The role of root canal treatment and the appropriateness of performing it on baby teeth.
Root canal treatment on baby teeth allows them to remain on the dental arch even if the dental pulp has been damaged.
Baby teeth consist of enamel, cementum, dentin and pulp.
The pulp contains nerves and blood vessels that supply the teeth with oxygen, minerals and nutrients.
When the integrity of the dental pulp is impaired or if it becomes infected root canal treatment is the solution of choice in such situations to keep these baby teeth on the dental arch.
Children can lose some baby teeth prematurely, even permanent teeth not yet erupted, if pulp disease is not treated in time.
Tooth conditions that can lead to this are dental trauma or deep decay.
These baby teeth, in addition to their masticatory, phonetic and aesthetic functions, also have the important role of preserving the space needed for the eruption of permanent teeth and guiding this eruption.
The alternative to endodontic treatment on baby teeth is tooth extraction.
From an aesthetic and functional point of view, root canal treatment on baby teeth is the optimal solution in case of dental pulp damage.
As a conservative solution, the functions of the jaw and tongue remain unchanged, chewing and speaking taking place naturally. Dental crowding is also avoided and the space of the permanent teeth is preserved until the natural age of eruption.
There are exceptional cases where one or more tooth buds are missing from the permanent dentition.
Keeping as many baby teeth as possible on the dental arch is crucial in such situations!
Although similar in shape, morphology and functionality to permanent teeth, baby teeth have certain particularities that determine a different approach to endodontic treatment.
Root resorption
Root resorption of baby teeth is the natural process by which the roots are dissolved and absorbed by the body, from near to near, as the permanent teeth erupt, so that the transition from the baby teeth to the permanent dentition occurs smoothly, without long periods of edentulousness.
Because of this phenomenon – root resorption – endodontic treatment on baby teeth is difficult and different from that on permanent teeth.
Inflammation of the dental pulp is often associated with dental pain. There are, however, exceptional situations where pulp necrosis can occur without a painful history.
When painful phenomena exist, the type of stimuli that cause them helps us to make a correct diagnosis.
Classification
The stimuli that can cause painful reactions are divided into:
– chemical (foods with an acidic pH – sweets, drinks, fruit)
– mechanical (pressing, in the bite, of antagonist teeth or food)
Causes
The painful response to one or more of the stimuli listed above helps us to differentiate between possible causes:
– the existence of deep caries
– cracking of a tooth
– incomplete or ill-fitting coronal fillings
– gum inflammation caused by the loss of one or more baby teeth or the eruption of a permanent tooth.
Treatment
Depending on the degree of damage to the dental pulp, the treatment chosen may vary between direct or indirect pulp capping, pulpotomy or pulpectomy.
Indirect pulp capping
Indirect pulp capping is the endodontic technique used in the treatment of deep caries, in which the removal of all the damaged tissue would expose the pulp chamber.
Instead of removing the entire caries tissue, a supporting layer is preserved for the application of calcium hydroxide. The aim of this technique is to stimulate neo dentinogenesis. (secondary dentin formation)
The effectiveness of this procedure is checked 3 months after the application of calcium hydroxide. If the process of neo dentinogenesis has gone as expected, the temporary filling is replaced by a permanent one.
If the remineralization of the remaining dentine and the degree of formation of the reaction dentine are unsatisfactory, the whole process is resumed by applying calcium hydroxide and the temporary filling for another 3 months.
Direct pulp capping
Direct capping is the endodontic technique of coating the dental pulp with calcium hydroxide.
The main feature of this technique is that the vitality of the dental pulp is fully preserved. Direct pulp capping is a conservative technique based on the principle of stimulating neo-dentinogenesis by stimulating it with calcium hydroxide. The treatment, on baby teeth, lasts 90 days.
The effectiveness of direct tooth capping is increased in the following situations:
– young and healthy patients (the best evolution is in developing teeth);
– pulpal exposure is small, aseptic, without bleeding;
– pulp vitality is good (shows sensitivity to stimuli)
Pulpotomy
Pulpotomy is the endodontic technique by which the coronal portion of the dental pulp is removed, preserving the vitality of the remaining pulp tissues.
In order to be carried out under optimal conditions, a number of conditions must be met:
– only the pulp of the dental crown is affected
– effective infection control (if present)
– effective sealing of the tooth after treatment.
The chances of success of this endodontic technique are estimated at 90%.
Pulpectomy
Pulpectomy is the endodontic technique in which the entire pulp tissue of the tooth is removed.
The steps to perform this procedure are:
– decontamination,
– chemical cleaning
– mechanical root canal treatment
– sealing of the root canal.
For root canal treatment on baby teeth, the sealing material must be resorbable so that the body can resorb the roots naturally, allowing the “full-term” loss of the baby tooth and eruption of the permanent one.
