Pulp Problems: Under the shadow of recent COVID-19 statistics, significant dental problems are rearing their ugly heads. Many parents have hesitated to bring their children to a pediatric dentist.
Indeed, as C. Eve J Kimball, MD, FAAP & Anupama Rao Tate, DMD, MPHB have stated, “The COVID-19 pandemic has meant delays in dental care for many families. Children whose dental problems might have been easily taken care of in an office setting may have had to wait to see a dentist.”
As a result, decay problems “have sometimes grown from simple surface involvement to an infection deep in the heart of the tooth, in that delicate red tissue known as “the pulp.”
We are sad to report that teeth cannot heal on their own. Additionally, as people have begun to return to regular appointments at Dentistry for Children, we have been noticing pulp problems more and more often. Thus, we felt it was time to review and update parents and care-givers on pulp problems and our pulp treatments.
Pulp Problem Treatments: Saving Baby Teeth
Once Dr. Troy King discovers pulpal involvement in a baby tooth, he will make every effort to save that tooth. You see, we want the tooth to “shed” on schedule at the end of its lifetime. You might say, “Why? It’s a baby tooth. It will fall out anyway?”
We have informed many parents and care-givers of the importance of baby teeth and the positions they are naturally in. Let us review the need to protect baby teeth.
- Those precious little primary teeth protect something even more precious: the buds for the permanent teeth.
- Your child is learning to hone his or her communication skills. Retaining every baby tooth is essential to his or her learning to pronounce sounds correctly so he or she can speak properly.
- Additionally, Baby teeth will help your child with chewing a proper diet until the slower-growing permanent teeth erupt.
- Likewise, you would be surprised to know how these “deciduous” teeth protect the positioning and shape of the permanent teeth, as well as your child’s mouth and expression.
Conquering Pulp Problems: Special Pulpal Procedures
Let’s take a look at our various stages of pulpal involvement for baby teeth like those we have recently seen with trauma and decay. There are different state-of-the-art treatments for pulpal infections. Each treatment protects teeth at a different level, depending on the extent of damage to the pulp.
1. Indirect Pulp Treatment: Protecting Teeth that Are Mildly Exposed
The treatment termed “Indirect Pulp Treatment” is partly revealed by its own name. It works best for protecting teeth that are deeply decayed. However, if we removed all the decayed parts of the tooth, we would expose the pulp. Like the name, “indirect,” the treatment works, well…indirectly.
This is because much of the Indirect Treatment depends on your child’s natural healing ability. Since removing all the decay would actually expose the pulp, Dr. King removes “as much soft decay.” as possible. He leaves remnants of harder decay. Thus he avoids penetrating the precious pulp.
Reacting to Indirect Treatment for Pulp Problem: What? You Leave Some Decay?
Calmly, let us explain a deeper detail. The next step is the application of an antibacterial agent over the hard decay and the remaining tiny tooth. This procedure seals and prevents infection. Be aware that in this pulpal procedure:
- The pediatric dentist removes the infected dentin.
- Then, several layers of lining cement are put into place.
- Now we come to the best part of the treatment: “These materials reduce the acidity caused by decay and they sterilize the surrounding infected dentin.”
Finally, here comes the tooth to its own rescue: As the inflammation subsides, the pulp deposits reactionary and reparative dentin to repair itself. Pulp Problem Number One–Solved.
Putting the Treatment Under “Wraps”
By the way, this exciting reaction is part of the treatment that happens under “wraps,” in the teeth of children. Dentists use a temporary filling. In the above case, a filling ensures your child’s comfort until 10 or 12 weeks later. Then we replace it with a permanent filling.
Now let’s imagine that three years later the tooth comes out. Yes, it exits. This is because it is time for it to be shed. It now makes room for a beautiful new and unaffected permanent tooth. The tooth is perfectly positioned because we saved the baby tooth and maintained its proper “parking” space.
Pulp Problem Number Two: Small Exposures Demand Direct Pulp Capping
We use Direct Pulp Capping when we discover that there are small incidental exposures of the pulp, but there is no decay.
In this treatment, Dr. King covers or “caps” the exposure directly. He uses similar cementing and materials mentioned above, “to create a dentin “bridge.” This seals “the exposure.”
When Part of the Pulp Must Go…Pulpotomy: Our Treatment Number Three
If Dr. King recommends Pulpotomy, it means he must remove part of the pulp to save the tooth. (One of our young patients also named this procedure the hippotumusy, but that is not an official dental tag. It’s only adorable.)
In such a case, decay has eaten very deep into the tiny 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 part of the pulp that the dentist will remove in this procedure.
Looking Ahead, Part Two: New series on Pulp Problems
In our next blog, we will detail Pulpotomy and also explain Pulpectomy, which is the extraction of the pulp. This is a baby tooth root canal procedure. It involves two tiny but complex procedures that deserve a blog of their own. And it comes your way in our next article. It is titled, Part Two of our new series on Pulp Problems.
If you will forgive a favorite pun inspired by one of our own patients, we always like to call this series of blogs, “Pulp Non-Fiction.” And we wrote it to underline the importance of saving and retaining your child’s tiny teeth.
Thank you for reading the blog at Dentistry for Children, and please visit us next week when we bring you the details about treating a tooth that might need a Pulpotomy or a Pulpectomy. Plus, we’ll also be bringing you some secrets for avoiding pulp problems, in spite of the pandemic situation.