Endodontic Treatment in Children

Typically, inflammation and infection that requires this kind of treatment come from:

• A deep cavity
• A cracked or fractured tooth
• Injury to the tooth

In permanent teeth, the most commonly known endodontic treatment is a root canal. During the procedure, a specialist called an endodontist would use an anesthetic to numb your child from pain, drill a hole in their tooth, and remove any inflamed or infected pulp (nerve and blood vessels) from the inner chamber. They'll carefully clean and disinfect the area, then fill and seal it. According to the American Association of Endodontists, 25 million root canal procedures are performed every year.

Endodontics is a specialty in dentistry that refers to the treatment of the inside of the tooth. Taken from the Greek words endo meaning "inside" and odont meaning “tooth,” endodontics is specifically concerned with the study and treatment of the dental pulp. Root canals are the hollows within a tooth where the nerve tissue, blood vessels, and some other cells are located. A root canal is a place in a tooth, while endodontic therapy is a dental procedure. Root canal treatment refers to an endodontic procedure that treats this part of the tooth.

According to the American Association of Endodontists, endodontic treatment is necessary when the pulp, the soft tissue inside the root canal, becomes inflamed or infected. If pulp inflammation or infection is left untreated, it can cause pain or lead to an abscess. Signs or symptoms that indicate you might need a root canal include:

• Severe pain while chewing or biting
• Pimples or raised bumps on the gums
• A chipped or cracked tooth
• Lingering sensitivity to hot or cold, even after the sensation has been removed
• Swollen or tender gums
• Deep decay or darkening of the gums
• Discolored or dark tooth (a sign it’s not getting nutrients from the root)
• A swollen jaw (usually indicates that the infection is spreading)

Usually, tooth and mouth pain will be persistent if you need a root canal as decay and damage is close to the nerves or roots of the tooth.

Parents often think that because a baby tooth will fall out anyway, there's no need for treatment. But infections can cause pain for your child and potentially lead to more serious conditions.

There are two kinds of endodontic treatment done on baby teeth. Non-vital pulp therapy is the aforementioned root canal that can be performed on permanent teeth. They can also be performed on baby teeth with more severe infections.

With vital pulp therapy, your child's pulp may be spared or partially removed depending on the infection's extent. There are four types of vital pulp therapy for baby teeth:

• Protective base. This procedure will be used if your child is experiencing tooth decay, but the pulp is not directly affected. Their endodontist will remove the decay, placing a protective material in the tooth before placing a filling.
• Indirect pulp cap. This is done when decay has come close to your child's pulp, but the decay doesn't touch it. Most of your child's decay is removed, then a protective dressing is placed over the remaining decay nearest the pulp. The American Academy of Pediatric Dentistry (AAPD) says that as long as the pulp is vital and asymptomatic, leaving some decay near the pulp but then covering the area with a biocompatible material can stimulate the repair of the dentin and inhibit further decay.
• Direct pulp cap. According to the AAPD, direct pulp caps are typically used for adult teeth when the pulp is normal but exposed by an opening of one millimeter or less. This opening could be caused by decay removal or because of an injury. Medicine would be placed on your child's exposed pulp to protect it before capping it with a filling material. Learn more about pulp capping.
• Vital pulpotomy. If the top part of the pulp in your child's tooth is affected by decay or injured by trauma, but the root part is still healthy, an endodontist may perform a vital pulpotomy. They will remove the decay, the infected or injured pulp, and leave the tooth's healthy root alone. The tooth's inside is filled with protective material, and the tooth will be covered with a crown.

Typically, it takes 1-2 days for the pain to subside and less than a week (3-4 days) to recover from a root canal. Call your healthcare provider if your treated tooth hurts for more than a week. There may be things you can do to assist the healing process. Eat soft foods for the first few days after treatment. Keep the area clean and use antibacterial mouthwash to prevent infection and follow the post care instructions from your endodontist. Avoid smoking as according to the Cleveland Clinic, this can make it harder for the tooth to heal.

By teaching your child to practice good oral hygiene and bringing them in to see their dental professional for regular checkups, your child can avoid most causes for endodontic treatment. If your child needs any of the above procedures, that doesn't mean it's too late to get them started with a good oral health routine. Getting them started on the path to good oral hygiene will give you both reasons to smile.

Oral Care Center articles are reviewed by an oral health medical professional. This information is for educational purposes only. This content is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your dentist, physician or other qualified healthcare provider.