Endodontic treatment in children/pediatric dentistry

Pediatric dentistry/children dentistry
No aspect of treatment in pediatric dentistry has been as controversial as endodontic treatment in children.

Endodontic treatment in children  involves the pulp of a teeth. The pulp contains the tooth nerve. It also contains blood vessels that provide the tooth o2 as well as nutrition. When the pulp is injured or infected, endodontic treatment is often done to make an effort to save the tooth

Endodontic treatment in children:-Pediatric dentistry/children dentistry

Endodontics in children is more challenging & difficult than adult due to the following reasons:-

1. Behaviour management problems in children
2. Limited mouth opening
3. Complexities of the root canal system such as presence of fine & tortuous canals,accessory canals,lateral canals,anastomoses etc in primary molars.
4. danger of injuring the permanent tooth bud.

How ever ,these can be overcome with patience, skill & considerable clinical acumen

Objectives of Endodontic Treatment in children:-Pediatric dentistry/children dentistry

1. Successful treatment of cariously involved pulp
2. Maintaining the tooth in the oral cavity in non-pathogenic & healthy condition
3. Endodontically treated teeth should help in mastication & serve as natural space maintainers.
4. Their retention in the mouth helps in speech
5. Guidance of developing dentition provided by the primary teeth.

Need of endodontic treatment in children:

1. Very important teeth such as primary second molar,when first permanent molar has not reupted or there is absence of the succedaneous tooth.
2. Tooth with is very sensitive to temperature chance
3. Has a broken tooth with exposed pulp

Contraindications For Endodontic treatment in children:-Pediatric dentistry/children dentistry

1. Furcation involvement due to caries
2. Severe mobility due to infection
3. Mobility due to physiologic root resorption

Other factors to be Considered:-Pediatric dentistry/children dentistry

1. The tooth has a good chance to remain in the oral cavity.
2. Endodontic Preservation should have more advantageous than extraction.
3. Level of patients cooperation
4. Parental desire
5. Level of caries activity of the child & over all prognosis.

Pulp therapy in Children's teeth can be classified as:-

Vital pulp therapy

Indirect pulp capping
Direct pulp capping
Pulpotomy
Apexogenesis

Non-vital pulp therapy

Partial pulpectomy
apexification

Vital pulp Therapy


Indirect pulp capping
In indirect pulp capping infected dentin is removed with out creating any pulp exposure then a medicament is placed in pulp chamber in an effort to remineralize the underlying demineralised dentin.

Endodontic treatment in children
pediatric dentistry/children dentistry

Indication

1. Teeth with deep caries, which are free from pulpitis
2. No history of spontaneous toothache.
3. No tenderness to percussion
4. No abnormal mobility
5. No internal or external root resorption detected radiographically.

Contraindication

1. Teeth with caries involving pulp.
2. tenderness to percussion.
3. abnormal mobility
4. Radiographic evidence of interradicular bone loss

Procedure

1. Removal of gross caries lesion.
2. placement of calcium hydroxide paste .
3. evaluation after 6-8 weeks
4. Permanent restoration

Direct pulp capping

This procedure involves the placement of a layer of protective material directly over the exposed pulp.

Endodontic treatment in children
Pediatric dentistry/children dentistry

Indication

1. Small pulp exposure during cavity preparation.
2. When the tooth is not painful.
3. Minimal or no bleeding from the exposure site.

Contraindication

1. Large pulp exposure
2. Presence of caries surrounding the exposure site
3. History of spontaneous pain
4. Excessive bleeding

Procedure

1. Complete caries excavation is done
2. Calcium hydroxide is placed( dycal is the material of choice)
3. The tooth is restored with intrim restoration
4. It teeth is asymtomatic for 6-8 weeks permanent restoration is done

Note:-Direct pulp capping is never done in primary teeth.

Pulpotomy

This procedure  is used when coronal part of  pulp is affected by decay or injury, but the root part is unaffected.The coronal part of the pulp is removed & medicament is placed over it to enable the radicular pulp to maintain its vitality.

Indication

1. Acute pulpitis
2. Caries which has resulted in invasion of microorganism into coronal pulp after exposure.
3. Permanent teeth with pulp exposed, when the root formation is incomplete.

Endodontic treatment in children
Pediatric dentistry/children dentistry

Non-vital pulp therapy

Partial pulpectomy

This procedure is done in primary teeth when both coronal & radicular pulp tissue show clinical evidence of infection.The term partial pulpectomy is preferred over root canal therapy as complete negotiation of accessory canal is not possible in primary teeth.

Indication

1. History of spontaneous pain, generally at nite
2. Presence of intraoral swelling & sinus
3. Clinically evident caries exposure.
4. Pathologic root resoption not involving more than 1/3rd of the root

Pediatric dentistry/children dentistry