Modern approaches to the treatment of pulpitis in primary teeth in children

Pulpitis is the inflammation of the pulp, the tissue located inside the tooth. This disease poses a fairly serious threat to the child’s body as a whole. Therefore, it should be taken as seriously as possible.

For those who doubt whether pulpitis of baby teeth occurs in general, we will answer unequivocally: it happens. And besides, it usually progresses much faster than in adults. In children, the hard dental tissues are thinner, and the dentinal tubules, on the contrary, are wider, which leads to the rapid development of infection inside the teeth. Therefore, in childhood, this disease much more often acquires a chronic form with all the ensuing consequences.

Why does pulpitis of a baby tooth occur? How to detect it? And what should parents do if this misfortune befalls their dear child?

Causes of pulpitis of primary teeth in children

Most often, according to dentists, this very unpleasant disease in childhood is caused by:

• If caries treatment is not carried out on time - in this case, microbes developing in the carious cavity and tooth tissue disintegrating under their influence provoke the active release of toxins. Under their influence, the inflammatory process of the pulp most often begins, which, if left untreated, can lead to very serious consequences.
• An acute infectious disease suffered by a child - during the course of an infection, tooth pulpitis in a child, as a rule, occurs against the background of decreased immunity and the appearance of a large number of bacteria.
• Injury to a baby tooth - this can be either an accidental damage to the tooth during play or rest, or too rough treatment of the oral cavity in the presence of caries, or even a careless action of the dentist;
• Medical errors in the treatment of caries - inflammation of the pulp can develop under the influence of incorrectly selected filling material or as a result of treating the oral cavity with too strong antiseptics, for example, alcohol, as well as due to overheating of dental tissues during the preparation of a carious cavity.

Incidence of pulpitis

Many parents do not take their children to the dentist, believing that pulpitis cannot develop in a child at 2 years old. Mothers think that if they don’t give their baby sweets, then caries won’t affect the enamel. Unfortunately, they are wrong. Tooth pulpitis can strike a child at 2, 3, or 5 years of age.

• At 2 years of age, pulpitis affects the baby's front teeth;
• From 3-4 years of age, children more often suffer from pulpitis in the back teeth. Often a 4-5 year old child comes to the dentist crying from pain in his molars. Surprisingly, such inflammations occur several times more often than pulpitis in the front teeth of children.

What symptoms indicate pulpitis of primary teeth?

The following will help you tell if your child has pulpitis:

Complaints about toothache

As a rule, it worsens in the evening and at night, as well as during the process of chewing food. There is almost always a reaction to cold or hot drinks. Painful sensations may occur when tapping the tooth. With an exacerbation of the inflammatory process, the pain becomes aching and constant.

However, it should be borne in mind that the rapid transition of the disease into a chronic form, characteristic of childhood, often leads to the disappearance of pain. Which does not mean there is no problem. And you should visit a doctor even if the tooth stops hurting.

Cheek swelling (swelling)

This symptom can often be found in photographs of pulpitis in baby teeth. However, it is not always observed. And, in addition, it can signal diseases such as periodontitis or periostitis. But pulpitis should not be ruled out. Only a doctor can make an accurate diagnosis. And you may have to take an x-ray.

Increased body temperature and deterioration of general condition

If the child has a strong immune system, then a high temperature may also indicate the development of the disease. In this case, the body reacts to the inflammatory process that began in the pulp. And if there are no suspicions of other diseases accompanied by an increase in body temperature, be sure to show the child to the dentist.

If your baby has a toothache, or you observe any of the above symptoms, you should immediately visit a doctor. Perhaps it's time to start treating baby tooth pulpitis. In any case, there is definitely a reason to visit the dentist’s office.

Preparing for treatment

So that the child is not afraid of dentists, the first visit should be preventive. It is carried out only to familiarize yourself with the environment of the doctor’s office and the instruments used. Before you go to have your teeth treated, you should:

• Talk to your child about doctors who treat teeth.
• Tell your child about the positive effects of treatment.
• Emphasize that this is a common procedure for all people to take care of their health, and not something very important and exceptional.
• Play “dentistry” with toys and family members.
• Do not frighten your child with scary terms.
• Don't lie that there won't be any pain. It is better to say that there may be some discomfort, but as a result the toothache will stop.
• The parents themselves should not panic or be afraid, so that the excitement is not passed on to the child.
• Visit the doctor in the morning when the child is active, not hungry or sleepy.
• Bring your favorite toy with you so that it remains in the child’s hands during the visit.
• Give the doctor the opportunity to communicate with the child without parental participation so that the doctor finds contact.
• Do not intimidate or beg the child if he does not allow himself to be examined.
• If you have lost control of the situation, reschedule the appointment for another time.

How to treat pulpitis of baby teeth

If you suspect that your son or daughter is suffering from this particular illness, then the best thing to do is to seek professional help as soon as possible. Because the disease is quite serious, and it requires correct diagnosis and qualified medical intervention.

There is no need to remove the tooth at all. Moreover, early removal can lead to the formation of an incorrect bite. The course of treatment of pulpitis in children largely depends on the stage of tooth development at which it is detected.

The fact is that the pulp can be completely removed only in the formed roots (and this takes several years from the moment the tooth erupts). Therefore, in most cases, the doctor removes the pulp only partially. As a rule, carious lesions are removed simultaneously with its part located in the crown of the tooth. This procedure is carried out after an anesthetic injection. After that, a medicine is placed at the bottom of the cavity and at the mouths of the canals, designed to disinfect the remaining tissues. Or, the pulp is first mummified, also through the application of drugs, and then removed.

Over time, such a “gasket” of medications is replaced or left under a permanent filling.

In case of pulpitis of milk teeth, first of all, it is necessary to eliminate the inflammatory process and prevent complications in the form of periodontal damage, which can cause improper formation of permanent teeth. There are 3 main methods in total.

Traditional

In most pediatric dentistry in public institutions, pulpitis is treated in a method called “devital amputation.” It involves several visits to the dentist:

1. On the first visit, the nerve is opened and a paste with devitalizing properties is applied to it (it “kills” the pulp). If it contains arsenic, then keep the paste in the tooth for 24-48 hours. Arsenic-free paste is applied for a period of up to 7 days.
2. In the next two visits, a special mixture is “pumped” into the tooth canals to mummify the infected pulp. Usually this is a resorcinol-formalin mixture.
3. At the next visit, a permanent filling is installed.

Biological method of treating pulpitis in children

Several years ago, dentists began to practice conservative methods of treating pulpitis in children. This conservative therapy does not require surgical intervention, is easier for the baby to tolerate and causes minimal complications.

Conservative treatment of pulpitis of primary teeth is carried out in stages:

1. The doctor opens the inflamed cavity.
2. Covers the bottom of the gum and pulp with a special mixture consisting of Shostakovsky balm, calcemin and artificial dentin.
3. After the mixture dries, the dentist seals the tooth using fluorine cement or phosphate cement spacers.

Doctors are ambivalent about such a procedure. Some consider biological treatment of pulpitis in children to be an excellent way to relieve the child of pain and create the most favorable conditions for the development of the apices of the roots of permanent teeth.

Many dentists believe that it is the conservative method of treating pulpitis of baby teeth that can provoke various periodontal inflammations.

In any case, treatment of pulpitis of primary teeth requires repeated visits to the doctor and a serious approach. Therefore, be persistent and patient, and also try to set up your child correctly so that every trip to the clinic does not become stressful.

Please note that there is no general approach here. The inflammatory process occurs differently each time. And only a doctor can decide how to treat pulpitis of a baby tooth in each specific case.

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Possible mistakes when treating pulpitis

Unfortunately, it is not at first glance that tooth pulpitis in a child is a simple ailment. Incorrect treatment can provoke nightmares such as periodontitis, periostitis and even acute polio.

The most common mistakes when treating pulpitis in children are:

• Incorrect assessment of the condition of the pulp and, consequently, partial removal of inflammation. In this case, the baby will very soon suffer from a new exacerbation.
• Loose bandage when removing pulp. In rare cases, doctors do not apply a temporary bandage with arsenic tightly enough, which can lead to burns and necrosis of the tissues of the cheek, tongue and mucous membranes.
• An overdose of arsenic can cause acute periodontitis, which requires longer treatment than pulpitis in a child.
• Trauma to the periodontium with a root needle. Incomplete cleaning of root canals during the treatment of acute or chronic pulpitis in children can also provoke periodontitis.

When should you visit a dentist?

The sensitivity of the neurovascular bundle of a tooth in a child is lower than in an adult, so the symptoms of its inflammation may be erased or absent altogether. It is important to contact a pediatric dentist when the first symptoms of caries appear - a dark spot on the tooth, or the child complains of pain. You should hurry up with your visit if:

• severe pain;
• increased pain when eating hot or cold food/drinks;
• bad breath;
• elevated body temperature;
• inflammation of the gums around the tooth;
• darkening of the enamel.

Treatment of pulpitis: how to adjust a child

Pulpitis of baby teeth causes a lot of trouble for the baby. There is no need to aggravate the already difficult days of the child; parents should definitely prepare him for a visit to the dentist.

Talk to the baby. Explain that the doctor will treat tooth pulpitis carefully and the patient will not feel pain. It is important that the child does not associate going to the dentist with torture chambers. Choose a positive doctor whom you trust, and dental treatment will become an exciting attraction.

The main task of parents is not to let the disease take its course. Since chronic pulpitis of the baby tooth, which is most often seen in the photo, can lead to further spread of the inflammatory process and damage to the rudiments of permanent teeth.

And don’t forget that preventing trouble is always easier. Therefore, do not allow pulpitis. Ensure that your child brushes their teeth correctly and regularly using high-quality oral hygiene products. And be sure to visit your dentist regularly.

ASEPTA BABY toothpaste for babies from 0 to 3 years old will help you quickly teach your baby to brush their teeth. The soft gel carefully cares for your teeth, reliably protecting them from caries. And the sweet taste of tutti-frutti makes the procedure pleasant and tasty.

Modern

If the child is calm and can withstand a long stay at the dentist, as well as in the case of formed tooth roots, a treatment method called extirpation is used. It can be vital, when the nerve is removed from the tooth during the first visit to the doctor, as well as devital, in which the pulp is opened and treated with a killing paste.

When the tooth canals are thoroughly processed, infected tissues are removed and sterile conditions are created, an anti-inflammatory paste is used to fill them, which will be absorbed along with the roots during the period of tooth change. The most commonly used is zinc eugenol paste. The method is effective, but to prevent the infection from reactivating again, cleaning the canals must be very thorough.

Another modern method is called vital amputation, the essence of which is to remove the upper section of the nerve and install a drug with an antiseptic and anti-inflammatory effect on the remaining pulp (Pulpodent and Pulpotek materials are often used). The medicine hermetically seals the lower part of the pulp, maintaining its viability.

Pulpitis of permanent teeth in children

Pulpitis of permanent teeth in children is a common ailment among adolescents. Surprisingly, newly erupted molars are especially sensitive to external influences, because during the first few years they are not yet saturated with mineral components.

Pulpitis of permanent teeth in children most often develops against the background of deep or medium caries. And if in children with formed tooth roots, pulpitis develops in the same way as in adults, then in adolescents with just developing roots, this ailment is significantly different from what is usual for parents.

Symptoms of pulpitis of permanent teeth in children

Acute pulpitis

Features of pulpitis in permanent teeth with incomplete growth include:

• Spontaneous pain. Children complain of unexpected, mild pain in the mouth. Unpleasant sensations arise suddenly, for no apparent reason. The pain can torment a teenager for hours, or it can go away on its own in 15-20 minutes. Often, various irritants, such as cold or hot food, cause discomfort.
• With acute diffuse pulpitis of permanent teeth in children, discomfort intensifies in the evening and at night. Soon the pain becomes constant, radiating to the temple, back of the head, ear or infraorbital area. Very soon, painkillers become ineffective.
• Softened dentin of the carious cavity, weakly pigmented, also indicates tooth pulpitis.
• Acute throbbing pain radiating to the trigeminal nerve is also a symptom of acute purulent pulpitis with incomplete root formation. It is noteworthy that the pain intensifies when consuming hot food or drinks and is relieved by cold food.

Chronic pulpitis

Chronic pulpitis of permanent teeth with unfinished growth, as in baby teeth, can occur as a primary process without an acute stage. The following symptoms are characteristic of chronic inflammation:

• Aching spontaneous pain;
• Unpleasant sensations when eating or pressing on a tooth;
• Prolonged pain from cold or hot food;
• Pulp bleeding.

Chronic gangrenous or fibrous pulpitis of permanent teeth in children can occur in both open and exposed pulp chambers. Fibrous inflammation is characterized by a dark red chamber that bleeds unpleasantly when touched. Gangrenous pulpitis is usually accompanied by gray-green discharge with a putrid odor.

Chronic pulpitis in children goes away sluggishly, the pain returns every now and then. A teenager complains of attacks of pain spreading along the trigeminal nerve.

Treatment of pulpitis of permanent teeth in children

Doctors distinguish two methods of treating pulpitis in permanent teeth. At the discretion of the doctor, therapy is carried out with partial or complete preservation or removal of the pulp. Let's look at each method in more detail.

Conservative treatment

“A living tooth has a better chance of survival than a dead one” - you’ve probably heard this common and, of course, fair phrase. Recently, dentists have mastered the biological method of treating pulpitis of permanent teeth in children, which is recommended for diseases such as:

• Pulp hyperemia;
• Traumatic pulpitis;
• Acute serous pulpitis;
• Chronic fibrous pulpitis without destruction of periodontal tissue;
• Acute pulpitis, lasting no more than a day;

Unfortunately, science has not yet moved that far forward, and biological treatment of pulpitis is effective when the child is in good condition and has a shallow carious cavity.

For adolescents with incomplete root formation, dentists treat pulpitis using the method of partial nerve preservation. This method helps complete the formation of the root system.

Symptoms

Depending on the course, pulpitis can be either acute or chronic. Acute is less common, but its symptoms are more pronounced. The process goes through two stages:

1. Serous, during which the pulp becomes inflamed and the canals are filled with serous fluid. The child begins to complain of very severe pain in the tooth, which usually appears at night or while chewing. The pain is usually one-time, and the lesion is often observed in teeth with absorbable or incompletely formed roots. After 4-6 hours the process moves to the next stage.
2. Purulent, during which purulent contents begin to form in the canals. The severity of this form is influenced by various factors, for example, the child’s immunity, bacterial activity or the condition of the tooth roots. Painful sensations may not be pronounced if the child’s immune system works well, microorganisms in the tooth are weakened, and pus comes out through the carious cavity. But much more often the pain syndrome is severe. The pain is very long-lasting, sometimes radiating to other teeth, and appears both when chewing and when the temperature of the food consumed fluctuates. The child refuses to eat and often cannot even touch the tooth. The baby's general condition may worsen with the appearance of fever and enlarged lymph nodes.

Chronic pulpitis often occurs without symptoms, and it can develop in teeth deeply affected by caries and under fillings. The tooth may hurt due to food getting into the hole or from a cold drink, which is why the child usually does not eat on the “sick” side. In the gangrenous form of the disease, pain in the tooth appears after hot food after some time, an unpleasant odor emanates from the tooth, and the child may feel bloating and heaviness in the tooth.