Pulp Non Fiction is a tongue-in-cheek twist on the movie title, Pulp Fiction.  Our theme, however, is quite different from the old show. At Dentistry for Children, we have written about the pulp treatment procedures previously. However, it’s time to update you about these procedures. In fact, as our state and city re-open, it is a very appropriate time to update you concerning the pulp in your child’s primary teeth.

Pulp Non-Fiction, Chapter I:  Keep Calm When You Hear “Pulp Involvement”

COVID-19 Disrupted Family Schedules? Is It Time For a Check Up?

Saying any of the words Pulpectomy, Pulpotomy or Pulp Treatment can make any parent gulp. In fact we have seen eyes fill with tears.  Let us be quick to inform you that pulp problems do not mean your child’s tooth is dead. Even the words pulp problem makes parents wince after an examination.  So, let’s begin with your memory of the basic tooth diagram. “We know you know that the chart shows the beautiful white enamel, dentin and pulp. And the very color and shape of the pulp, at the heart of the tooth, causes that parental wince.”

Pulp Non-Fiction, Chapter II:  Post Corona Virus Dental Concerns

By the way, the story of pulp non-fiction begins with decay and infection. Needless to say, we have been worried about our young patients and tooth decay since the COVID-19 quarantine. We assure you that we continue to provide your child’s dentistry with the utmost concern for health and safety.  However, we cannot help but be concerned. You see, we worry that fear of  the coronavirus will cause neglect and decay of children’s teeth, and lead to tooth loss.

Our Personal Invitation:  Please call and check in with us for an appointment if you know your child is due for a check-up, or overdue– or even if you are new. It is only through regular check-ups that we can prevent tooth decay and the health problems it causes.  We will be glad to review our process for protection and security against viral infection of any kind, and COVID-19 particularly.

Chapter III of Pulp Non-Fiction:  First Class Treatment for the Heart of a Tiny Tooth

If decay and infection penetrate the enamel of your child’s tiny tooth, we are well armed to fight it with modern dental technology. In fact, our first concern, if the exam and x-ray reveals pupal involvement in the baby tooth, is saving the tooth.

Treating Decay in Baby's Teeth is a PART OF Pulp Non Fiction

Quality Pulp Treatments Can Cause a Sad, Decayed Tooth to Regain its Functionality and Personality.

We want it to stay in place and then shed at the end of its normal lifetime. We have stated this previously, and it remains true in 2020. Let’s examine the reasons for this:

  • In the first place, your child’s primary teeth protect precious buds for the permanent teeth.
  • In the second place your child needs his or her baby teeth to learn to form the sounds and letters of proper speech.
  • Thirdly, baby teeth are perfectly shaped and spaced to assist your child in chewing an appropriate diet. We hope to keep them healthy until the slower-growing permanent teeth erupt.
  • Likewise, did you know the “Baby” or “deciduous” teeth protect the positioning and shape of the permanent teeth?

Chapter IV of Pulp Non-Fiction: Pulp Involvement by Stages:

There are various stages of pulpal involvement for baby teeth with trauma and decay. Likewise, we want to inform you about the state-of-the-art treatments that work best in different cases.

First, Indirect Pulp Treatment: The Kindest, Gentlest Treatment

When the pulp is barely exposed, Dr. Troy might recommend the aptly-named, indirect pulp treatment.  Indirect Pulp Treatment is explained by its own name. We have found “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,” the treatment works, well…indirectly.”

This treatment makes the most of your 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 Shock to Indirect Treatment

Parents always say, “What? You leave some decay?” Stay calm and take a lesson from pulp non-fiction.  Calmly, let us explain:  The next step in indirect treatment is the critical and meticulous application of an antibacterial agent. Thus, we seal the heart of the tiny tooth against infection.

In this pulpal procedure, the dentist first removes outer layers of infected dentin. Then he puts several layers of lining cement into place.

Now here is the most amazing  part of this pulp non-fiction  treatment:

1.   “These materials reduce the acidity caused by decay and sterilize the surrounding infected dentin.”

2.   And now, comes the tooth to its own rescue:  As inflammation subsides, the pulp reacts and actually grows reparative dentin to repair itself.  

Keeping the Indirect Pupal Treatment Under “Wraps”

Keeping Baby Teeth Beautiful (Pulp Non Fiction)

Protect Those Tiny Baby Teeth Because Decay Is Not Pretty… And It Really Hurts.

By the way, we want you to know that this exciting reaction in the dentin layer is part of the treatment that happens under “wraps,” or rather, under a temporary filling. The filling will guard your child’s comfort zone. Then 10 or 12 weeks later, we will replace it with a permanent filling.

Three years later the tooth comes out, all by itself. It does this because it is time for it to shed. It will thus make room for a beautiful new, and unaffected permanent tooth.  And that tooth will be perfectly positioned into the natural contour of your child’s jaw and mouth.  Why? That is the wonder of pulp non-fiction.  This magic  treatment saved the baby tooth and maintained its perfect “parking” space until it was time for the permanent tooth to make its grand entrance.

Second, Direct Pulp Capping–Treatment for the Smallest Exposures

In another case, when there are exposures of the tooth pulp, but no decay, Dr. King might recommend Direct Pulp Capping.

In this treatment for tiny fissures, Dr. King will simply cover or “cap” the exposure directly. In this procedure, he will use similar cementing and materials, exactly as described above. Thus he will “create a dentin “bridge” to seal the exposure.”

Third, When Part of the Heart of the Tiny Tooth Must Go– Pulpotomy

Dr. King will utilize the procedure called “pulpotomy,” if he sees a deep infection in the pulp.  He recognizes that a partial pulp removal is necessary to save the tooth. In these cases, the decay has eaten deeply into the primary tooth. “However, the dentist finds the inflammation and infection is “confined to the coronal (inside the crown) area of the pulp.” Although it is sad, you might guess that is the part of the pulp that Dr. King will remove. But he can still save the tiny tooth.

Pulpotomy:  How to Save the Root Areas of the Tooth

With the Pulpotomy, Dr. King can preserve the living root areas of the pulp.  Over several weeks, he will judge the success of a pulpotomy by the health of the remaining pulp. Again, he will work with your child’s natural healing ability.

Here are the critical concerns:

  • As always, the control of the infection is crucial.
  • The dentist must perform precise and complete removal of the inflamed pulp tissue.
  • Likewise, the dentist will apply meticulous layers of cement-like wound dressing.
  • He will also apply some Very Important Meds: Dentists use medicines and preparations. With these medicines, he can  stabilize the living tissue. These medications also prevent further infection.
  • Meanwhile, with meticulous care, he watches as the remaining pulp survives. As in the previous treatment, the goal is to help the  pulp “function normally until lost naturally.”
  • For example, you might hear about MTA (Mineral Trioxide Aggregate.) As we have stated in previous blogs, “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.” You can find out more pulp non-fiction at this informative online resource.
  • Most importantly, the medicines applied by the dentist can encourage that all important dentin formation. Then that amazing tiny little tooth can actually contribute to healing itself, as explained in the First Treatment listed above.

The Fourth Pulp Treatment:  When All of the Pulp is Infected: Pulpectomy

Dental Anatomy… Notice the Beautiful Pulp at the Heart of the Tooth.

Sometimes infection has gone beyond the crown and the root of the tooth. In this case, we still strive to save the basic tooth with a Baby Tooth Root Canal. This a procedure that is even more detailed than any of the three above. Dentists call this procedure on a primary tooth, a Pulpectomy. We will save it for another update, and call it the sequel to Pulp Non-Fiction—a “Part Two,” coming to you in our next blog.

As always, thank you for reading the blog at Dentistry for Children, and please visit us again soon.