Symptoms that indicate a need for endodontic treatment can include toothache, sensitivity to hot and cold, or if the pulp has been exposed due to fracture and the child is experiencing sensitivity.
The type of endodontic treatment that may be recommended depends on how seriously the pulp is affected, an evaluation of the tooth and the results of an X-ray. There are two types of pulp therapy, depending on the condition of the tooth pulp:
1) Vital Pulp Therapy the goal of vital pulp therapy is to preserve and protect the pulp. In this procedure, the pulp is only removed from the crown of the tooth and not from the root. Vital pulp therapy is only recommended if there is no swelling or abscess and the tooth is not loose. There are four main types of vital pulp therapy for baby teeth:
Protective Base – This treatment is done when the tooth is only affected by decay and the pulp is healthy. First the decay is removed, then a protective material is inserted into the tooth and then the tooth is filled.
Indirect Pulp Cap – This treatment is carried out when decay has come close to the pulp but does not reach it. The endodontist will remove as much of the decayed matter as possible without touching the sensitive pulp. A protective dressing is placed to cover the pulp which helps to speed up the healing process. A filling is placed on top of the dressing.
Direct Pulp Cap – This procedure is performed when a little bit of the healthy pulp has been exposed due to tooth decay or fracture. Medicine is applied to the exposed pulp to prevent infection, then the pulp cap is placed and the tooth is filled. Direct pulp cap procedures have a higher success rate in permanent teeth, so this therapy is rarely used for baby teeth.
Vital Pulpotomy – This treatment is an option when only the crown portion of the pulp has been damaged by decay or trauma and the root portion is still healthy. The dentist will remove all tooth decay along with the damaged portion of the pulp, leaving the healthy root pulp intact. Medicine is applied to the exposed portion of the root, and the tooth is filled and enclosed with a stainless steel crown. The crown protects the weakened tooth from future fracture or damage. If a vital pulpotomy is performed on a child’s permanent tooth, it is usually done as a temporary measure to allow the tooth’s root to finish growing. If necessary, a complete root canal treatment may be performed once the tooth root has matured.