Many parents are of the opinion that there are no nerves in baby teeth. However, this is not the case. This misconception arose for two reasons:
- A child’s front teeth usually fall out on their own and often without pain;
- they can be easily pulled out with a regular thread (in fact, this is due to the fact that when the molars erupt, they “push out” the weak roots of the milk teeth).
Milk teeth, like molars, have nerves that are part of the pulp.
This is a special connective tissue whose main function is to provide nutrition to the tooth. If it is removed, nutrients stop flowing and dentin formation stops. All this leads to faster tooth loss.
Therefore, the myth that there are no nerves in children's baby teeth is very harmful. It leads to the fact that parents do not monitor the condition of the baby’s oral cavity. Such negligence can cause the development of various disease processes and, as a result, the need for unpleasant and expensive treatment. To avoid this, your child should be taught proper nutrition and proper oral hygiene from childhood.
When is a child's dental nerve removed?
The main indication for removing a nerve in a child’s tooth is pulpitis.
The disease is characterized by inflammation of the pulp, in the tissues of which there are vessels and the nerve itself. Pulpitis is accompanied by severe pain, deterioration of general condition and weakened immunity. There are risks of inflammation spreading and complications developing. Nerve inflammation is a complication of deep caries. Microbes that penetrate the dentin gradually infect the pulp, resulting in pulpitis. If treatment is not carried out in a timely manner, the pathological process begins to progress, gradually spreading to the soft tissues, and then to the jaw bone.
Removal of the nerve of baby teeth is not carried out only if the child has already begun the process of changing teeth, and a permanent tooth is growing in the coming months. An x-ray is taken to determine the prognosis. For such indications, tooth extraction is performed, since there is no risk of bite displacement.
How are permanent teeth different from molars?
The most obvious difference is the number of teeth. A person has 28-30 molars, but only 20 primary teeth. There is a difference in the size of the crowns and even the roots of the teeth. According to dentists, baby teeth are smaller than molars. This is explained by the fact that children have a much smaller jaw than any adult. Consequently, it is not able to accommodate teeth the size of molars.
The thickness of dentin and enamel also differs significantly. In baby teeth they are much thinner. But if the dentin and enamel of primary teeth are inferior in thickness to molars, then in the case of pulp volume, it is the non-permanent teeth that take precedence. An interesting fact is that it is not necessary to visit a dentist to remove a baby tooth. But if we are talking about removing a molar incisor, you cannot do without the help of a qualified dentist. After all, this process takes much longer and is characterized by pronounced pain, increased body temperature, and slight bleeding from the gums.
What symptoms should you contact your dentist for?
Ideally, you should visit the dental clinic with your child every six months, and if signs of caries appear, treatment should begin immediately. But more often, parents turn to specialists when their child begins to suffer from severe toothache.
You should make an appointment with a dentist if your child exhibits the following symptoms:
- feeling of bursting and dull toothache;
- reduction of pain after eating hot food or during sleep;
- tooth sensitivity when eating;
- purulent odor from the mouth even after brushing your teeth;
- extensive carious cavity;
- other damage to the dental crown.
Pulpitis is characterized by rapid progression of the inflammatory process. If the nerve is removed at the initial stage, there will be no complications. In advanced cases, the pathological process can develop into a cystic or granulomatous form, or the infection begins to spread to the jaw bones or sinus tissue.
Is it worth treating baby teeth under anesthesia (sedation)
Despite the fact that many parents consider baby teeth to be fake (or, on the contrary, by nature more protected) and underestimate the problems that arise with them, it is still painful to treat baby teeth - just like molars. Therefore, it is important to contact pediatric dentistry, since the requirements for anesthetics for children are more stringent, and the necessary drugs may not be available in a regular “adult” clinic.
In many cases, treating baby teeth under anesthesia is not only possible, but also necessary. A distinction must be made between anesthesia and sedation. Sedation is the process of calming a small patient, relieving excessive agitation or fear before dental procedures. It is achieved with mild, safe means (for example, nitrous oxide) and is not accompanied by pain relief.
Anesthesia involves the patient falling asleep and dental treatment in his sleep. For children, the use of two drugs is allowed: sevoran, administered through a special mask, and propofol, administered intravenously. These are safe, well-tested products that are highly effective and do not affect the child’s nervous system.
Anesthesia is used in cases where it is difficult for the doctor to establish contact with the child, or there is a pathological fear of dental procedures. And also when a voluminous or complex intervention is expected: removal of several teeth, treatment of deep caries or pulpitis, etc. It is very difficult for a preschool child (or primary school student) to sit motionless in a chair for more than 20-30 minutes, and anesthesia will allow him to receive the necessary treatment in full, completely unnoticeably and painlessly.
Methods for depulpation of the dental nerve
The method of removing a nerve in a baby tooth is determined by the stage of pulpitis and the degree of tissue damage. Treatment may involve partial or complete depulpation. The decision on the method of performing the procedure is made by the attending physician.
At the Martinka Children's Dental Clinic, dental nerve removal for children is performed using two methods.
- Chemical. The dentist puts a drug into the tooth cavity that “kills” the nerve. The drug does not affect healthy tissue. While the paste is in effect, a temporary filling is placed on the tooth. After 1–5 days, the filling is removed, and the pulp and nerve are removed. The method is only available for complete depulpation.
- Instrumental. The child is given anesthesia to relieve pain. The tooth is opened and the pulp is removed completely or partially using special instruments. At the end of the procedure, a medicinal paste with anti-inflammatory and antiseptic action is placed into the tooth cavity. A temporary filling is installed. After a few days, the drug is removed and a permanent filling is installed instead of a temporary filling.
If the inflammatory process has started, then upon completion of treatment, the dentist may prescribe a course of antibacterial drugs. Taking painkillers is permissible only as prescribed by a doctor.
Anatomy of a primary tooth in a child
We are talking about a full-fledged bone formation, the nutrition of which is carried out through numerous microtubules - due to this relationship, hard tissues are strengthened. The structure looks like this:
- crown - the visible part covered with enamel,
- dentine,
- pulp chamber - pulp or neurovascular bundle,
- root system.
The photo shows the structure of the tooth
. The enamel covering temporary incisors and molars is much more fragile and thinner than in adults. Next comes the dentinal layer with a network of microtubules leading to the pulp - it is this that provides nutrition to all surrounding tissues. It is permeated with blood vessels and nerve endings, and its inflammation leads to severe piercing pain. It should also be recalled that children grow only 20 temporary elements: 8 incisors, 4 canines, 8 molars.
Does it hurt or not?
The sensitivity of teeth is provided by a nerve that is located in the pulp tissue. For this reason, both the pathology itself and the process of its elimination presuppose the presence of pain.
Dentistry has ample opportunities for painless treatment of pulpitis. Anesthesia is used for this. Modern drugs are safe and do not pose a risk to the child’s health.
Methods of dental anesthesia.
- Local anesthesia. An anesthetic is injected into the soft tissues, eliminating any sensation for a certain period of time. To ensure that the child does not feel the injection, topical anesthesia is additionally used.
- Sedation. The method is also called “medicated sleep.” Pain relief is achieved by placing the child under a mild general anesthesia. To administer the anesthetic, intravenous and inhalation methods are used. The duration of anesthesia is from 10 minutes to 2 hours.
When treating young children under 5 years of age, dentists give preference to medicated sleep. It is difficult for a child to simultaneously cope with fear and maintain a calm position, which can complicate the procedure and cause tissue injury. Sedation allows you to eliminate psychological trauma and any painful sensations, as well as make the dentist’s work easier and speed up the treatment process.
How to recognize the problem and is emergency treatment required?
Due to the reduced sensitivity of the pulp, pain during inflammation may be mild and not cause severe discomfort. In this case, the process of tissue destruction occurs rapidly. It is important to visit the dentist regularly and not ignore your child’s complaints of pain when chewing or when eating cold and hot foods.
Treatment for pulpitis should be immediate. The disease is dangerous due to complications - periodontitis or periostitis. It can also spread to a permanent tooth that has not yet erupted and destroy it.
Consequences of nerve removal
In the first 1–2 days after treatment, the tooth may hurt, but the intensity of the pain gradually decreases. To alleviate the condition, you can take analgesics recommended by a specialist. There are no other consequences of nerve removal.
Since pulpitis is most often caused by caries, during the treatment process the dentist removes the affected crown tissue. Restoring the integrity of the tooth is performed after removing the temporary filling. For correction, a filling material that does not contain toxic substances is used. In some cases, when the area of the carious cavity is too large and there is a risk of the filling falling out, it is recommended to install prostheses (stump or artificial crown.
Many parents mistakenly believe that depulpation implies the absence of a nerve in a permanent tooth. However, this is not at all true. Temporary and permanent teeth have separate systems and tissues that are not interconnected.
Martinka Children's and Adolescent Dentistry treats pulpitis by removing the nerve. Timely and correctly performed removal of the nerve of a baby tooth has no consequences. The integrity of the tooth is restored, and its functionality is preserved.
My baby is teething - how can I help him?
The child's profuse salivation will tell you that the first tooth is on the way. 1-2 months before the first tooth erupts, the baby’s saliva begins to flow so actively that it is already difficult to do without aprons and bibs.
All your older relatives will probably tell you about the unpleasant side effects of teething. However, there are many misconceptions here.
The very first teeth usually come out painlessly. What most often happens is this: while spoon-feeding a child, the mother hears the sound of metal on the edge of a tooth - that is, she detects an event that has already happened, without even noticing anything unusual in the child’s behavior.
The emergence of canines and molars may be more difficult. The baby may be capricious, refuse to eat, sleep poorly, and put everything in his mouth. You should take care of inflamed gums - regularly treat them with special gels, offer your child to chew a cooling ring (cold relieves pain well).
However, do not believe that an increase in temperature is associated with teething. Fever and catarrhal symptoms are caused by an infection that is “caught” by the child’s body, weakened by malnutrition and lack of sleep. That is why, during the period of teething, it is better to protect the baby from communicating with strangers. Digestive disorders, an upset stomach of a child at the time of teething, is associated with his desire to chew and suck everything he can reach, just to relieve discomfort in the gums. This is how pathogenic microbes enter his mouth. Try to surround your child with clean objects, wash his hands and toys more often. Regularly let your baby chew small pieces of solid food - dried bread, bagel, apple slice, etc. This will help the teething of those teeth that are already “on the way”, improve blood supply, and therefore nutrition of the gums, develop the chewing reflex, and help the formation of the speech apparatus.
