While children rarely undergo the exact procedure adults refer to as a “root canal,” they frequently require similar, specialized treatments for an infected or damaged dental pulp. The soft tissue inside every tooth, known as the pulp, contains the nerves, blood vessels, and connective tissue. When this pulp becomes inflamed or infected due to deep decay or injury, a pediatric dentist must intervene to save the tooth. Preserving primary (baby) teeth is important for proper chewing, speech development, and maintaining the correct spacing for the future permanent teeth. These procedures are collectively known as pulp therapy and are designed to avoid premature tooth loss.
Specialized Procedures for Primary Teeth
For a primary tooth, the approach to treating an infected pulp depends on the extent of the damage. The least invasive option is a Pulpotomy, often informally called a “baby root canal” because it involves partial removal of the pulp. In a Pulpotomy, the dentist removes only the infected pulp tissue located in the crown, or top portion, of the tooth. This technique is used when the inflammation is limited to the coronal pulp chamber and the tissue inside the root canals remains healthy and alive.
After removing the diseased tissue, a medicated material is placed in the pulp chamber to promote healing and seal the remaining healthy pulp. The goal is to preserve the tooth’s root vitality so the tooth can remain fully functional until it naturally exfoliates.
If the infection has progressed past the crown and into the root canals, a more extensive procedure called a Pulpectomy is necessary. This involves removing all of the infected pulp tissue from both the crown and the entire length of the root canals. The canals are then thoroughly cleaned, disinfected, and filled with a special resorbable paste that the body can naturally dissolve. This resorbable material is crucial because it allows the permanent tooth below to erupt normally without being blocked. The objective of both procedures is to eliminate the infection and hold the tooth in place to ensure the correct path for the incoming permanent tooth is maintained.
When Is Pulp Therapy Necessary
Pulp therapy is recommended based on clear physical evidence of deep damage or infection, often confirmed by X-rays. The most common cause is deep dental decay, which has progressed through the hard enamel and dentin layers to reach the soft, inner pulp tissue. Once bacteria enter the pulp, they cause inflammation and infection.
Symptoms can include persistent or throbbing tooth pain, particularly discomfort that wakes a child up at night. Swelling and redness around the tooth or gums, known as an abscess, are strong indicators that a severe bacterial infection has taken hold. Sensitivity to hot or cold temperatures that lingers after the stimulus is removed can also signal that the pulp is inflamed. Sometimes, a tooth that has experienced significant trauma, such as a fall that results in a cracked or chipped tooth, may expose the pulp to bacteria. If the pulp has died, the tooth may begin to look gray or discolored, though pain might not be present because the nerve is no longer functioning.
Treating Pulp Issues in Young Permanent Teeth
When a child’s permanent tooth is involved, the treatment approach changes significantly, especially if the tooth has not finished developing. A young permanent tooth has an “open apex,” meaning the end of the root is wide open and the root walls are thin. Standard adult root canal therapy is not a viable option because it could compromise the tooth’s long-term strength.
Instead, dentists perform specialized treatments aimed at encouraging the continued development of the root structure. If the pulp is still healthy and alive, a procedure called Apexogenesis is performed. This involves removing only the infected or damaged part of the pulp and then placing a biocompatible material, such as Mineral Trioxide Aggregate (MTA), directly over the remaining vital tissue. The MTA creates a seal and stimulates the healthy pulp to continue building the root and strengthening the tooth walls.
If the pulp is entirely dead or necrotic, a procedure called Apexification is used to encourage the formation of a hard, calcified barrier across the open root tip. This is achieved by placing an agent like calcium hydroxide or MTA inside the root canal system. This induced barrier then acts as a solid base against which a final root canal filling material can be placed, effectively sealing the root tip.
The Role of Crowns and Prevention
Following a Pulpotomy or Pulpectomy on a primary molar, a final restoration is immediately necessary to protect the weakened tooth structure. Removing infected pulp tissue leaves the tooth more brittle and vulnerable to fracture under the forces of chewing. In most cases, a pre-fabricated stainless steel crown (SSC) is placed over the tooth to provide complete, full-coverage protection.
The stainless steel crown seals the tooth against further bacterial contamination, which is important for the long-term success of the pulp therapy. These crowns are highly durable and remain in place until the tooth is naturally lost, ensuring the tooth can function normally. The full coverage restoration safeguards the tooth from fracture and maintains the arch space required for the permanent tooth’s eruption.
Parents can actively reduce the need for pulp therapy by focusing on preventative measures. Regular check-ups allow a dentist to identify and fill small cavities before they reach the pulp. Applying dental sealants to the chewing surfaces of molars can prevent deep decay from starting in the natural grooves of the teeth. Good oral hygiene, including brushing twice a day with fluoride toothpaste and flossing, remains the most effective defense against the decay that leads to pulp infection.