Do baby teeth need root canal treatment?
In my years of practising paediatric dentistry, I have encountered some parents who have expressed dismay when told that their children’s teeth require root canal treatment…yes, I mean the baby teeth. The first question would often be “Is it necessary?”. Baby teeth are just like adult teeth, so they can have the same problems, toothache, infection etc. Every tooth has blood vessels and nerves. Baby teeth do not all shed at once. Usually the baby teeth will shed one-by-one over the years from aged 6 to 12. So there are some baby teeth which need to last in the mouth for a few more years before the adult successors are ready to erupt into the mouth (see post for dental development). Baby teeth are important for speech, aesthetics and maintaining good alignment for the permanent teeth in the future.
The most common reasons for a baby tooth root canal treatment would be dental trauma or dental decay (also known as caries). Dental trauma and caries make the tooth nerves vulnerable to bacterial invasion when the dentine layer is exposed from tooth fracture or decay. A filling may be able to stop this bacterial invasion if the bacterial attack does not progress further. Dentists do this by removing or drilling the decayed portion and/or applying medicine over the exposed dentine before finally filling the tooth to its original shape. A root canal treatment is usually required when bacteria continues progressing into the next layer of the tooth: the pulp, also known as the root canal space. The pulp is the innermost layer of the tooth which houses the nerves and blood supply of the tooth. A normal filling at this stage may not resolve the problem.
When bacteria starts attacking the pulp, the body tries to produce more fighter cells in the pulp to ward off the attack from the bacteria. This will cause an increase in the pressure within the pulp and result in a toothache. The chances of the pulp to fight this invasion successfully on its own are low because the bacterial progression is quick and usually by this stage, there is an overwhelming amount of bacteria. At this time, there will be a lot of pain and usually the toothache is spontaneous and made worse when the child is lying down about to sleep. Eventually, the cells in the pulp die and blood circulation within the pulp stops. The dead cells would then release toxins giving rise to infection. Infection of the tooth may manifest as toothache and/or swelling at the gums near the affected tooth root tip. When a tooth is infected, a normal filling alone will not solve the problem. A filling will not be able to get rid of the bacteria that has travelled into the pulp of the tooth. Therefore, a root canal treatment or an extraction would be the options for treatment.
Baby teeth are smaller and therefore the bacterial invasion through the tooth cavity can reach the pulp easily. For this reason, a partial root canal treatment (termed as pulpotomy) may be recommended to remove bacteria that have entered the pulp or close to the pulp chamber. Pulpotomy is a procedure where the pulp tissue in the chamber is removed to ensure no bacteria is left in the pulp before the tooth cavity is sealed with medication and an appropriate filling material. Pulpotomy is only when the tooth is not yet infected, meaning the pulp tissue at the root area is still healthy. If the whole pulp (chamber and root) is invaded by bacteria, a complete root canal treatment is required. A complete root canal treatment would involve the removal of the pulp tissue from the whole tooth and disinfection of the root canal space with medication and mechanical cleaning to rid of all the bacteria within the tooth. Finally, a proper filling over the root canal-treated tooth is important to ensure bacteria does not re-enter the root canal space.
Therefore, a root canal treatment (either partial or complete) may be necessary for the baby tooth if the pulp is deemed to be affected by bacterial invasion. The option to carry out root canal treatment or extraction for a baby tooth depends on a few factors:
How long the affected tooth is expected to last in the mouth
The amount of tooth structure remaining after removal of decay or any loose fragment
The condition of the root(s) of the tooth
The ability of the child to cooperate with the treatment
The extent of infection