Are Root Canal Treatment (RCT) Needed? Causes, Signs & Therapy

Often parents come to me with a lot of anxiety because their child would have been advised a root canal treatment for his or her milk tooth. This anxiety precipitates to the question that why does the milk tooth need an RCT (root canal treatment) when it is going to fall out anyway. Are Root Canals for Baby Teeth Necessary? To answer this question we must first understand the anatomy or makeup of our teeth.

Children’s teeth are primary teeth & also called milk teeth. There are 20 in total, due to jaw size being small for young children. Primary teeth eruption begins at the age of 6-10 months and continues to about 24-39months. There are three types of teeth; incisors (cutting teeth), canines (tearing teeth), and molars (grinding or chewing teeth). Each tooth consists of two parts, a crown, and a root. Crown is the portion we see in the mouth, visible to us and root, which embeds itself in the jaw. The tooth has three layers starting with enamel which is the protective layer, also considered the hardest tissue in the body then comes the dentin, which forms the main bulk of the tooth and lastly the pulp, which houses the nerve and blood supply of the tooth. The purpose of the primary teeth is to breakdown food into smaller pieces to aid in digestion and maintain space for permanent teeth to come through.

Signs & Symptoms That Require Root Canal Therapy

In children, dental caries and traumatic injury are the most common reasons for a need to do an RCT. When the tooth starts decaying and the extent of decay spreads deep into the dentine-pulp border, the patient may have the following symptoms...

1. Pain at night
2. Pain on biting, exposure to hot and cold
3. Intra-oral or extra-oral swelling

Root Canal Treatment Therapy

A cavity involving the nerve of the tooth may cause a child to experience intense pain. In such a case the dentist would decide what treatment to give to the pulp, which is called pulp therapy. This may be in the form of a root canal, Pulpotomy or pulp capping for the affected tooth depending on patient s symptoms and radiographs. The purpose of pulp therapy is to maintain the vitality of the affected tooth so that the tooth will not be lost early. Early loss of back or posterior primary teeth may cause future problems with eruption of the permanent teeth. [Read - What Toothpaste to Buy?] 

There are four forms of pulp therapy is given below...

1. Indirect Pulp Capping

This involves, where deep decay is approaching or barely exposing the pulp where removing all the decayed parts of the tooth would expose the pulp. Instead, as much soft decay is removed as possible leaving only harder remnants without penetrating into pulp. We then apply an antibacterial agent and sealing it further with a filling to prevent infection. These materials reduce acidity caused by decay and sterilize surrounding infected dentin. By allowing the inflammation to subside, reparative dentin is deposited by pulp to further protect itself.

2. Direct Pulp Capping

This involves covering the exposed area of the pulp with calcium hydroxide in cases where there is mechanical or traumatic exposure not because of carious exposure.

3. Pulpotomy

This involves removing the coronal (crown) portion of the pulp leaving the root portion of the pulp behind. The main purpose behind this is to preserve the healthy part of the pulp by removing the diseased tissue. Next, a biocompatible medication is placed to prevent bacterial growth and to sooth the remaining nerve tissue. A final filling and mounting a stainless steel crown follow this.

4. Pulpectomy

This Involves complete extirpation or complete removal of the pulp oath from the crown and root portion of the tooth. The canals are cleaned, disinfected and filled with a resorbable material. The final filling and crown are then given.

After endodontic (RCT) treatment there might be mild soreness, this can be treated with appropriate painkillers. Keep in mind; all these procedures are best performed under local anesthesia. Sometimes if the patient is not co-operative then mild sedation or nitrous oxide can also be used under appropriate conditions. In nutshell, my friends, please have a regular family check-up with your dentist, and keep smiling!!