Root Canals for Kids: Are They Really Necessary or Are There Alternatives?

Do Kids Need Root Canals? 0:00

Hello, I'm Dr. Michelle and I want to tackle a question that I frequently get from parents. Do kids really need root canals? And how do root canals in kids differ from root canals in adults? Well, you've probably heard me talk about the concerns with adult root canals with the fact that the tooth can't completely get cleaned, that it has dead tissue inside, that bacteria can find, that it may lead to infection and inflammation and other systemic issues. So is this a concern for children as well?

Well, let's jump into this and find out really how does this relate. First of all, the kind of root treatment that we do in a child is different than the kind of root treatment that we do in an adult, primarily because the teeth are different. The teeth in a child are meant to come out. They are temporary teeth, they're for a few years, and they will be replaced with a permanent tooth.

Why Children's Teeth Need Different Treatment 0:52

So if a child has a deep cavity, this is really honestly the main cause for this issue or trauma to the tooth. They fall on their bike or the trampoline or something and knock a front tooth. It may lead to either the nerve being exposed on the inside of the tooth or the tooth actually dying. If that happens, there's two options that we have for children's teeth. The first is called a pulpotomy, and the second is called a pulpectomy. So if you recall or if you've listened to any of my videos about the different layers of the tooth, you'll know on the outside there's the enamel.

The next layer in is called dentin, and the inside layer is called the pulp. That pulp contains the nerves and the blood vessels for the tooth. Now those nerves and blood vessels extend into the tooth, and beyond the outside of the tooth as well. So that is what connects it with the rest of the body. So when we talk about this on a child, if they have a deep cavity that's irritating the pulp, which you now know is the nerve and the blood vessel in the center of the tooth, it will lead to pain, to toothaches.

They drink something cold and they go, oh mom, my tooth hurts. And as a mom and a grandma myself, I know that that just tears at your heartstrings, doesn't it?

Pulpotomy vs. Pulpectomy 2:12

You don't want to have your little child have a toothache. So you take them to the dentist. The dentist says, unfortunately, that cavity is already at that nerve or that pulp section of the tooth. Interesting thing here is that it's very common for this to happen quickly. Children's teeth are thinner, the enamel layer is thinner, the dentin layer is thinner, so it takes less time for a cavity to get from the outside to the inside of the tooth. So many times when we are doing an exam on a child and we find a deep cavity like this, The parents are just devastated.

They say, I had no idea. Like I didn't even know that there was something going on. How could they already have this deep of a cavity? And like I said, it's partly because these teeth are just thin. There's not a lot there and these issues progress very quickly. So once the cavity is nearing the nerve, those symptoms may show up. Sensitive to cold, sensitive to maybe sometimes biting or touching the tooth. But if the tooth is still alive, we can do something called a pulpotomy. What that means is the pulp tissue in the upper portion of the tooth.

So the part that you can see. that pulp tissue is removed, a medication is placed at that level and it's filled from there up. But the nerve tissue in the roots is left alone. Now, why would you do this? Why is this different than you do in an adult tooth? Because of the way that adult teeth erupt and baby teeth or children's teeth are lost. What happens is the children's tooth sitting up above, the adult tooth is coming down from underneath. and as that adult tooth comes up it actually starts to dissolve the roots.

So if we can keep the nerve tissue in the root structure that adult tooth may continue to erupt and come in as it should without any interference.

When a Pulpotomy Is Used 4:10

This is really only possible if that tooth is still alive. So if they still have cold sensitivity that's a good sign. The second root treatment that's done in children is called a pulp ectomy. So ectomy means all of it is removed. So all of the pulp from the top all the way down is removed. Usually this is done if the tooth is already infected. It's already dead, it hurts to bite on, they have swelling, they have pus, they have those kinds of things on the side of the tooth. So all of the nerve tissue is removed and it's filled up.

The challenge is, you can't really completely fill these children's teeth. Like I talk about, we can't really completely fill adults teeth either, but it's even more difficult in these children's teeth because that adult tooth is coming up, it's dissolving those roots, The structure is very different from child to child and in the same child from year to year as teeth are coming in and coming out, everything's different. So what do we do here at Total Care Dental? We do a couple of things differently.

First of all, we work on prevention. So we really work to ensure that we never have to have these difficult conversations with you about your child. But it may be that it's too late for those things that we're already here and we're going to have the conversation. So we do a couple of things different. For a pulpotomy, what we do is we use some medications to treat that nerve tissue that are more biocompatible, that the body likes better. That is what we do when we do a pulpotomy. We also fill it up with materials that the body is going to like better.

So we do some pulpotomies here at Total Care Dental. When would we do them? We do them when a child is quite young. So if there is a baby molar in a child's mouth, and these baby molars come in at two years old, right? If there's a baby molar that has deep decay, tooth still alive, but it's really cold sensitive, the cavity's already getting close to the nerve, what we do is we will remove that nerve tissue on the top, fill it up, and place a crown on the tooth to protect it. Why the crown? Because oftentimes that decay has taken away a lot of the tooth structure and there's just not enough there to hold a filling anymore.

When Infected Teeth Need Removal 6:32

We will do this if a child is particularly young and if it's going to be a long time until those adult teeth come in the mouth. These front teeth, they're lost and replaced at around age, you know, six to eight or so, and then it moves back from there. The very back baby teeth aren't going to be coming out and the adult teeth coming in to replace them until a child is sometimes upwards of 12, 13 years of age. So if one of those baby molars has decay, deep decay, and this child is six years old, they need a tooth in that spot for six years or more.

And the issue is, is if that tooth is removed early, the teeth that are erupting behind it, so those permanent molars that come in behind the baby teeth, they will come in too far forward. Now this is gonna require a lot of orthodontic work to move them back out of the way, so we have room for the adult teeth to come in. So if the tooth is still alive, we will choose to do a pulpotomy to save that tooth in the mouth for as long as we can. Again, a crown goes on the top to help preserve the tooth because there's not a lot of tooth left.

Now if the tooth is already dead, it's already infected, it's swollen, it has pus, any of those things, it's much more likely that that tooth is going to re-infect after treatment. So we don't traditionally do pulp-ectomies. And that situation will remove the tooth and we will plan for something called space maintenance. What is space maintenance? It's holding that space open till we know that permanent tooth would come in. Sometimes it's not possible. Sometimes we're removing teeth on a six-year-old and that tooth isn't going to come in until they're 12. So we will worry about this when it's time to do orthodontics and just know and plan that we're going to have to make space again.

This is all about how do we help the child through their growth and development phases. Toothaches will lead to nutritional issues because they avoid foods that hurt their teeth. Teeth issues also lead sometimes to confidence problems. If they've lost teeth, if they have tooth decay. So we want to help your child through their growth and development ages.

Prevention and Holistic Care 8:40

Teeth issues, if they lose teeth early and the teeth all collapse in, and close up those spaces, it can also lead to airway problems, which leads to growth and development issues, focus problems, cognitive issues, and on and on and on. You can see how important teeth are. You don't really understand this when you're just looking at a tooth. They are so important to the growth and development of the child. So let's recap a little bit. Prevention is number one. What do we do here at Total Care Dental?

We do a few things differently. We use ozone to try and stop tooth decay while it's just starting. We use hydroxyapatite to do the same. We talk to you about nutrition and why this cavity maybe started in the first place. We work hard with things like silver nitrate to stop or slow down decay that may be progressing until perhaps the Child is older and the tooth that's coming in below is about there. We work to really help your child through those growth and development ages. Prevention is key. If the cavity is already to the nerve, not infected, still alive, we will do a pulpotomy and a crown unless the tooth is going to be out in let's say six months to a year.

If that's the case, then we may just help it out a little early knowing that the tooth is going to be there soon. Worst case scenario, tooth is already infected. cavity is already to the nerve, it's already swollen, that tooth is going to be removed and we are going to manage the space for the next teeth to come in properly. These are always difficult conversations. It's never easy to hear that your child has significant tooth issues, but it is so important to know the choices you're making will affect their growth their development and everything that comes later.

So find a holistic dentist, someone that understands all of these things and can support you in supporting your child. If you're local, we would love to see you here at Total Care Kids at Ortho. This is all that we do. We take care of kiddos and we help them to live well because that is my mission. Also check out all of our other videos and information here that you can share with providers near you. because kids are all of our future, and if we can help them to have healthy mouths, we can help them to live well and be well.