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.

Cleaning and expansion of root canals

Root canal cleaning begins with measuring its length. A special instrument that resembles a needle in appearance is inserted into the root canal. A special apparatus is attached to this instrument - an apex locator. When the root apex is reached, the device beeps and the distance to the apex appears on its display.

After measuring the length, the doctor begins to clean the canal from the remnants of the nerve and expands it. Root canals can be expanded using hand instruments that the doctor holds in his hands or using machine or rotary instruments. Rotary instruments are inserted into a special tip - an endomotor. Development with machine tools is more modern and more expensive. It speeds up the process and provides higher quality processing. In order for a doctor to achieve a similar effect using hand instruments, the doctor will need much more time. After each insertion of each instrument, the doctor rinses the root canal with a chlorine-containing antiseptic.

After processing and drying the root canal, it is filled.

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.

Measles canal filling

The procedure for filling root canals is carried out in various ways, for example: by the method of cold lateral (side) condensation of gutta-percha pins (reliable and affordable). Pins that resemble gutta-percha sticks in appearance are inserted into the root canal. After insertion, these sticks are compacted against one of the walls of the root canal. Between the gutta-percha there is a special paste for filling the canals.

The most modern method is filling the root canals using the vertical condensation method of hot gutta-percha. With this method, the doctor seals the top of the root canal using a heated gutta-percha pin. After this, the remaining volume is filled with hot liquid gutta-percha. This method is more expensive.

After the filling, if everything is done well, the doctor removes excess gutta-percha and sealer, and then installs a temporary filling. X-ray control is required. Permanent tooth filling in one visit is carried out only in exceptional cases, since it is necessary for the material to cool completely.

After root canal filling, discomfort may persist for some time. The tooth may be sensitive when biting. Within a few days the pain goes away.

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.

Preventive measures

Obviously, it is better to prevent a dental problem than to subject the child to treatment and, accordingly, stress. But for this it is necessary to take care of prevention, and for this purpose, parents should take note of the following recommendations:

The sooner you start taking care of the condition of your child’s teeth and oral cavity, the better. Even during pregnancy, the expectant mother should eat properly and also enrich her diet with foods high in calcium and fluoride. At the same time, you should start carrying out daily hygiene procedures even before the first teeth appear - you can clean your gums from bacterial plaque using special napkins or fingertips,

The photo shows oral hygiene in a baby using a special napkin.
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As soon as the child reaches the age when he can brush his teeth on his own, he needs to be taught daily hygiene. At the same time, he must learn how to clean correctly, and a pediatric dentist will help you with this,

The future smile depends on the health of baby teeth
You should limit your child’s consumption of sweets, including sweet mixtures for little ones. Excess sweets in the diet is one of the most common causes of dental caries in childhood.
Regular preventive examinations at the dentist’s office will allow you to detect the problem in time, and therefore quickly deal with it. At the same time, it is better to show the baby to a specialist as soon as his first teeth appear.

Parents need to understand that treatment of baby teeth is an extremely important condition for the health of permanent teeth. Therefore, if caries or any other dental diseases develop, the child should be immediately shown to a specialist. And in order to prevent problems from arising, it is necessary to take your child to the dentist for preventive examinations 3-4 times a year.

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.

Symptoms

If periodontitis is diagnosed in children, symptoms and treatment depend on the form of the disease (acute or chronic). In acute periodontitis, there is a sharp initial and severe, increasing and incessant pain. The intensity of pain increases when pressure is applied to the damaged tooth. Other signs include:

The gums near the diseased chewing element swell noticeably.
The child's body temperature rises.
The appearance of weakness and attacks of nausea are noted.
The lymph nodes become enlarged and pain is felt when pressing.

In case of chronic periodontitis, a child’s primary tooth, which is treated in a clinic, does not have characteristic signs. Painful sensations can occur if you press on a sore tooth, or during contact with hot or cold food. In addition, there are the following symptoms:

A fistula forms on the gum if the disease develops into a granulating form.
The child becomes drowsy, gets tired quickly, and general weakness appears.
Appetite worsens.
Increased body temperature.

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.

What materials are used

Many parents are interested in what is currently used to fill children’s teeth. Not so long ago, the choice of materials used to fill children's teeth was not as diverse as it is today. At one time, dentists more often resorted to using amalgam, but this composition cannot be called completely safe and harmless to the body, especially when it comes to a child. Later they began to use glass ionomer cement, but it also has its disadvantages. For example, it takes quite a long time for the material to harden, which is not always convenient if there is a baby in the dental chair.

On a note! Often, special pastes are used to fill the root canals of baby teeth. Such compositions are not able to provide perfect tightness if used to fill a vertical cavity. In addition, after some time they dissolve, and therefore are not intended for permanent filling.

This is how a child’s teeth are filled with reflective composites.

To date, the situation has changed a little, and today pediatric dentists increasingly prefer fillings made of light-curing composite, as well as compositions that are a combination of a hybrid composite and glass ionomer cement. These materials are characterized by increased strength, are easy to polish and have a high degree of adhesion.