanding. The rapidly evolving field of regenerative endodontics will undoubtedly reshape the way practitioners approach in root canal treatment in kids.