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.

Does a mother's dental health affect her baby?

When should we start thinking about our children's oral health?

Newborn babies do not yet have teeth - surely this is too early to worry about cavities or gum problems? 

What about during pregnancy?

Expectant mothers are keen to do everything they can for the health of their baby. However, many are unaware that  their own dental health problems can have effects on their general health and their unborn child. 

Research has shown that mothers with gum disease have a three times greater risk of poor and pregnancy and birth outcomes such as pre-term deliveries and low birth weight. This can occur as bacteria from the mouth and their by-products have the ability to cross the placenta to the developing baby and trigger inflammatory responses. Another study has shown a link between gum disease and pregnancy (gestational) diabetes.

Also, mothers with poor oral health and high levels of the bacteria which cause dental decay are at greater risk of passing these bacteria to their newborn babies, putting them at an increased risk of developing dental cavities at an early age. For more information on this, click for the previous blog post.

Problems with oral health in pregnancy

Unfortunately, due to pregnancy hormones, some women can be more susceptible to gum problems during pregnancy. Warning signs of periodontal (gum) disease include swelling, redness, bleeding and sensitivity.

Nausea and vomiting and extreme tiredness can also cause problems and lead to dental hygiene being neglected. Pregnancy cravings and the need to each more frequently may increase the risk of dental decay if sugary snacks are consumed often. 

Many women are concerned about the safety of dental treatment during pregnancy. However, treatment should not be unnecessarily delayed if appropriate safety precautions are taken. Active decay should be removed and the cavity filled. Pain and infection should not be left untreated, as these can cause stress and danger to both the mother and her developing baby. 

Guidance for expectant and new mothers

• Remember that your own dental health can have an effect on your baby, both during pregnancy and after birth.
• See a dentist for a consultation as soon as possible. Be sure to tell your dentist if you are pregnant as this may affect the treatment or medication prescribed. 
• Cleaning (scaling and polishing) and many other treatments are safe during pregnancy, you can discuss the best options with your dentist. 
• The second trimester (14th to 20th week) of pregnancy is usually the best time to get treatment done if required.
• X-rays are generally avoided during pregnancy but if they are required for urgent treatment then small x-rays using a lead apron to protect the rest of your body can be taken.  
• Maintain your oral health during pregnancy to prevent gum disease and decay. Try not to neglect brushing and flossing.
• If you are having gum problems, in addition to regular professional cleaning, using a chlorhexidine (antibacterial) mouthwash may help.
• Diet and nutrition is especially important during pregnancy. Although you will need to eat more frequently, try to choose snacks that are sugar free between meals.
• Take your new baby to see a dentist when they are 1 year old. An early check-up enables the dentist to assess the risk factors for your child developing dental decay and give personalised preventive advice.

Is Dental Decay Contagious?

Tooth decay is the single most common chronic childhood disease, despite also being preventable.

Is dental decay a contagious disease? 

Is it possible to catch it from someone else?

In a previous post we discussed what causes dental cavities. 

To summarise, bacteria (germs) in our mouths convert sugar in food and drink that we consume into acid which damages teeth.

Bacteria live in dental plaque - a sticky film which builds up naturally on our teeth. Dental plaque contains many types of bacteria but only a small number of these cause dental decay. The main type of bacteria which causes dental caries is Mutans streptococci. Studies have shown that individuals with higher levels of Mutans streptococci are at a greater risk of cavities.

Recent research has shown that babies are not born with decay-causing bacteria. Any time after birth bacteria can be passed on from other people, especially mothers and other close caregivers. Once these bacteria are transmitted to a babies mouth, especially after the first teeth come through, they multiply and become established within dental plaque.

Bacteria can enter the baby's mouth by kissing, sharing food utensils, toothbrushes or other habits that transmit saliva.

If parents and other caregivers have cavities and poor oral hygiene they will have higher levels of decay-causing bacteria which can be passed onto their child.

The risk of a child developing cavities will be less if they are not infected with decay-causing bacteria at an early age.

Children can also "catch" bacteria from other children by sharing food and toys, but they are more likely to receive bacteria from their mother and other close relatives before this happens.

What can be done to reduce the risk?

Parents and caregivers can reduce the risk of passing on decay-causing bacteria from their own mouths by:

• cleaning their own teeth well, to reduce the amount of plaque (which contains bacteria)  in their mouths
• avoiding sugary snacks and drinks between meals which can lead to decay 
• visiting the dentist regularly for check-up and getting any cavities filled 
• avoiding sharing items such as food, spoons, cups and toothbrushes with their baby
• kissing the baby on their cheek, rather than the mouth