Importance of deciduous teeth

Your child’s ‘baby’ or deciduous it is important to save in order to maintain the space for their adult teeth. Although baby teeth will be lost gradually until children turn 12, they are important to maintain the arch integrity and to guide the eruption of the permanent successors. Baby teeth help to keep all of the teeth in alignment so that the permanent tooth will grow in the correct position. If they are removed, teeth will often shift, leading to crowding and future need for braces. The innermost part of the tooth is called pulp, protected by strong outer layers namely enamel and dentine. It contains nerves as well as the blood vessels which keep it alive and healthy. A deep cavity in your child’s baby tooth may go into the pulp of the tooth which is still alive thus causing a lot of discomfort and pain to the child.

In this case, a ‘pulpotomy’ is recommended to save the tooth by preventing nerve and root death. During this pulpotomy procedure only the part of the infected pulp tissue in the tooth is removed. A medicated filling is placed inside the tooth and a filling is used to restore your child’s tooth.

How do you prepare for pulpotomy?

The dentist will take x-rays of your child’s tooth so that the extent of the decay and infection in the tooth can be identified.

How is pulpotomy done?

Pulpotomy is done under local anaesthesia (tooth and its surrounding area will be numb throughout the procedure). Nitrous oxide or oral medicine may also be used as sedation to help calm anxious children who are unable to cope with local anaesthesia only.

The dentist will then use a drill and some hand instruments to remove the decayed areas until it reaches the pulp. The damaged pulp will be removed and a medicament such as formocresol or ferric sulfate is placed over the remaining root part of the pulp. The cavity is then closed up by a filling material and often this tooth will be protected with a stainless steel crown so it lasts long enough until it naturally exfoliates.

When pulpotomy is done well it relieves the pain being experienced and also restores your child’s tooth function.

When is pulpotomy not suitable anymore?

The dentist will first examine the tooth to ensure the decay on the tooth is not that severe and the nerve in the root of the tooth is salvageable. Pulpotomy cannot be performed on a loose tooth (ready to exfoliate) or when there is already a swelling and abscess around the tooth. Like wise if the tooth is already badly broken down and unrestorable, the tooth is often extracted.

What if the tooth is abscessed but still restorable?

Abscessed tooth means the nerve of the tooth has completely died and infected. If the crown of the tooth is restorable, root canal treatment will then be recommended. This treatment is somehow similar to the root canal therapy on a permanent tooth but it can be accomplished in one visit provided the child is cooperative and not in acute pain.

Pulpectomy which involves complete removal the infected dead pulp and draining the pus will be carried out. Oral antibiotics will also be given to your child in a course of five days to help resolve the infection. During the procedure, the dentist will clean the pulp canals using special hand instruments and place resorbable paste material namely Zinc Oxide Eugenol into the nerve chambers with the help of x-ray films. The tooth will then be restored with a stainless crown. Your child will be given follow up review appointment every 6 months until the tooth exfoliates.