Treatment of pulpitis of deciduous teeth in children

Surprisingly, many parents are still convinced that milk (temporary) teeth in a child do not have to be treated, as opposed to permanent ones. Unconscious mothers and fathers claim that they do not treat tooth decay in their children just because these teeth will still fall out anyway. There are frequent cases that do not treat timely and pulpitis of primary teeth, even despite severe pain in the child.

This idea of ​​optional treatment of primary teeth is absolutely wrong, moreover, it is a very dangerous ignorance!

Pulpitis temporary teeth in children in most cases develops on the background untreated caries in time. When a milk tooth begins to hurt, the child experiences no less pain than adults with pulpitis of permanent teeth. Sometimes parents look for ways to help the baby with improvised methods, most often stuffing with “chemistry” (painkillers), which often just do not help, but most importantly, they do not solve the problem itself.

Depending on the child’s immunity, pulpitis in a milk tooth without adequate treatment can go into complications (periodontitis, periostitis and others) both in a few months and in a day. There were cases when the baby died from complications of pulpitis due to blood poisoning, when from the first pulpitis toothaches to severe swelling of the face and subsequent death only a few days passed.

To avoid serious problems, it is necessary to treat caries in children on time, but if pulpitis has been delayed and started, treatment should be done immediately, you should not suppress the pain with pills and wait until the tooth deigns to fall out itself.

 

Symptoms of acute pulpitis of primary teeth

In children acute pulpitis in milk teeth is less common than chronic, but it manifests itself more aggressively than in a permanent bite. The acute form is divided into serous and purulent stages, which determine the condition of the baby, the nature of the pain, as well as the intensity and duration of the attacks.

Acute serous pulpitis of a milk tooth is similar in clinical picture to acute focal pulpitis in permanent teeth. As a rule, for the first time, pain occurs at night. Often a child complains of pain during meals.

In acute serous pulpitis, an inflammatory process develops in the pulp tissues, leading to oxygen starvation (hypoxia) of the pulp. As a result, the so-called serous exudate or serous fluid appears, which fills the channels.

In such cases, the pain is often one-time in nature, temporary teeth with unformed or absorbable roots are affected. Within 4-6 hours after the first pain attacks, acute serous pulpitis passes into the purulent stage, which almost always makes caring parents go to a pediatric dentist.

The severity of the purulent form of pulpitis, as well as serous, is largely determined by the formation of the roots of the milk tooth, the reactivity of the child's body (immunity), the activity of microbes that cause inflammation of the "nerve" inside the tooth and some other factors. For example, sometimes the pain is not expressed, if the child has good immunity, the microbes inside the tooth are weakened and there is an exit of pus through large carious cavitythat communicates with the pulp chamber

The photo shows a pulpitis milk tooth with a deep carious cavity:

However, most often the clinic of purulent pulpitis is bright. It does not look like a clinic of acute pulpitis in an adult, and often occurs with characteristic signs of periodontitis: fever, purulent exudate in the canal, severe pain when chewing.

Among symptoms severe prolonged pain with short intervals between seizures predominates. Often, an acute pain attack in a milk tooth occurs during meals due to temperature fluctuations. Sometimes the baby cannot indicate exactly which tooth hurts, since the pain can be given to neighboring teeth, to the upper jaw.

If the parents do not go to the dentist in time to treat milk tooth pulpitis, then the child may gradually feel worse overall health: the temperature rises, sleep is disturbed, the baby may refuse to eat due to constant pain. It can be very painful to touch the tooth, the gums around it also become painful.

From the practice of the dentist

When they come for an appointment with pulpitic pains, there is almost always a deep carious cavity in the milk tooth. Probing its bottom and extracting softened carious dentin can be very painful. Upon opening (with or without anesthesia) of the layer covering the "nerve", a drop of pus is released from the cavity, but there may still be a living pulp in the depths. Moreover, she often bleeds painfully.

Acute purulent pulpitis is sometimes complicated by periodontitis, lymphadenitis, as well as periostitis ("flux"), and often in a very short period of time, sometimes in a day. Some of these complications are often accompanied by severe intoxication, when all systems of the weakened body of the child suffer and even the threat of the baby's death appears.

Photo of the flux on the gum of a child:

 

Traditional approaches to the treatment of pulpitis of temporary teeth in children

Based on the fact that acute pulpitis of a milk tooth is such a state of inflammation of the “nerve” that can lead to very tragic consequences, the primary goal of treatment is to eliminate such risks. On the one hand, tooth extraction is easiest, but tooth extraction is almost always a trauma for the baby’s fragile psyche, it is a surgical operation and, in the end, there may be a permanent malocclusion in the future.

Let's look at how pediatric dentists treat milk teeth for pulpitis in some budgetary organizations: hospitals or polyclinics at the place of attachment. To treat pulpitis of temporary teeth, the antediluvian method of devital amputation is still used there, which, however, is still popular in some private clinics.

This method is to some extent gentle for the child's psyche, since it does not require exposure to tools on the milk tooth canals. Instead, an arsenic paste for a period of 24 to 48 hours, or a devitalizing paste that does not contain arsenic, for a period of up to 7 days or more, is placed on the opened "nerve" for the first visit.

On the second and subsequent visits (1-2), “pumping” of the resorcinol-formalin mixture and then the paste is killed at the beginning of the canals of the milk tooth. The paste effectively mummifies the infected pulp, thereby preventing its putrefactive decomposition. Usually in the third or fourth visit to a temporary tooth a permanent filling is established.

On a note

Almost every dentist in Russia has directly or indirectly encountered and often continues to experience results. treatment of pulpitis in adults and children with the devital method, during which resorcinol-formalin paste was used. After such treatment, the teeth after a while become stained in any shade of red: from pink to dark red and brown.

Due to the fact that over the years this paste creates a “plug” in the channels of permanent teeth, it is almost always difficult or impossible to retrain such a tooth. Dental surgeons who specialize in extractions when faced with similar teeth warn patients in advance that there are serious risks of complex and lengthy extractions, since resorcinol-formalin paste, in addition to “narrowing the channels” for many years of existence, also solders the roots of the tooth with the surrounding his bone. Often in such situations, the root of the tooth crumbles and leaves the hole in small parts.

The photo shows what a permanent tooth looks like in an adult several years after treatment of pulpitis with the use of resorcinol-formalin mixture:

 

Modern methods and means of treating pulpitis of primary teeth

For calm children who can withstand prolonged treatment of pulpitis of milk teeth with formed roots, vital or devital extirpation is applied (treatment in two or three visits). In the first case, the “nerve” is immediately removed from the canals, and with devital extirpation, the devitalizing paste is first placed on the opened pulp on the first visit to kill it.

Photograph of the removed dental "nerve":

After thorough mechanical and drug treatment of the canals of the milk tooth with the extraction of infected pulp and the creation of sterility, the canals are filled with paste, which has an anti-inflammatory effect and eventually resolves with the roots when changing the temporary tooth. Most often, pediatric dentists use zinc-eugenol paste as a root filling, but the paste, which is preferred by foreign colleagues, Magipex, has proven itself well.

Studies have shown that only a good cleaning of the root canal system leads to a normal result, preserving the milk tooth from the repeated activation of infection in it until the physiological shift. However, there are many supporters of an equally effective and modern method: vital amputation, which involves only partial removal of the upper (coronal) part of the “nerve”, and a special medicine is installed on the root pulp.

Previously used preparations based on eugenol paste and calcium hydroxide have been successfully replaced by Swiss-made Pulpotec (Pulpotek) and its Russian analog Pulpotent (VladMiva), which have a long anti-inflammatory, antiseptic effect and hermetically cover the pulp root stump.

On a note

Pulpotec powder contains iodoform (a strong antiseptic), polyoxymethylene (for surface protein denaturation) and zinc oxide, and the liquid contains dexamethasone acetate (anti-inflammatory effect), formaldehyde (antiseptic and mummifying effect), as well as antiseptics phenol and guaiacol.

The drugs can not only keep the root pulp in a viable state, but also prevent the development of pain during and after treatment. Unlike resorcinol-formalin paste, Pulpotec and Pulpodent do not stain the tooth and are not as toxic to the body, reducing the number of visits to the child to a minimum.

 

The specifics of the treatment of pulpitis of a milk tooth with unformed roots

In order to better understand how pulpitis of a milk tooth with unformed roots is treated, you should first understand the terms. Unformed roots are the roots of a temporary tooth that have an unclosed apex after eruption of a milk tooth. The complete formation of the roots usually lasts several years, as well as their resorption during physiological change of teeth.

In case of infection from the carious cavity into the pulp chamber, pulpitis can develop, which should be treated immediately to avoid the development of complications that pass to the rudiment of a permanent tooth.

A feature of the choice of the method of treating pulpitis in the case of unformed roots is the impossibility of applying extirpation methods, that is, complete pulp extraction and channel processing along the entire length of the root. That is why pediatric dentists prefer biological and amputation treatments for such cases.

Consider first the biological method for the treatment of pulpitis of a deciduous tooth (conservative). This method involves maintaining the entire pulp in a viable state, however, it has many contraindications and requires the observance of ideal asepsis and antiseptics during operation to avoid repeated pain.

First, under the anesthesia, the carious cavity is cleaned of necrotic tissues, and therapeutic paste (usually based on calcium hydroxide) is applied to the bottom of the cavity or directly to the opened pulp for several days. After the cessation of pain, a permanent filling is placed on the milk tooth.

Thanks to the biological method of treatment, the tooth remains alive, that is, the stored pulp allows you to supply its tissues with nutrients, maintaining high strength. But a tooth with a removed “nerve” over the years becomes more and more fragile and prone to spalling of the walls bearing the seal.

Amputation methods for the treatment of pulpitis of deciduous teeth with unformed or absorbable roots are very popular among dentists. The essence of such methods follows from their name - the infected pulp is simply amputated, removing from the pulp chamber.

In this case, both “ancient” methods of devital amputation by the resorcinol-formalin method can be used, as well as modern vital (under anesthesia and without arsenic) amputation techniques with therapeutic coating of the root pulp with antibiotics, enzymes, calcium-containing preparations, etc. Pulpotek and Pulpodent preparations "Also suitable for the treatment of pulpitis in deciduous teeth with uncovered root tips.

In the photo - arsenic-containing temporary filling in the tooth:

It is interesting

Devital amputation is a method of treating pulpitis, which initially involves killing the pulp and then mummifying it with potent and often toxic pastes. To cure pulpitis with this "old" method, you need not one visit, but three or more. Long-term results, taking into account many years of experience with this method, most often turn out to be negative.

 

Possible errors in treatment and how they threaten the child

During the treatment of pulpitis of milk teeth in children, medical errors are more common than in adult dentistry. This is due to the specifics of children's admission, when the child often interferes with the doctor to carry out all the necessary manipulations with proper accuracy and in full. To minimize the severity of mistakes and for violent children, children's dentists can resort to devital amputation with the resorcinol-formalin method, since in another way the child simply does not give the opportunity to save the milk tooth until its physiological shift.

In pediatric dentistry, for the treatment of pulpitis of a deciduous tooth, for example, an error such as an incorrectly placed paste for pulp devitalization is encountered. The hardest result of such an error is tolerated if the paste is arsenic. If the child does not allow the tooth to be treated qualitatively, then the doctor puts it not on the opened "nerve", but on the soft bottom of the prepared cavity, because of which it often not only does not work, but also causes even more severe pain. An urgent help in this case is to re-paste the paste.

There are cases when the devitalizing paste is placed next to or directly on the gum, since in children the carious cavity is often occupied by the overgrown gum or is located close to the gingival papilla. The consequence is severe pain, and upon the arrival of the child to the doctor, a burn caused by the components of the paste is found on the gum. Prevention of such a complication is compliance with the paste formulation technique, and when you get a burn, you need to prescribe anti-inflammatory wound healing gels or pastes.

During treatment of canals in a milk tooth with pulpitis, bleeding may occur due to the fact that the tops of the roots may not be formed or already slightly resorbed, and the dentist can forcefully remove files from the canal processing (special needles) outside the root, injuring adjacent tissues . It is difficult to stop bleeding even with special drugs.

Sometimes an inexperienced doctor may make mistakes such as perforation of the root and breaking of the instrument in the tooth canal. Since the channels in milk teeth are almost always very wide, the percentage of such complications is very low, but the severity is the same as in the case of permanent teeth in an adult. As a result of perforation of the tooth root and fracture of the instrument in the canal, periodontitis or periostitis can subsequently develop due to inflammation of the tissues around the root.

To prevent these complications, the pediatric dentist removes a chip from the channel in an accessible way, and closes the perforations with special material, for example, ProRoot MTA. In some cases, for lack of necessary equipment and materials, the doctor simply mummifies the canals with the resorcinol-formalin method.

The photo shows an example of a tool broken off in a tooth canal:

 

How to prepare a child for treatment

In order for the child not to be afraid to treat teeth (even with severe pain during pulpitis), it is required long before that to make the first preventive visit to the pediatric dentist. The success of the first visit depends equally on the dentist and the baby's parents.

The visit should be for guidance only. During it, the child gets acquainted with the new cabinet environment, tools, showing only curiosity, not fear, but even such a visit requires preparation.

Before going to the dentist, follow these recommendations:

• talk with the child before the preventive visit 1-2 days before he hears “horror stories” from peers;
• tell your child only about positive experiences;
• Do not emphasize the importance of the event, as caring for health is a common procedure;
• tell us about your future visit to the dentist as about meeting a new friend;
• play "at the dentist" with the whole family: show an example that you are not afraid of the doctor yourself;
• do not use scary dental words;
• do not deceive the child that it will not hurt, better say that it will probably be unpleasant at first, but then the tooth will not hurt;
• Do not experience fear and panic yourself, then this will not be transmitted to the baby;
• the best option for a visit to the dentist is the morning when the child slept, ate well and was active;
• it is better if you go to the dentist with your favorite toy so that the child constantly fumbles in his hands;
• let the doctor find contact with your child without your help;
• if the child resists, interferes with the reception, then he should not be intimidated, threatened, implored, etc.
• you should try to gain the trust of the child, so if the situation is out of control, it is better to postpone the next time.

If the child is initially uncontrollable and anxious, often falls into hysterics, then he should be prepared medically, relieving the upcoming stress. An over-the-counter drug Tenoten Children’s is ideal for this. 20 minutes before the treatment of caries or pulpitis of primary teeth, the child should be given one tablet under the tongue for resorption.

With high or moderate stress, Tenoten relieves tension, causing inhibition of mental processes. As a rule, after 20-30 minutes the child gives all the necessary manipulations.

To make the child feel comfortable in the dental chair, it is necessary with early age start a visit to the dentist for the purpose of prevention. With the proper level of hygiene, timely preventive examinations and quality control of toothbrushing, you can avoid not only pulpitis, but also caries, and save the baby's teeth until their physiological change.

 

An interesting video about the importance of treating pulpitis in primary teeth

 

A few more useful doctor's explanations regarding pulpitis of primary teeth