Root Canal Treatment for Baby Teeth - Pulpectomy

What is a Pulpectomy?

Pulpectomy is the name given to root canal therapy for baby teeth. This is required when decay or injury to a tooth has caused infection of the nerve. The aim is to keep the tooth until the correct time for it to fall out. 

I have been told my child needs a pulpectomy - why can't he just have a normal filling?

It is possible to place a filling in cases where the decay is only affecting the first two layers of the tooth - the enamel and the dentine. 

Diagram is of an adult tooth but illustrates the same stages of decay

Once there is infection within the nerve of the tooth this needs to be dealt with properly. If this is not done the nerve will eventually die and an abscess can occur when the infection spreads outside the tooth. Apart from causing severe pain, dental abscesses can cause fever and other health problems. As adult teeth develop close to the roots of baby teeth untreated infection can spread to and affect the normal development of the permanent teeth.

It's just a baby tooth - wouldn't it be better to pull it out?

Although they are lost early in life, primary teeth, also called baby teeth or milk teeth, are essential in the development and placement of the permanent teeth.

Baby teeth maintain the spaces for permanent teeth to erupt into. If baby teeth are lost too early other teeth may tilt into or take up the vacant space, forcing permanent teeth to come in crooked. 





If the baby tooth is getting close to being pushed out by the adult tooth that replaces it, a pulpectomy may not be advised. This can be judged by looking at an x-ray of the teeth. In this case the baby tooth can be left to fall out naturally or, if there is spreading infection, may need to be extracted.

How is a pulpectomy done?

1. An opening is made through the top of the tooth. If the nerve is not completely dead, local anaesthetic will be required to numb the tooth first - click here for more information on this.
2. The decay and infected nerve are removed. The root canals are cleaned and shaped using small files and then washed and dried. 
3. The empty root canal space is then filled with a paste which is able to resorb as the tooth root loosens to make way for the new adult tooth.
4. A filling is then placed in the top part of the tooth. An x-ray will be taken to check the root filling.

Most teeth with pulpectomies will require a crown (cap), as when the nerve is dead or removed the tooth is more brittle and more likely to fracture. For baby teeth near the back of the mouth a pre-formed metal crown is most often used. This may be done or the same or the next visit.

Will the procedure be difficult for my child to cope with?

Pulpectomies do require slightly more cooperation from your child than for a simple filling. However, as baby teeth have shorter, wider and less complex root canals than adult teeth the procedure is less complicated and takes less time than for root canal treatment in adult teeth. There should be no pain, as long the tooth has been numbed where this is required. Your child might feel a slight tugging sensation while the canals are being shaped using the files. The procedure is usually completed in one visit of approximately half an hour, but make take two visits if the nerve is very infected.

What is the success rate for pulpectomies?

Clinical studies have shown a 78 to 96% success rate with the latest materials use for filling root canals in baby teeth. 

Are there any precautions that should be taken after treatment?

• Avoid eating and drinking for the first 20 minutes.
• If your child had local anaesthetic to numb the tooth they will need to be careful not to bite their lip or tongue until the numbness has worn off.
• On the day of treatment it is best to stick to softer foods that don't require a lot of chewing and avoid very hot food and drinks.
• There is sometimes some mild pain or discomfort as the tooth settles down. This can be relieved using children's paracetomol. (Calpol or Crocin).
• Your child should avoid biting heavily on the tooth until it is restored with a crown, as it may be brittle and prone to fracture.
• The teeth should be brushed normally.

How you can influence your child's dental health

Children learn by copying important adults in their lives. This is a natural process by which children learn about the world around them. 

Your behaviour, expressions  and reactions will usually have a greater impact on your child than what you say to them. 

Parents have a unique position of influence in their children's lives, as a role model and first teacher. This influence can have either a positive or negative effect. How can we use this influence in a positive way to improve our children's oral health?

• Parents choose what babies and young children eat. Parents usually introduce children to the same foods that they eat.  If children are given a healthy, balanced diet at an early age they are much more likely to choose a healthy diet themselves when they are older. 
• If you are constantly snacking on high fat and high sugar snacks your children are likely to do the same. When shopping, plan your meals and also think about healthy food to keep in the house for snacks when you or your children get hungry between meals. 
• For more information on a diet that is good for you teeth see this link.

• Give your children a good example to follow by letting them see you brushing your teeth regularly. 
• Teach your child about the importance of looking after their teeth. There are books and videos which can make learning fun.

• You will need to brush your child's teeth until they can learn to do it effectively for themselves from around six years old. Older children will still require encouragement and supervision. Also see post on top toothbrushing tips.
• Children whose parents regularly visit the dentist are more likely to do the same.
• Take your child to visit a dentist before they have any pain or problems. Find a dentist who is good with children. Regular check-ups enable the dentist to assess your child's risk for developing decay or gum disease and give preventive advice. Any problems can also be seen early and treated or prevented from progressing.

Did you know that children whose parents are anxious about visiting the dentist are much more likely to become anxious themselves? A recent study showed that parents' attitude towards dentistry are often passed on to their children.

Children look to their parents to learn how to respond  to a new situation and can pick up on their parent's anxiety. This means that some children are very anxious even before they first visit the dentist.

We will look at ways to help anxious children in a future post. For help on overcoming your own anxiety, see this blog (click for link)

Even if you are anxious, try not to let this show to your child. Avoid making negative remarks about the dentist in front of your children.

Once children get interested in looking after their teeth they can be encouraged to see the dentist as someone who helps them to stay healthy.