Root Canal Treatments on Children

*BigSmiles Dental*
When decay or the bacteria causing decay advances so far that it invades the pulp (nerve) of your child's tooth, removal of the pulp and inflamed tissue from the root canals can often save the tooth. As strange as it may seem to perform root canal on children, it is actually a very common treatment. It is an excellent option when the premature loss of a baby tooth will result in loss of important space for adult teeth later, or the loss of important function of the tooth. There are basically two common treatments – one is called pulpotomy and the other is called pulpectomy, or children's root canal treatment.

Pulpotomy treatment involves removing only the top part of the tooth's nerve and preserving the nerve stumps left in the roots by mummifying them using a solution with formaldehyde. This solution was first introduced in1904 and is intended to act as a fixative and antimicrobial agent. Although this treatment has been done on children's teeth for a very long time, research in the last two decades indicates that there is a 30% failure rate (premature loss of the tooth) within 36 months. Other concerns include the formaldehyde causing enamel defects in the associated adult tooth and formaldehyde migrating into other tissues throughout the body especially the kidneys. Formaldehyde is known to have mutation and cancer-causing potential.

Additionally, pulpotomy is not advisable if:

• your child's tooth has caused pain;
• there is an abscess present;
• the pulp tissue does not bleed when amputated or if it bleeds uncontrollably;
• the baby tooth is ready to come out; or
• there is no bone covering the associated adult tooth.

For all of the above reasons, I believe it is prudent to perform pulpectomy (children's root canal treatment) if possible and practical. A pulpotomy remains an acceptable treatment when cost is the biggest concern and only one or two teeth are involved (thus limiting exposure to the formaldehyde), or when the tooth is expected to be lost within 36 months in any case.

Pulpectomy, or children's root canal treatment, involves removing all of the pulp and nerve tissue right to the end of the roots. After cleaning and shaping the canal spaces with small files, the space is filled with a resorbable disinfecting filler called zinc oxide and eugenol. This material also has a very long history in dentistry but has less toxicity concern than formaldehyde. One drawback to pulpectomy is that takes significantly longer than pulpotomy to complete and can be nearly impossible to provide to children who are not completely comfortable and co-operative.

*BigSmiles Dental Care*Cloverdale Dental*Cloverdale*
- Cloverdale Dentist