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.

How are baby teeth different from molars?

Baby teeth appear at the age of six months. First, the central incisors erupt on the lower jaw, then on the upper jaw. By about 2.5 years old, the baby already has a full, white-toothed smile. His mouth contains 20 milk teeth, which will serve the child for several years.

After about six years, temporary teeth begin to be replaced by permanent teeth. When the baby brings the first “trophy” to his parents, it causes sincere joy and tenderness. And also the desire to carefully examine what the baby is holding in his fist. And while studying the tooth, parents can draw several wrong conclusions.

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The first is that baby teeth have absolutely no roots. This impression is created because the root shoot of a fallen tooth is usually located on only one side, and sometimes it does not exist at all. In fact, primary incisors and molars, of course, have roots, but over time they become smaller.

This occurs in order to ensure a natural and painless process of changing the dentition. When the time comes to change the bite, the roots of the baby teeth gradually dissolve. And thanks to this, the indigenous ones “push out” their predecessors from the gums, taking their place.

The second incorrect conclusion may be related to the size of the tooth. It seems incredible that such a “baby” could have the same structure as an “adult” native.

“The structure of baby teeth is almost the same as permanent teeth,” comments Natalya Terentyeva. “They have roots, root and coronal pulp, root canals through which nerve fibers pass. Milk teeth differ from molars in that their enamel is weakly mineralized, which means it is more susceptible to destruction and the development of carious processes.”

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.

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.

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.

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.

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.

Features and stages of the procedure

The dentist decides to remove the nerve of a baby tooth.
The procedure begins with a routine examination. It will take the doctor less than half a minute to decide whether to remove the nerve or not. To do this, a temporary onlay is placed on the tooth. Then the removal procedure itself is carried out. Local anesthesia is performed with a solution of ice-caine. The main task of the dentist is to open the tooth enamel using a drill and clean the dental canals so as not to damage the inner row of teeth.

Pulp removal ends with thorough disinfection. After this, the tooth is filled. In difficult situations, a follow-up appointment is scheduled to take an X-ray of the tooth. Sometimes the filling is placed temporarily. A special medicinal composition in the form of a paste is placed under it. And after the time of action of the medicine has expired, the filling is replaced with a permanent one.

Fillings used in dentistry can be of varying quality. There are no uniform standards for doctors. Therefore, parents simply do not know what they are using to glue their children’s mouths shut. But specialized private medical institutions should talk about what materials they work with. Children's fillings, as a rule, have good aseptic characteristics, but their durability is questionable. Dental cement will last about a year and a half.

After the procedure, the tooth is considered dead. It does not react to thermal and acid-base influences. But now it is collapsing at twice the speed. Enamel tubules instead of pulp cannot provide adequate nutrition for the entire tooth.

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.

Indications for removal

Indications for the removal of a baby tooth are only two situations: inflammation of the pulp with subsequent death of the nerve or depressurization of dentin.

But the reasons for this can be a variety of situations, including injuries:

Caries
Pulpitis
Periodontitis
Traumatic brain injuries, strokes

Caries on children's enamel develops in a matter of days. If harmful microorganisms manage to get into the pulp, the baby tooth will turn black after a couple of weeks. And at the site of infection, a hole is formed through which infection of the entire body, abscess of the gums and bone tissue can occur.

Pulpitis is a consequence of advanced caries. The soft tissues of the pulp chamber cease to perform their functions. The tooth is attacked by microbes from the inside. They gradually destroy blood vessels and nerve endings in the pulp, turning them into a source of infection.

Periodontitis poses the greatest danger, since the infection penetrates into the area of the neck of the tooth, which is adjacent to the gums and roots. In advanced situations, this can cause complications when the lower teeth erupt. For example, excessively compacted tissue can cause the growth of a molar to grow abnormally.

If there are any injuries or chips, the child should be seen by a doctor. Every meal you eat will promote the growth of bacteria. In such cases, the teeth are either removed completely or the broken part is built up.