What is pulpotomy?

During a pulpotomy the infected part of the nerve is removed while the remaining healthy nerve is left behind. A sedative medication is placed inside the tooth to prevent sensitivity and to promote healing. A cap is then placed on the tooth.

What is pulpectomy? (Root Canal Treatment)

A pulpectomy is carried out by the total removal of the nerve, of the infected/ abscessed tooth. A cap is then placed on the tooth.

Why does my little child need pulp therapy/ root canal treatment? Isn’t it a treatment for adults?

When tooth decay (cavity) isn’t treated on time, it gets deeper and the infection reaches the nerve (pulp tissue). Sometimes the tooth may be asymptomatic (have no complaints) initially. The child will eventually have episodes of pain (often severe) and swelling.

Once the cavity affects the nerve, the tooth can either be saved with root canal treatment or needs to be extracted. Since milk teeth require to function in the mouth for many years, saving them with root canal treatment is always the treatment of choice. Sometimes the degree of infection is severe and condition of the tooth really bad. We may then need to extract the tooth and place a space maintainer.

What will the procedure involve?

All teeth requiring root canal treatment will need to be numbed first with a local anaesthetic. The infected pulp tissue (nerve) along with bacteria is then removed. The canals within the roots are treated with a disinfectant and filled with a medicated paste. The tooth is then restored with a filling and a stainless steel crown.

Will root canal treatment in milk teeth affect the permanent teeth?

Infection around the roots of the milk tooth can irritate the developing permanent tooth. Therefore treating an infected milk tooth will affect the permanent tooth positively, if at all!

There is no connection between the nerve (pulp tissue) of the milk tooth and that of the permanent tooth. They are separate entities.

Will the treatment be painful?

Your child will receive local anaesthesia in the tooth to be treated. This will numb the tooth and make treatment pain free.

Is a cap necessary after root canal treatment?

Teeth requiring root canal treatment, most often have very large cavities. This makes these teeth prone to fracture after treatment. The chances of the large filling chipping post treatment are also high.

To ensure success of treatment, we always insist on a stainless steel crown on all milk teeth that receive pulp therapy.

Will the tooth fall naturally?

Yes. Teeth treated with pulpotomy/ root canal treatment usually shed naturally along with their cap. Rarely may they need to be extracted, years later, when the permanent is ready to erupt.  

 FACT 1

Children have 20 milk teeth. These start to appear any time between the age of 6 months to a year. They continue to erupt until the child is around 3 to 4 years of age.

FACT 2

Milk teeth shed (fall) when the permanent teeth below them are ready to erupt. Only the lower two front teeth fall at approximately 6yrs of age. Every year thereafter, the child will lose roughly two to four milk teeth. The milk molars shed between 10 and 13 years.

FACT 3

The first dental visit should coincide with the eruption of the first milk tooth or latest by the child’s first birthday. You can then be counselled on appropriate oral hygiene measures and infant feeding habits. This can go a long way in preventing severe early childhood caries.

FACT 4

Babies often experience sore gums, increased drooling, loss of appetite and disturbed sleep when they cut their milk teeth. They may become cranky and want to chew on a toy or their fingers to get relief. Chewing on unclean objects/ fingers may lead to diarrhoea, fever. This is not caused by teething and you must contact your paediatrician if the child is unwell.

FACT 5

The sooner you start cleaning your baby’s teeth, the better! From birth until one year of age, wipe the gum pads and teeth with a clean damp cloth. Introduce a soft baby brush by one year.

FACT 6

Paediatric fluoride toothpaste (500 ppm) could be started by two years. Switch over to fluoridated toothpaste containing 1000 ppm of fluoride once your child learns to spit and gargle, and accepts the taste. These recommendations hold good when non-fluoridated water is consumed. Most parts of the country do not have natural fluoride in the drinking water. The municipal water supply in India is also not fluoridated. If you live anywhere in the areas which have fluoride in the drinking water, introduce a fluoride toothpaste at 6 years of age.

FACT 7

When the baby falls asleep whilst feeding, the last mouthful of milk (breast & bottle) is not swallowed. This milk pools around the teeth and causes decay. The upper front teeth and molars are the ones to be affected the most.

FACT 8

A twice-a-year check-up is recommended for most children. Regular dental visits help your child stay cavity free. Some children need more frequent dental visits because of increased risk of tooth decay, unusual growth patterns or poor oral hygiene.

With our changing lifestyle and food habits, dental cavities in kids are very common now. Absenteeism from school due to toothache is also rising. This is the first post in a series about Preventing Dental decay in children written by our expert Dr Meenakshi Kher, a renowned pediatric dentist practicing in Mumbai.

How do cavities occur?

The mouth harbors naturally occurring bacteria. Some of these are cavity forming. When a child eats foods containing fermentable carbohydrates (sugar and starch), these bacteria convert the carbohydrates into acids. The acids dissolve the enamel surface of the tooth to create holes (cavities) in them.

How can further tooth decay be prevented?

Every child’s preventive dental needs would vary depending on the family’s dietary habits, oral hygiene habits, tendency to develop cavities etc. The dentist has to work with the parents to devise a customized preventive dental programme for their child consisting of a good oral hygiene regimen, fluoride gel or varnish applications, pit & fissure sealants, dietary modifications and regular dental visits.

How soon should I start cleaning my baby’s teeth?

The sooner you start the better! From birth until one year of age, wipe the gum pads and teeth with a clean damp cloth. Introduce a soft baby brush by one year. This can be used with a pea sized amount of non-fluoridated tooth paste. By two years of age, a pediatric fluoride tooth paste (500 ppm) could be started. Switch over to a fluoridated toothpaste containing 1000 ppm of fluoride once the child learns to spit, gargle and accepts the taste. (The municipal water supply in India is not fluoridated. These recommendations hold good when non fluoridated water is consumed. This is true in most parts of the country.)

Can my child brush his/ her own teeth?

Small children do not have the dexterity (motor skills) to brush their teeth effectively. It is recommended that a parent or care giver brush a child’s teeth, until the child is at least 6 years of age. In older children, brushing must be supervised. Encourage your child to brush after meals and snacking. Teach older children flossing. Tongue cleaning with tooth brush or tongue cleaner is also a must.

What foods cause cavities?

Your child must have a balanced diet for his/her teeth to grow properly and for healthy gums around teeth. A diet high in refined carbohydrates will place your child at a risk of tooth decay. Starches include breads, biscuits, chips, pasta and other such food. And remember that sugar is not limited to sweets and chocolates. A variety of foods contain ‘hidden sugars’ and these could cause tooth decay too.

How often should I take my child to the dentist? Why visit the dentist twice a year when my child has never had a cavity?

A bi-annual (or twice-a-year) dental check up is recommended for children. Some children may need more frequent dental visits because of increased risk of tooth decay, unusual growth patterns or poor oral hygiene. 

Regular checkups can detect a cavity early (long before your child complains of pain and needs extensive treatment). Periodical professional teeth cleaning remove debris that build up on the teeth, irritate the gums and cause decay. Fluoride treatments renew the fluoride content in the enamel, strengthening teeth and preventing cavities. Hygiene instructions improve your child’s brushing and flossing, leading to cleaner teeth and healthier gums.

Your child may need additional fluoride, dietary changes, or sealants for ideal dental health. Orthodontic problems can be identified and timely treatment suggested.

The following tips will help your child be part of the cavity-free generation:

1. Beware of frequent snacking
2. Brush effectively twice a day (preferably after every meal) with a fluoride toothpaste
3. Floss once a day
4. Have sealants applied when appropriate
5. Seek regular dental check-ups
6. Assure proper fluoride through regular use of fluoride products and fluoride gels and varnishes