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Pediatric pulp therapy removes infected dental pulp from the roots of teeth and relieves dental pain associated with the infection. The main goal of pulp therapy is to maintain the health of teeth and the supporting tissues affected by injuries, caries, or other causes.
Pediatric dentists can also perform pulp therapy on primary (baby) teeth. In the past, dentists would extract primary teeth with reversibly inflamed pulps instead of preserving the pulp. Premature loss of primary teeth can result in a malocclusion (teeth misalignment), esthetic, and functional problems in permanent teeth later on. Although, with the introduction of pediatric endodontics and pulp therapy, primary teeth can be preserved until they naturally fall out.
The pulp chambers in teeth contain the nerve, blood vessels, and connective tissue. The dental pulp within the chamber is a gel-like consistency consisting of 75 percent water and 25 percent organic materials. The pulp is located between the dentin, enamel, and cementum of a tooth.
Additionally, the dental pulp provides sensory innervation (stimulation) through a tooth’s nerve. However, when it becomes infected, the teeth typically become severely sensitive to sweets, hot, or cold substances.
The pulps in primary teeth are closer to the outer surface, which allows cavities to progress quicker and spread into the dentin more rapidly. This is because primary teeth have thinner enamel than permanent teeth and the thickness of the dentin between the pulp chambers and the enamel is also less.
The type of pulpal therapy needed depends on whether the patient’s dental pulp is vital or nonvital and if the pulp is capable or incapable of healing. Your dentist also evaluates the symptoms associated with the infection and your medical history. The most common pulpal treatments include:
A protective liner is a thinly-applied liquid that covers the pulpal surface of deep carious lesions. Liners protect a child’s primary or permanent tooth after cavity removal and before placing a restoration, such as a filling. The liquid covers the base of the cavity nearest to the pulp and protects the restorative material used to cover the cavity. The liners also promote healing of the pulp tissue, reduce tooth sensitivity, and prevent injuries to the pulp.
This treatment is an alternative to a pulpotomy, but includes similar steps. IPTs treat primary teeth that have deep cavities approaching the dental pulp. During the procedure, your dentist leaves the cavitated dentin around the pulp to avoid pulp exposure. The success rates of IPTs are similar to pulpotomy procedures. Dentists can perform IPTs on both primary and permanent teeth, but the procedures vary depending on the severity of the infection.
This procedure may be recommended if a large, deep cavity is completely removed and the dental pulp becomes exposed. In this case, your dentist will use stepwise excavation instead. During the procedure, they only partially remove the cavity to help prevent pulp exposure. After two to 24 months, your dentist re-opens the cavity, removes the remaining decay, and permanently restores the tooth. Patients who have deep cavities with severe pain, irreversible pulpitis, or experience extreme sensitivity to cold or hot substances are not candidates for this procedure.
Direct pulp caps can be placed on primary or permanent teeth. During cavity preparation, a small portion of the dental pulp can become exposed. In this case, your dentist will place a cap over the exposed pulp to protect it from infection. Although, direct pulp capping on primary teeth is not recommended.
A pulpotomy is more invasive than the pulpal treatments listed above and involves the removal of the infected portion of the dental pulp (coronal pulp). Your dentist only preserves the healthy aspects of the pulp tissue. Treatment is necessary if cavity removal results in exposure of the pulp or in a primary tooth with reversible pulpitis, which means the tooth can still be saved.
A pulpectomy is a root canal procedure that involves the complete removal of pulp tissue from a tooth with irreversible pulpitis or necrosis (dead tissue). Pulpectomies rarely treat severely decayed primary or young permanent teeth with irreversible pulpitis, which means the pulp cannot be saved.
Risk factors associated with infected dental pulp include:
Signs that a child may need root canal therapy on a primary or permanent tooth include:
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Banava, S. Stepwise Excavation: A Conservative Community-Based Dental Treatment of Deep Caries to Inhibit Pulpal Exposure. Iran J Public Health. 2011; 40(3): 140. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3481642/
Fuks, Anna, and Benjamin Peretz. Pediatric Endodontics Current Concepts in Pulp Therapy for Primary and Young Permanent Teeth. Springer International Publishing, 2018.
Nowak, Arthur J. Pediatric Dentistry: Infancy through Adolescence. Elsevier, 2019.
Pulp Therapy for Primary and Immature Permanent Teeth. American Academy of Pediatric Dentistry (AAPD). 2014. https://www.aapd.org/globalassets/media/policies_guidelines/bp_pulptherapy.pdf
Seale, NS. Indirect pulp therapy: an alternative to pulpotomy in primary teeth. 2010 Nov;127(11):1175-83. NCBI: https://www.ncbi.nlm.nih.gov/pubmed/21309277