Pulp has been the subject of previous blogs at Dentistry for Children in the past.  However, we believe it’s time for a 2018 detailed update about the pulp in your child’s primary (baby) teeth.  Welcome to part 1 of our two-part series on treatments for decay and infection in the pulp of a child’s baby-tooth.

Almost any parent winces at the mention of this treatment after examining a child’s teeth.  We know many of you recall the tooth diagram.  You remember that chart shows the enamel, dentin, and pulp.  And the very color and shape of the tissue at the heart of the tooth causes that parental wince.

Pulp Involvement Does Not Mean the Death of the Tooth

Inflamed and Infected Pulp is Very Painful.

Deeply Infected Teeth Can Cause A Child Extreme Pain.

Fear not, parents!  There are several first class treatments for your child’s tooth if decay and infection have penetrated the enamel, the dentin, and even the precious pulp.  What do we do if exam and the x-ray reveals pulpal involvement in the baby tooth?  It goes without saying that we will make an effort to save the tooth, so it can shed at the end of its normal lifetime.  We have published reasons for this previously.  However, to review:

A. Your child’s primary teeth protect precious buds for the permanent teeth.

B.  Your child needs his or her baby teeth to learn to speak properly.

C.  The baby teeth help your child chew a proper diet until the slower-growing permanent teeth erupt.

D. Baby or deciduous teeth protect the positioning and shape of the permanent teeth.

This blog reveals the various stages of pulpal involvement for baby teeth with trauma and decay.  We will also explain the state-of-the-art treatments that work best in different cases.

Treatment Number 1:  When Pulp is Barely Exposed…Indirect Pulp Treatment

The treatment named Indirect Pulp Treatment is partially explained by its own name.  It works best for teeth that are deeply decayed.  But where removing all the decayed parts of the tooth would expose the pulp like the name, “indirect,” treatment works, well…indirectly.  This is because much of this procedure depends on the child’s own natural healing ability.  Here’s how:  The dentist knows that if he removed all the decay, he would actually expose pulp.  So, he removes “as much soft decay as possible, leaving only harder remnants without penetrating into the pulp.”

Parent’s React With:  What? You Leave Some Decay?

Calmly, let us explain:  The next step is the application of an antibacterial agent.  Thus it will be sealed to prevent infection.  Be aware that in this pulpal procedure, all outer layers of infected dentin are removed.  Then several layers of lining cement are put into place.  Now here is the best part of the treatment:  “These materials reduce the acidity caused by decay and sterilize the surrounding infected dentin.”  Here comes the tooth to its own rescue:  As inflammation subsides, the pulp deposits a reactionary and reparative dentin to repair itself.

Keeping the Tooth in Treatment Under “Wraps”

Fear is Contageous

Don’t Show Fear of the Dental Procedure or Your Child Will Catch It.

By the way, this exciting reaction is part of the treatment that happens under “wraps,” or rather, under a temporary filling.  That filling ensures your child’s comfort until 10 or 12 weeks later when we replace it with a permanent filling.

Two or three years later the tooth comes out—because it is time for it to be shed to make room for a beautiful new and unaffected permanent tooth.   And that tooth will be perfectly positioned because we saved the baby tooth and maintained its “parking” space.

Treatment Number 2:  When Small Exposures Happen… Direct Pulp Capping

We typically employ Direct Pulp Capping when tiny incidental exposures of the pulp occur, but there is no decay.   In this treatment, Dr. King will simply cover or “cap” the exposure directly.  He will use similar cementing and materials as mentioned above, “to create a dentin “bridge” to seal the exposure.”

Treatment Number 3:  When Part of the Pulp Must Go…Pulpotomy

Pulpotomy is indicated when a partial pulp removal is necessary.  In these cases, decay has eaten deeply into the primary tooth. However, the dentist finds the inflammation and infection are “confined to the coronal (inside the crown) area of the pulp.”  As you might guess that is the tissue the dentist will delicately remove in this procedure.

Pulpotomy:  Good News and Bad News

That might be the bad news/good news scenario.  You see, the good news is that with the Pulpotomy, we can preserve the living root areas of the little tooth.  Over the coming weeks, the dentist will judge the success of a pulpotomy by its health and recovery.

Here are the critical concerns:

  • As always, control of the infection is crucial.
  • The dentist must perform a precise and complete removal of the inflamed tissue.
  • Likewise, the dentist will apply meticulous layers of a cement-like wound dressing.
  • Very Important Meds:  “Dentists use medicines and preparations to stabilize vital tissue and prevent it from becoming infected.  This allows the remaining vital or living tissues of the pulp to survive so that the tooth can function normally until lost naturally.”
  • For example, you might hear about MTA (Mineral Trioxide Aggregate.) This amazing substance is bio-compatible with living tissues.  Likewise, MTA promotes healing.  And it seals the root canals.  This stops possible leaks and arrests the dreaded spread of infection. 
  • Most importantly, it can encourage that all important dentin formation so that the awesome tiny little tooth can actually contribute to healing itself.

Treatment Number 4:  When All of the Pulp is Infected…Pulpectomy

All's Well That Ends Well

With Proper Treatment, the Story of This Infected Tooth Has a Happy Ending.

Unfortunately, none of the pulp in a primary tooth can be saved if the infection has gone deeply into the tooth, beyond the crown and root.  The good news is that Pulpectomy or a Baby Tooth Root Canal can save the basic tooth in position.  However, since that procedure is more detailed, we will save it for a Part 2, coming in our next blog.

If you will forgive a tiny pun inspired by one of our own patients, we like to call this series of blogs, “Pulp Non-Fiction.” And we wrote it to underline the importance of saving those tiny teeth.  Thank you for reading the blog at Dentistry for Children and please visit us again soon.  Next time we will bring you the whole-truth-of-the-tooth which needs a Pulpectomy.