Treatment of pulpitis in milk teeth in children

Caries is a fairly common problem with children's teeth, and many parents believe that its treatment is not so important, because the teeth are milky and soon they will fall out. However, such irresponsibility often leads to complications, one of which is pulpitis.

So called inflammation of the tooth pulp, which is a connective tissue deeply located inside the teeth with nerves, blood and lymphatic vessels. In the people, pulp is often simply called the dental nerve. The disease mainly affects milk molars, with the lower teeth becoming inflamed more often, although pulpitis of the front milk teeth is also found. It is important to note that in childhood, pulpitis develops faster than in adults because of the low strength of the dentin and thin enamel.

The most common cause of pulpitis is the lack of treatment for tooth decay. The infection first affects the enamel, then spreads to the dentin and as a result enters the pulp. Much less often, the development of pulpitis provokes trauma to the tooth, including accidental exposure of a nerve caused by a dentist during the treatment of caries.

Depending on the course, pulpitis is both acute and 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 with the filling of the channels with serous fluid. The child begins to complain of very strong pain in the tooth, which usually appear at night or while chewing. Pain is usually one-time, and the lesion is often observed in the 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 channels. The severity of this form is influenced by various factors, for example, the immunity of the child, the activity of bacteria or the state of the tooth roots. Painful sensations may not be pronounced if the child’s immune system works well, the microorganisms in the tooth are weakened, and the pus is released through the carious cavity. But much more often the pain syndrome is strongly pronounced. The pains are very long, sometimes they give up in other teeth, appear when chewing, and when the temperature of the food consumed varies. The child refuses to eat and often can not even touch the tooth. The general condition of the baby may deteriorate with the appearance of fever and an increase in lymph nodes.

Since the sensitivity of the pulp in children is reduced, the disease often develops without pain. For timely detection of pulpitis, it is important to regularly visit the dentist with the child, as well as to treat all teeth affected by caries at an early stage.

The fact that the child is important to show the pediatric dentist as soon as possible prompt these symptoms:

• Severe pain in the tooth.
• The appearance of pain when eating hot food or cold drink.
• Unpleasant smell from the darkened tooth.
• Inflammation of the tissues around the tooth.
• Increased body temperature.

The question of the need for treatment of pulpitis should not arise at all. If a child has this disease, it should be treated immediately. It is unacceptable to give the child pain medication and wait for the loss of the sick baby tooth. Without treatment, such a problem with teeth can result in serious complications, such as periostitis or periodontitis.

In the following video, a pediatric dentist will tell you why it is so important to treat baby teeth and how to do it.

Sometimes pulpitis is so hard and threatens the life of a child that the easiest way to remove a tooth is completely. However, in most cases, the doctor tries to keep the baby tooth in order to prevent the violation of the bite. In this case, the treatment of a tooth in public organizations and private clinics is different.

In most children's dentistry in public institutions, pulpitis is treated in a manner called “devital amputation." It provides several visits to the dentist:

1. At 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 the paste is held in the tooth for 24-48 hours. Paste without arsenic is laid for a period of up to 7 days.
2. In the next two visits, a special mixture is pumped into the canals of the tooth to mummify the infected pulp. Usually it is a resorcin-formalin mixture.
3. In the next visit, establish a permanent seal.

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

When the canals of the tooth are thoroughly processed, the 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 tooth change. The most commonly used zinc eugenol paste. The method is effective, but in order for the infection not to activate again, the canal cleaning must be very thorough.

The roots of milk teeth are formed for a long time after eruption, therefore there may be situations where a tooth is infected with caries, at whose roots the apex has not yet closed. Difficulties in the treatment of such a tooth are due to the following factors:

• The roots in the teeth are short, and their channels are wide.
• The upper part of the roots is a zone of "growth", the injury which will prevent the formation of the root.
• There is a fairly high risk of infection by the germ of a permanent tooth.
• All manipulations are important to perform as carefully as possible.
• We can not allow the material for filling and tools to leave the zone in which the top opening begins to expand.
• Completely remove the pulp and process all the channels will not work.
• The best way out would be an amputation treatment. It consists in removing the infected pulp from the tooth in any way (with or without arsenic).
• Often, a biological method is also used, the essence of which is in cleansing a tooth from dead tissue and laying a medical paste with calcium hydroxide for several days, after which a permanent filling is established.

That the kid was not afraid of dentists, the first visit should be preventive. It is conducted only for familiarization with the situation of the doctor’s office and the instruments used. Before you go to treat your teeth, it is worth:

• Talk to your child about doctors treating teeth.
• To tell the baby about the positive effects of treatment.
• Emphasize that this is a routine 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 scare the child in terrible terms.
• Do not deceive that there will be no pain. It is better to say that discomfort is possible, but as a result toothache will stop.
• Do not panic and do not be afraid of the parents themselves, so that the excitement is not transmitted to the child.
• Visit the doctor in the morning when the child is active, not hungry and not sleepy.
• Take your favorite toy with you so that it stays in the hands of the child during the visit.
• To enable the doctor to talk with the child without parental involvement, so that the doctor can find a contact.
• Do not bully or beg the child if he is not given to conduct an inspection.
• If you lose control of the situation, move the reception to another time.

Unfortunately, the treatment of pulpitis in children is often carried out with errors, as it is not always possible to carry out all the necessary manipulations in full and with the required accuracy due to the child’s anxiety. There are such problems:

• The devitalization paste is applied incorrectly (not on the nerve), as a result of which the pain does not diminish, and the paste has to be applied again.
• Due to the proximity of the gum paste can cause burns and quite severe pain.
• With unformed roots or in the case of the beginning of their resorption, manipulations on the processing of channels can cause prolonged bleeding.
• Sometimes there is a perforation of the root of the baby tooth, the result of which can be periodontitis, as well as periostitis.
• Due to the inexperience of the doctor, a broken instrument may remain in the tooth canal.

The main way to prevent pulpitis is the timely and correct treatment of caries in children. To prevent tooth infection, it is important to pay attention to hygiene, teaching the child to properly brush their teeth from an early age. It is also important to monitor the baby's nutrition, providing his body with the necessary nutrients, in particular, important minerals for the teeth. Sweet food should be limited, and at night should be given only to drink water.

Watch the following video, which describes the features of pulpitis in children.