The National Institute of Dental and Craniofacial Research reports that 42 percent of children ages 2 to 11 develop cavities in their baby teeth. When the decay is severe, it may result in pulpitis, or the inflammation of the pulp. A pulpotomy in primary teeth may be performed if the tooth is still vital and the decay has extended to the pulp. Here's what you need to know about the symptoms and how dentists can diagnose and treat this condition.
Symptoms and Diagnosis
The pulp of the tooth houses the top portion of the nerve and blood vessels. When it is inflamed, it can be very painful. TheAmerican Academy of Pediatric Dentistry notes a few symptoms of reversible and irreversible pulpitis. Reversible pulpitis is painful when it is touched, but the pain subsides and is alleviated by over-the-counter pain medications. Irreversible cases include an unprovoked toothache, excessive mobility of the tooth, and inflamed soft tissue that isn't a result of gingivitis or periodontal disease.
An X-ray will show a very large and deep dental decay of the tooth. The dentist must next determine if the tooth can be repaired after the decay is removed. A tooth that cannot be repaired will require extraction. Depending on the age of the child and location of the tooth, additional decisions for temporary replacement or space management may be necessary to allow for proper eruption of the permanent tooth. The next decision for the dentist is to determine if the nerve in the tooth is still alive (vital) and just inflamed from the decay. If the nerve is dead (necrotic), it may require a root canal (pulpectomy) or extraction instead of a pulpotomy. Finally, if the tooth is ready to be exfoliated to make room for the eruption of the permanent tooth, it should be extracted.
There are two approaches to treating an inflamed nerve from decay, notes the Journal of International Clinical Dental Research Organization. The first is an indirect pulp cap where the pulp chamber or the upper portion of the nerve is not removed. Instead, a medication is placed on top of it to reduce the inflammation, prevent the progression of the decay and promote healing.
The second approach is the pulpotomy, or the removal of the pulp chamber above the area where the nerve extends into the root or roots of the tooth. A medication is also applied to the base of the chamber to maintain the vitality of the nerve in the root and prevent any further infection. The tooth is then restored. A primary molar usually will have a stainless steel crown placed, and a front tooth may receive a form of composite restoration.
To avoid an inflamed tooth pulp altogether, a great oral care routine is essential. For children especially, a fluoride toothpaste and daily use of a mouthwash are important for keeping their primary teeth healthy. Additionally, within six months after the first teeth erupt, that's a sign that you should schedule regular appointments with your child's dentist.