Treatment of pulpitis of primary teeth in children: stages of treatment, prevention

Untimely treatment of caries in children leads to the development of pulpitis - inflammation of tooth tissue, including blood vessels and nerve bundles. The lower molars are most often affected, but the disease occurs even on the anterior elements. Therefore, pulpitis in children occurs even more often than in adults. This is due to a number of factors:

thin weak enamel;
large volume of pulp;
wide root canals;
less mineralization;
weak immunity.

In addition to caries, pulpitis can be caused by trauma, including poor treatment.

Symptoms

Inflammation occurs in acute and chronic forms. Acute occurs less frequently, but has more severe symptoms and occurs in two stages:

serous. The inflamed pulp is filled with serous fluid. There are complaints of severe pain in the tooth, intensifying at night and when chewing. The pain, as a rule, is intermittent, appears once and subsides. Most often, the process occurs in teeth with unformed or absorbable roots. After 5–6 hours, a transition to another stage occurs;
purulent. Pus forms in the tissues, which begins to melt cells and tissues. The severity of the condition is influenced by immunity, dental condition, and bacterial activity. If the pus has an outlet in the form of a carious cavity or fistula, then the pain is mild. In the absence of outflow, the pain syndrome is bright and long-lasting, intensifying when chewing or eating cold or hot food. The general condition may worsen and fever may appear.

Chronic pulpitis occurs after acute pulpitis or on its own and is characterized by vague symptoms. Pain can only occur under unfavorable factors - cold or hot, too sweet food. The child begins to chew on one side, an unpleasant odor appears, and a bursting and pressing sensation occurs.

The danger of this form is that it is almost asymptomatic. Because of this, inflammation affects more and more tissues. Chronic pulpitis is of three types:

fibrous. The lightest and most common form. Fibrous tissue grows, the pulp may bleed, and episodic pain appears from mechanical and thermal contact;
hypertrophic. Develops with severe destruction of the tooth crown. Pathological growth of pulp tissue occurs, which fills the carious cavity;
gangrenous. The most severe form, accompanied by pulp necrosis. The tooth becomes gray and bad breath appears due to tissue decomposition.

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What are measles canals?

Despite their size, teeth have a rather complex structure. They consist of a visible part - the crown, which rises above the gum, and an internal part - the root, which is located in the gum. In this case, inside the tooth there is a so-called pulp - a bundle of blood vessels and nerves that fills the root canal of the tooth. Thus, the root canals of teeth are a small cavity inside the tooth in which venous and arterial vessels and nerve fibers are located. Root canal treatment is precisely the treatment of the internal cavities of teeth, most often the area occupied by nerve endings, or pulp.

Why treat dental root canals?

Diseases such as caries, pulpitis and periodontitis can lead to root canal diseases. Typically, when treating such dental diseases, a cavity is formed in the root canals. Any open cavity in the teeth can lead to serious consequences. This is primarily due to the fact that food particles can get into the voids, which will begin to rot over time. With rotting, microbes are formed, and after them, infections. Infections, in turn, lead to serious inflammation, which must be eliminated again so that they do not cause abscesses. The resulting cavity must be closed with filling substances.

How are dental root canals treated?

Root canal treatment involves removing the nerve bundle from the pulp chamber and further filling the canal.
The procedure seems simple, but there are some peculiarities. Immediately before treatment, anesthesia is necessary, as the procedure can be quite painful. After the anesthesia has taken effect, it is necessary to get to the pulp chamber, for which the tooth is drilled with a drill.

When the pulp chamber has become accessible with a special tool - a pulp extractor - the bundle of nerve endings is removed, freeing the cavity from the inflamed pulp. It would seem that immediately after this you can fill it.

However, the resulting cavity is so thin that it is technically impossible to fill it. To do this, it is increased in size using special tools of different diameters, resembling small files.

After increasing the size of the root canal cavity, they must be treated with anesthetics to prevent infection, and filled with a special material - gutta-percha.

In some cases, after filling with gutta-percha, pins are installed into the root canal cavity for more reliable fixation of subsequently installed crowns.

Recommendations after the procedure

For some time after the root canal treatment procedure, pain may occur, most often associated with mechanical impact on the tooth - for example, during eating.
This is quite normal. The effect of anesthesia ends, the body begins to respond to artificial intervention. To avoid discomfort, you can take painkillers of varying strengths depending on the severity of the pain. If there is swelling after the procedure, you can apply ice to the outside of the cheek on the side of the treated tooth.

If the pain does not go away within several days or, even worse, intensifies, you should immediately consult a doctor to avoid even greater complications.

Tomsk dentistry Dentarus employs experienced therapists who carry out similar procedures every day. By contacting them, you will receive a careful approach and effective treatment at an affordable price. Do not delay going to the doctor, as it is always easier and cheaper to treat in the initial stages. Sign up for a free examination with a doctor right now.

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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.

Treatment methods

The treatment of primary teeth in general does not differ from the treatment of permanent elements. If the child’s condition is serious, there is a threat of infection spreading throughout the body, amputation is performed. In most cases, the tooth is preserved to prevent malocclusion. Therapy is carried out in different ways:

traditional. Involves treatment in three visits. During the first one, the nerve is opened, a devitalizing paste with arsenic is applied for 24-48 hours or without it for a period of up to 7 days. On the second visit, a pulp mummification mixture based on resorcinol-formalin is placed into the canals. At the last visit, a permanent filling is installed;
modern. It takes place in 1 – 2 visits. If the child can sit quietly for a long time at the doctor and the roots of the tooth are formed, extraction is performed. The nerve is removed either on the first visit or after applying the paste. Next, the canals are carefully processed, infected tissue is removed, an anti-inflammatory paste (for example, zinc eugenol) is applied and closed with a filling. The composition will gradually dissolve along with the roots when changing teeth;
partial vital amputation. The doctor removes the upper portion of the nerve and applies an antiseptic and anti-inflammatory medication that seals the remaining living pulp.

When treating teeth with immature roots, a different approach is chosen. This is due to several reasons:

the apex of the roots has not yet closed and there is a risk of infection of the permanent tooth germ;
the roots are short and the channels are wide;
trauma to the upper zone of the root can lead to disturbances in its formation;
It is impossible to remove the entire pulp and perform a complete canal treatment.

Most often, they choose amputation of the pulp by any method or biological treatment, when the tooth is cleaned of the affected tissue and a paste with calcium hydroxide is applied for several days. After this, a filling is installed.

Features of canal treatment for primary teeth with formed roots

When treating a baby tooth with formed roots, good cleaning of the root canal system leads to a normal result, preserving the baby tooth from reactivation of infection until physiological change. After cleaning, the root canals of baby teeth are filled with a special paste, which will be absorbed as the roots of primary teeth are absorbed . It is this type of root canal filling that does not prevent the eruption of permanent teeth. After root canal treatment, the tooth is closed with a filling, and in some cases with a crown, since the tooth with the “nerve” removed becomes more and more fragile over the years and prone to chipping of the walls that support the filling.

Is it possible not to treat pulpitis if the teeth are baby?

There is a common opinion that it is not necessary to treat baby teeth, because they will soon fall out. This is the biggest mistake parents make. Untreated pulpitis leads to irreparable consequences and even affects permanent teeth:

purulent abscess, periodontitis, life-threatening condition;
deep infection affecting the germ of a permanent tooth;
malocclusion due to early tooth extraction due to untimely treatment;
pain interferes with normal chewing of food, uneven load on the teeth leads to accelerated destruction of other elements.

Are there nerves in baby teeth?

The structure of baby teeth is similar to the structure of permanent teeth:

The outside of the tooth is covered with one of the hardest tissues of the body - enamel. The tooth is additionally covered with a cuticle - a membrane that wears off when chewing food;
There is bone tissue under the tooth. It is the basis of the tooth and is located around the root of the tooth;
the canal and crown are filled with pulp, in which numerous capillaries and nerve endings are intertwined. Milk and molar teeth begin to form in the child, who is still in the womb of the mother. Medical research has proven that these teeth already have roots and nerves.

By the time a child’s first teeth begin to erupt, their roots have already dissolved. Milk teeth are destroyed under the influence of acids found in food, pathogenic microorganisms and mechanical damage. A child's first teeth are covered with a thinner layer of enamel, so they hurt, just like adults.

If your tooth starts to hurt, don’t delay your visit to the pediatric dentist. Inflammation may begin, which will affect the gum tissue, and tooth treatment will be more painful.

Prevention

The main method of preventing dental and oral diseases is regular visits to the dentist and treatment of caries in the early stages. It is important to teach a child hygiene and the rules of brushing teeth from the first years of life. Parents should control the diet, which should contain all the necessary substances, limit sweets and allow only water to drink at night.

Doctors at the VIMONTALE clinic treat pulpitis of primary teeth in children of any age. Specialists not only master modern painless techniques, but also know how to find contact with a child, know how to reduce anxiety and win the favor of the youngest patients.

Expert of the article you are reading:

Lozinskaya Alla Nikolaevna

Pediatric dentist, general dentist.

Other indicators for the removal of baby teeth

Caries, which can develop on the teeth of a two-year-old child. The resulting carious cavity can become a source for the spread of infection.
Inflammation of the pulp, which occurs against the background of advanced caries.
Periodonitis. Inflammation of the soft tissues around the tooth.
This disease occurs in 3-5% of children.
Trauma, as a result of which the tooth became loose and part of the tooth broke off. When a tooth is injured, the nerve bundle often ruptures. The pulp becomes unviable and must be removed.