Treatment of pulpitis of primary teeth in children is gradual. Temporary teeth with root resorption

Surprisingly, many parents are still convinced that a child’s baby (temporary) teeth do not need to be treated, unlike permanent ones. Irresponsible mothers and fathers claim that they do not treat caries in their children simply because these teeth will soon fall out anyway. There are often cases where pulpitis in baby teeth is not treated in a timely manner, even despite the child’s severe pain.

This idea of the optional treatment of baby teeth is absolutely wrong, moreover, it is very dangerous ignorance!

If an infection enters the pulp chamber from a carious cavity, pulpitis may develop, which should be treated immediately to avoid the development of complications that spread to the permanent tooth germ.

Features of the choice of treatment method for pulpitis in the case of unformed roots is the impossibility of using extirpation methods, that is, complete extraction of the pulp and treatment of canals along the entire length of the root. This is why pediatric dentists prefer biological and amputation treatment methods for such cases.

Let us first consider the biological method of treating pulpitis baby tooth(conservative). This method involves preserving the entire pulp in a viable state, however, it has many contraindications and requires adherence to ideal asepsis and antisepsis during work in order to avoid recurrent pain.

First, under anesthesia, the carious cavity is cleaned of necrotic tissue, and a medicinal paste (usually based on calcium hydroxide) is applied to the bottom of the cavity or directly onto the exposed pulp for several days. After the pain stops, a permanent filling is placed on the baby tooth.

Thanks to biological method treatment, the tooth remains alive, that is, the preserved pulp allows it to supply its tissues with nutrients, supporting high strength. But a tooth with a removed “nerve” becomes more and more fragile over the years and is prone to chipping of the filling-bearing walls.

Amputation methods for the treatment of pulpitis in primary teeth with unformed or absorbable roots are very popular among dentists. The essence of such methods follows from their name - the infected pulp is simply amputated, removing it from the pulp chamber.

In this case, both “ancient” methods of devital amputation using the resorcinol-formalin method, and modern vital (under anesthesia and without arsenic) amputation techniques with therapeutic coating of the root pulp with antibiotics, enzymes, calcium-containing drugs, etc. can be used. Preparations “Pulpotek” and “Pulpodent” » are also suitable for the treatment of pulpitis in primary teeth with uncovered root tips.

The photo shows an arsenic-containing temporary filling in a tooth:

This is interesting

Devital amputation is a method of treating pulpitis, which involves first “killing” the pulp, and then mummifying it with potent and often toxic pastes. To cure pulpitis with this “old” method, you need not one visit, but three or even more. Long-term results Taking into account many years of experience in using this method, they most often turn out to be negative.

Possible errors during treatment and how they threaten the child

During the treatment of pulpitis of primary teeth in children medical errors happen more often than in adult dentistry. This is due to the specifics children's reception when the child often prevents the doctor from carrying out all the necessary manipulations with due accuracy and in full. To minimize the severity of errors and for violent children, pediatric dentists can resort to devital amputation using the resorcinol-formalin method, since otherwise the child simply does not have the opportunity to save a baby tooth until its physiological replacement.

In pediatric dentistry, when treating pulpitis of a baby tooth, we encounter, for example, such an error as incorrectly applied paste for pulp devitalization. The most difficult result of such an error is tolerated if the paste is arsenic. If the child does not allow the tooth to be treated efficiently, then the doctor places it not on the exposed “nerve”, but on the soft bottom of the prepared cavity, which is why it often not only does not work, but also causes even more severe pain. The immediate help in this case is to re-install the paste.

There are cases of placing devitalizing paste next to or directly on the gum, since in children the carious cavity is often occupied by overgrown gums or located close to the gingival papilla. The consequence of this is severe pain, and upon the child’s arrival to the doctor, a burn caused by the components of the paste is discovered on the gum. Prevention of such a complication is to follow the technique of applying the paste, and if you receive a burn, it is necessary to prescribe anti-inflammatory wound-healing gels or pastes.

During the treatment of canals in a baby tooth with pulpitis, bleeding may occur due to the fact that the apices of the roots may not be formed or are already slightly resorbed, and the dentist can forcefully remove the files for canal treatment (special needles) beyond the root, injuring adjacent tissues . Stop bleeding even special drugs it can be difficult.

Sometimes an inexperienced doctor can make mistakes such as perforation of the root and breaking off the instrument in the tooth canal. Since the canals in baby teeth are almost always very wide, the percentage of such complications is very low, but the severity is the same as in the case of permanent teeth in an adult. As a result of perforation of the tooth root and breakage of the instrument in the canal, periodontitis or periostitis may subsequently develop due to inflammation of the tissues around the root.

To prevent these complications, the pediatric dentist removes a piece of the instrument from the canal in an accessible way, and the perforations are covered with a special material, for example, “ProRoot MTA”. In some cases, for lack of necessary equipment and materials, the doctor simply mummifies the canals using the resorcinol-formalin method.

The photo shows an example of an instrument broken off in a tooth canal:

How to prepare your child for treatment

In order for the child not to be afraid to have his teeth treated (even with severe pain during pulpitis), it is necessary to make the first preventive visit to the dentist long before. pediatric dentist. The success of the first visit depends equally on the dentist and the baby’s parents.

The visit should be for informational purposes only. During it, the child gets acquainted with the new environment of the office, tools, showing only curiosity and not fear, but even such a visit requires preparation.

Before going to the dentist, follow these recommendations:

talk to your child before the preventive visit 1-2 days before he hears “horror stories” from his peers;
tell your child only about positive experiences;
do not overemphasize the importance of the event, since taking care of health is a common procedure;
talk about your future visit to the dentist as if you were meeting a new friend;
play “dentist” with the whole family: set an example that you are not afraid of the doctor;
do not use scary dental words;
do not deceive the child that it will not hurt, it is better to say that it may be unpleasant at first, but then the tooth will not hurt;
do not experience fear and panic yourself, then this will not be passed on to the baby;
the best option for a visit to the dentist is in the morning, when the child has slept, eaten well and is active;
It’s better if you go to the dentist with your favorite toy so that your child constantly plays with something in his hands;
let the doctor find contact with your child without your help;
if a child resists and interferes with the reception, then he should not be intimidated, threatened, begged, etc.
You should try to gain the child’s trust, so if the situation gets out of control, it is better to postpone the appointment until next time.

If the child is initially uncontrollable and anxious, often falling into hysterics, then he should be prepared with medication, relieving him of the upcoming stress. The over-the-counter drug Tenoten for Children is ideal for this. 20 minutes before treatment of caries or pulpitis of baby teeth, the child should be given one tablet under the tongue for resorption.

With high or moderate stress, Tenoten relieves tension, causing inhibition mental processes. As a rule, after 20-30 minutes the child allows all the necessary manipulations to be carried out.

In order for a child to feel comfortable in the dental chair, it is necessary to start visiting the dentist for the purpose of prevention. With the proper level of hygiene, timely preventive examinations and quality control of teeth cleaning, you can avoid not only pulpitis, but also caries, and preserve your baby’s teeth until their physiological change.

Interesting video about the importance of treating pulpitis of baby teeth

A few more useful explanations from the doctor regarding pulpitis of baby teeth

Pediatric pulpitis is much more common than adult pulpitis. Dentists explain this pattern by the structural features of baby teeth, in which connective tissues more loose, root canals wider, and the dentin is less mineralized than that of molars. Another explanation for the fact that pulpitis in children is much more common is an imperfect immune system. This means that the likelihood of catching a cold or inflammation in childhood ten times higher than in adults. However, nature has balanced this nuisance by the fact that pulpitis of a baby tooth is practically painless in 65% of cases. This is where the danger lies.

Classification of pulpitis in children

Hypertrophic

In children this type Pulpitis is very rare, mainly due to prolonged chronic irritation. An almost completely destroyed tooth crown and pulp tissue that has grown due to constant trauma are signs by which hypertrophic pulpitis can be recognized. Sometimes the pulp tissue rises only slightly above the level of the “roof” of the tooth cavity, but it also happens that it fills the entire carious cavity. When probing the pulp bleeds. Basically, the child does not feel pain, except perhaps when eating, and then it is weak and insignificant. When conducting a diagnosis, it is extremely important for the doctor to distinguish between the manifestations hypertrophic pulpitis from the gingival papilla and periodontal granulation tissue.

Gangrenous

Children's gangrenous pulpitis of primary teeth often develops from acute diffuse pulpitis. The child feels virtually no pain, but the diseased tooth itself may become darker. On examination, the carious cavity is most often shallow. There is a putrid odor from the mouth associated with the decay of the pulp and its interaction with microbes. A fistula may swell on the gum, at the apex of the root. A child's lymph nodes may be enlarged, but remain painless. Dental opening of a carious cavity causes almost no pain.

Chronic pulpitis in children

Usually occurs with shallow caries, without communication with the dental cavity and in most cases prevails over the acute form of the disease. Chronic childhood pulpitis can worsen if protective forces the body is weakened. Symptoms of exacerbation include complaints of constant nagging pain, which increases with mechanical stress (chewing, pressure on the tooth). Aggravated pulpitis is also characterized by swelling of the surrounding soft tissues and inflammation of the lymph nodes. Sometimes the child’s temperature rises and his general condition worsens. This form of pulpitis is similar to the course of chronic pulpitis in adults.

Chronic pulpitis in the acute stage

Exacerbation of chronic pulpitis in children is caused by worsening conditions for the outflow of exudate (liquid that forms at the site of inflammation) and weakening of the immune system. The child begins to complain of a constant aching toothache, which intensifies when pressing on the tooth; soft dental tissues swell, and the lymph nodes become inflamed and begin to hurt. The carious cavity in the case of aggravated chronic pulpitis can be of different depths, and the dental nerve is less painful than in acute pulpitis. This disease can be detected using an x-ray, which will show destructive change at the apex of the root.

Acute partial pulpitis

In baby teeth, acute partial pulpitis is quite rare, because due to the characteristics child's body very quickly turns into acute general pulpitis - in just a few hours. It is almost impossible for parents to “stop” the disease at the development stage. Partial pulpitis is characterized mild pain, since in baby teeth with unformed roots and wide root canals there are all conditions for good outflow of exudate.

Treatment of pulpitis in children

Children's pulpitis is insidious in that it is not always possible to determine it at the beginning of development. In addition, it is psychologically more difficult for the child to endure the examination and he cannot always correctly assess the sensation of pain. Therefore, in order not to start caries of baby teeth, next stage If you have periodontitis, parents should take your child to the dentist every 4 to 6 months. If, upon examination, pulpitis is detected, the doctor must decide on a treatment method depending on the stage of development of the disease and group affiliation teeth. As a rule, in cases of acute toothache, young children have to have their teeth treated using anesthesia.

Treatment methods for pulpitis in children

In pediatric dentistry, there are several methods for treating pulpitis of primary teeth:

The biological method of treating pulpitis in children involves preserving the pulp: the coronal and root parts of the pulp are treated while maintaining their viability.
Partial pulp amputation: the coronal pulp is removed, creating conditions for the functioning of the root part. The method is recommended for the treatment of caries of molars in childhood, when it is very important to preserve the root part of the pulp, which is involved in the formation of tooth roots.
Complete pulp removal: the coronal and root parts of the pulp are completely removed, followed by filling the canals.

The price of treatment for pulpitis of a baby tooth depends on many factors: the complexity of the situation, treatment methods and materials used in pediatric dentistry.

If pulpitis is not eliminated in time, then more will be required in the future. complex treatment periodontitis, all this may be accompanied by a tooth cyst, a fistula on the gum and others unpleasant complications. Be that as it may, parents should remember that the child’s health and its maintenance depend largely on themselves! It is likely that visiting a pediatric dentist every six months to preventive examination, your child will never know what a drill and the removal of baby teeth are!

Questions that constantly worry parents huge variety, and one of them is “Can children’s baby teeth hurt?” Unfortunately, they can. Dental diseases Even the kids are not spared. In childhood, acute pulpitis does not occur as often as chronic pulpitis, but it is much more painful and aggressive than in adults.

Intensity of pain, general clinical picture The course of the disease is determined by the form of pulpitis, which can be:

acute serous;
purulent.

The serous form is very similar to acute focal pulpitis in adults: the first signs of the disease usually appear at night, and during the day there may be discomfort while eating and drinking. Acute serous pulpitis of primary teeth in children is accompanied by inflammation of the periodontal tissues, which leads to a lack of oxygen supply to the pulp. This provokes the filling of the root canals with a special liquid called exudate. Painful sensations may not be constant, or even occur once. However, in most cases, the serous stage turns into a purulent stage after 4-7 hours. And that’s when the search for a dentist begins.

Formation of pulpitis in baby teeth

On the severity of the leak purulent form the following factors influence:

immunity performance;
level of formation of baby teeth;
activity of pathogenic bacteria.

If the baby’s immune defense is very strong, then pulpitis of a baby tooth can be almost painless, since the activity of bacteria is restrained by the body and there is a way out for pus from the pulp. But most often the disease occurs in a very expressive form.

The purulent stage of pulpitis in childhood often resembles not a similar disease in adults, but periodontitis: fever begins, fluid accumulates in the canals, and severe pain occurs when pressing on the affected teeth.

The nature of the pain is paroxysmal, each episode can last quite a long time, interspersed with short breaks; these sensations often occur while eating, especially hot or cold foods. Children are not always able to indicate the exact location: pain can be felt not only in the affected tooth, but also in neighboring molars and in the jaw.

Treatment of pulpitis in a child is not as painful as in adults

If, when such signs appear, you do not consult a doctor and do not begin treatment for pulpitis of baby teeth, in children other unpleasant symptoms will be added to the pronounced pain:

fever;
decreased activity;
refusal to eat and drink;
disturbance of sleep and routine;
sore gums.

Delay is fraught not only with aggravation of the baby’s condition, but also with complications that do not take long to occur: lymphadenitis, periodontitis, periostitis (“flux” in popular parlance). This is all extremely dangerous conditions not only for health, but even for the life of the child, so appealing for medical assistance at the first symptoms of inflammation in oral cavity must be urgent. Against the background of general intoxication and the addition of a bacterial complication, the consequences can be unpredictable.

Traditional methods of treating acute childhood pulpitis

Due to the likelihood of complications and danger severe conditions, which can provoke pulpitis in children’s primary teeth, treatment is primarily aimed at eliminating such risks. Of course, the easiest way is to simply pull out the affected tooth, but such manipulation can not only affect the child’s psyche, but also have an impact on the formation of the bite.

Pulpitis in a child - what to do?

In public clinics and dental offices, and even in some commercial centers, the method of non-vital amputation is most often used. The method has long been known, tested many times, and is quite gentle in terms of distress for the child, since there is no direct effect on the root systems of the tooth. It happens like this:

First, a special paste with arsenic is applied to the exposed area of the nerve (yes, the question “Are there nerves in baby teeth?” the answer is also affirmative) for 1-2 days or a devitalizing composition without arsenic for a week.
At a subsequent visit, the tubules are filled with special pastes, which provide antimicrobial effect onto the pulp and, as it were, “mummify” it, thereby preventing further development purulent process.
The last visit ends with a filling.

Modern approach to the treatment of pulpitis in children

For babies who can sit quietly long time, and who have already formed root system teeth, there are two methods of modern therapy:

vital;
devital.

The first thing that involves vital treatment of baby teeth in children is removal of the nerve. And devital therapy consists of a gradual impact on the pulp in several stages. The method consists of meticulous treatment of the root canals with mechanical and medically to create complete sterility inside the tooth and subsequent insertion into the root canals special compounds. These pastes have an anti-inflammatory effect and a resorbable effect, which does not have any effect on the replacement of temporary teeth in the future.

Domestic dentists prefer zinc-eugenol paste for root filling, while foreign specialists respect the composition of Magipex, which has also proven itself to be excellent. But not only immediate help with pulpitis depends on these materials, but also later life tooth Because it's an opportunity re-infection depends on whether there is a nerve in the baby tooth, and on how carefully the treatment was carried out during treatment.

Damaged teeth in a child - what does this mean?

Despite the gentle “regime” of the devital technique in the treatment of acute pulpitis, there are no fewer fans of the opposite method – the vital one. It involves not complete removal, but partial: in this case, the apex of the nerve is removed, and the roots are filled with special medications.

Modern medicines, used in pediatric dentistry, have a pronounced anti-inflammatory and antiseptic effect long-term, at the same time, the sealing of the tooth roots is performed “excellently”. The previously widely used formulations with eugenol and calcium hydroxide have been successfully replaced by Swiss-made (Pulpotek) and domestically produced (PulpoDent) preparations. These medications not only significantly prolong the “life” of the pulp, but also help reduce pain during the treatment and recovery process.

Unlike previous preparations, modern pastes do not contain dyes and do not have any toxic effects on the children's body and allow them to reduce the number of visits to the dentist, making the treatment of pulpitis in children more effective.

Features of the treatment of acute forms of pulpitis with an unformed root system

When, when baby teeth appear, the tops of the roots remain uncovered, they say they are not unformed roots. Their full development usually occurs over several years. That is why the specifics of therapy for such teeth are quite different from similar methods of influencing the formed system.

With an immature root system of temporary teeth, the vital and devital methods described above are not suitable, since there is no possibility of fully influencing the pulp. The treatment of tooth canals also becomes difficult. Therefore, as the best way In pediatric dentistry, amputation or biological treatment is used.

What to do if a child has pulpitis in a tooth?

The biological technique is conservative option allowing complete preservation of the pulp. However, the method is very complex, has a wide range of contraindications and requires absolute sterility during treatment, since whether children’s baby teeth will hurt after such an intervention largely depends on the quality of aseptic and antiseptic treatment. First of all, the carious cavity is thoroughly cleaned of dead and damaged tissue, and then medications are applied either to the bottom or to the exposed nerve.

After a few days, when the pain goes away completely, the tooth is closed with a permanent filling. Thanks to this treatment option for acute forms childhood pulpitis, the tooth continues to receive good nutrition due to the preserved pulp, while the amputation method deprives the molars of this opportunity.

However, from large quantity Because of contraindications and the sufficient complexity of biological treatment, simple amputation is used much more often. It can be performed both in the traditional devital method using arsenic-based compounds, and in the modern vital method using local anesthesia and arsenic-free pastes, as well as options involving the participation of antibacterial drugs and various remineralizing agents.

And parents should remember that when a child’s baby tooth hurts, the question “what to do” should not arise; it is necessary to seek help from a pediatric dentist as quickly as possible.

Treatment of pulpitis of primary teeth in children

Diseases of primary teeth in children are not harmless problem, contrary to most parents. Without proper treatment, they lead to disturbances in the formation and growth of molars. Pulpitis in children is the most common disease resulting from specific features structure of children's teeth. Next, we will consider how pulpitis manifests itself, why it occurs, what forms it has and methods of treating young patients.

The soft tissue located inside the tooth, with many nerves and blood vessels, is called pulp. As a result of exposure to any irritating factors its tissue becomes inflamed and the patient develops pulpitis. The most common factors of childhood pulpitis are pathogenic microorganisms(staphylococci, streptococci), penetrating directly into the tooth due to the presence of a carious cavity.

The localization of the disease in the mouth may vary, but in most cases the disease affects lower teeth and molars. The front teeth are less likely to suffer. Advanced pulpitis can lead to complications such as periodontitis or periostitis. In childhood similar complications progress much faster than in an adult, even within a day. There are cases where, in just a couple of days of development of an acute form of pulpitis, a child began to experience blood poisoning, which ended in death. Important task parents - to detect and treat caries in their children in time.

Reasons

Milk teeth are more susceptible to disease than molars, and the special structure of temporary teeth is to blame. Their enamel is thinner, dentin is not strong, and the pulp chamber is wider. The dentinal tubules of baby teeth are wide and short, as a result of which the inflammatory process spreads quickly. Immune protection The child’s body is not fully formed, which prevents it from fighting infection as effectively as an adult; the result is that infectious and inflammatory diseases are so common in childhood.

Factors that increase risk:

presence of caries;
injuries to tooth enamel;
frequent infectious diseases;
chemical or thermal effects on teeth;
unintentionally exposed nerve as a result of dental procedures.

In 85% of cases, the disease occurs due to caries, when the enamel is affected, later infection passes onto dentin and penetrates directly into the pulp.

Photos

Species

Pulpitis in a child can manifest itself in acute and chronic form. The first type is diagnosed less frequently, but its symptoms are much more severe.

Spicy

Serous stage. The canals fill with serous fluid and the pulp becomes inflamed. The first pain often comes at night, and during the day it manifests itself in temporary attacks during chewing. After 5 hours the next stage begins.
Purulent stage. Characterized by the formation and accumulation of pus in the canals. If the child strong immunity, That discomfort may not occur, and the pus will come out through the cavity destroyed by caries. But most often purulent acute pulpitis manifests itself long-term pain. The child cannot say exactly where it hurts, because the pain radiates to nearby teeth. Lymph nodes and body temperature may increase. Most parents take their children to the dentist.

Chronic

Sometimes chronic pulpitis appears as a complication of the acute form, but most often it occurs as an isolated disease. The manifestation of chronic pulpitis in children can be of three types. Exacerbations of the disease are identified as a separate form.

Gangrenous inflammation can be recognized by the absence of sharp pain immediately after eating hot or cold food; after a while, a nagging sensation appears toothache. With this form of pulpitis, the child develops bad smell from the mouth, sometimes the baby feels heaviness or bloating in the area of the affected tooth. Swelling and inflammation of the periodontium may occur.
Chronic fibrous pulpitis, like gangrenous, is the primary stage of the disease. It is detected during an examination by a dentist and is characterized by the presence of a carious cavity and softening of the tooth dentin. After cold or hot food painful sensations disappear as quickly as they appear. This type of pulpitis sometimes goes away without visible signs, and parents seek help only when the process is already at an advanced stage.
Hypertrophic appearance The disease is characterized by the growth of the pulp, existing crowns are often destroyed, and pain occurs when chewing food.

Transition from healthy tooth to periodontitis

Symptoms

Sometimes pulpitis is asymptomatic. In such cases, regular visits to the dentist will help detect the disease in time. But most often the following signals indicate the presence of problems in the oral cavity:

increase in temperature;
inflamed tissue around the tooth;
painful reaction to hot or cold food;
putrid odor from the mouth;
inflammation of the lymph nodes;
swelling.

Signs of the disease can occur separately or appear together. In any case, you need to immediately show the child to the doctor.

Diagnostics

After visiting a pediatric dentist, the child must undergo a number of mandatory procedures to assess the condition of the oral cavity and choose a strategy for the treatment process.

Don’t delay going to the doctor and getting examined

A general survey of parents and the child about when the pain began, how severe it is, and what is the frequency of its occurrence.
Examination of the mouth, facial contours and lymph nodes.
Directed dental diagnostics. The condition and thickness of dentin and gums, the reaction of teeth to irritants, and the severity of swelling (if any) are assessed.
If necessary, the child is sent for a dental x-ray or EDI.

After full diagnostics The baby is prescribed appropriate treatment.

Treatment

The choice of treatment method is influenced by the child’s age, his individual characteristics, the condition of the root canals, as well as the nature of the pulp damage. There are traditional and modern methods treatment of pulpitis in children, which differ not only in the materials used, but also in the technique of implementation.

In any case, the dentist's goal is to avoid the removal of baby teeth if possible, but sometimes it is still necessary.

Traditional methods

In regular children's clinics, you will most likely be offered the method of non-vital amputation. It involves working in several stages.

During the first visit, the doctor applies an arsenic-free devitalizing paste to the exposed “nerve,” which must be worn for about 7 days. Or paste containing arsenic. Then the exposure time is reduced to 2 - 2.5 days.
After the pulp and its contents are destroyed with the paste, a resorcinol-formalin mixture is injected into the tooth canals. The hole is treated with a paste that mummifies it, preventing it from rotting and decomposing. You may have to go to the appointment several times.
During last visit a permanent filling is installed.

It should be noted that it is impossible to treat a tooth treated with paste, since over time it creates a kind of “plug” in the canals. Removing such a tooth can be very problematic.

The process of treating the disease: drilling, cleaning the canals, filling

Modern approach

If the roots of the teeth are sufficiently formed and the child can withstand long-term manipulation, then it is recommended to use devital or vital extirpation. Such methods require 2-3 visits to the dentist.

The difference lies in the first stage of preparation. During vital extirpation, the canals are immediately freed from the nerve, and the devitalizing procedure begins with the installation of a devitalizing paste on the exposed pulp. It gradually kills the nerve. Next, according to the standard scheme, the canals are mechanically cleaned and treated with medication. The next step is to remove the damaged pulp and place the paste into the sterile canal. Use zinc eugenol paste or foreign analogues. Distinctive feature pastes used in work using such methods is the possibility of their resorption along with the roots when the teeth are replaced with molars.

Another effective one modern way which allows you to cure tooth pulpitis is vital pulpotomy. Its task is to leave the entire contents of the tooth, or at least part of it, in a viable state. Upper part the nerve is partially removed, and the root pulp is treated with a special medicine. “Pulpodent” and “Pulpotek” are widely used; they are practically non-toxic, relieve pain during and after the procedure, keep the tooth viable, preventing re-infection.

Treatment of immature roots

When a baby's primary teeth erupt, the tops of their roots remain uncovered for some time. The described condition of baby teeth is called unformed. Extirpation methods with canal treatment and complete removal of the pulp are not suitable here. Pediatric dentists have two more options at their disposal.

Biological. Such treatment is considered conservative and requires precision and care from the specialist, since the slightest mistakes with antiseptics will lead to repeated pain. In addition, it has enough contraindications.

The biological treatment method involves maintaining the vitality of the pulp. Thus, it continues to supply the tooth tissue with nutrients. Painful sensations are blocked by anesthesia, the carious cavity is cleared of infected tissue, and the hole or bottom of the cavity is treated medicinal paste. After a few days, the pain goes away and a filling is placed on the tooth.

Amputation. One of the most popular in dental practice. How pulpitis is treated with this method is clear from its name. The method involves removing the affected pulp from the teeth. Almost all drugs can be used for manipulation: from resorcinol-formalin to Pulpotek or Pulpodent.

You need to understand that during devital amputation the pulp is completely killed. In addition, potent toxic pastes may be used. Over time, after such manipulations, the tooth begins to crumble and break off.

Mistakes and Consequences

Due to their fragile psyche and unconscious resistance, children often prevent the dentist from carrying out the procedure according to all the rules. Fear of visiting a doctor, the unknown and painful sensations are perceived by the child as torture, not help. For restless children, devital amputation is performed with resorcinol-formalin (this allows the tooth to be somehow cured).

Children often get burns on their gums due to paste getting there. As a result of such mistakes, the pain intensifies, the child is sent for another appointment, the work is done again, and wound-healing gels are prescribed.

Treatment of children with unformed roots is characterized by the risk of bleeding due to the efforts made by the doctor during cleaning of the canals. The needle injures the tissue, and it is quite difficult to stop the bleeding, even using hemostatic drugs.

Inexperienced dentists sometimes encounter problems such as part breaking off dental instrument in the canal of the teeth or perforation of the root. Risks serious tissue inflammation. In such cases, the part that remains in the canal is removed, and a special material is used to close the perforation. If the doctor does not have the necessary equipment, then most often with the help of drugs they simply mummify the canal.

Preparation

To minimize the risk of negative consequences After treatment, the child needs to be prepared in advance. Ideally, at the first visit the doctor will not perform any interventions, but will simply conduct a preliminary examination and give the baby the opportunity to adapt to the situation.

Parents' tasks before visiting a pediatric dentist:

Tell your child that bad teeth can be cured and the pain will go away.
explain that the usual procedure awaits them, all children and adults go to the doctor to treat their teeth if they start to hurt;
Do not intimidate the child under any circumstances and do not tell scary stories about doctors;
Do not deceive the baby that there will be no pain. It’s better to say: “Yes, it will be unpleasant, but after treatment your teeth will stop hurting”;
keep calm, first of all, to the parents themselves;
You can show in a playful way how manipulations are carried out, and let the child do them himself with family members;
Bring your favorite toy to your appointment. If the baby wants, let him hold it in his hands;
choose a time when the child feels well, has slept and eaten;
If the baby flatly refuses and becomes hysterical, don’t force it, it’s better to reschedule the session for another day.

There are times when children are initially very scared, worried and capricious. In such situations, you can give the baby an approved sedative and visit the dentist after 20-30 minutes. If the child is too restless, the doctor may recommend the procedure be performed under general anesthesia.

Prevention

Prevention of pulpitis is timely treatment caries. It is necessary to carry out regular dental examinations, because, for example, chronic fibrous pulpitis (without external signs) can only be identified by a specialist.

In addition, to prevent caries from occurring on your child’s teeth, his body needs all the minerals necessary for teeth. Limit the consumption of sugary foods, give only water before bed and teach your child to brush their teeth daily.

Pediatric dentistry is a separate medical branch, where the doctor’s professionalism must be combined with knowledge of the psychology of children. All dental diseases are curable, the main thing is to little patient let me perform the manipulations correctly. Baby teeth are always treated, because pulling them out is dangerous for the formation of a correct bite.

The first thing to do is to accustom your child to regular dental examinations. The sooner the better. The baby will not only be familiar with the environment of the treatment room, but will also begin to understand why he came here. Children often run away from the reception in panic because they associate it with some kind of execution. In this case, to persuade him to come again - big problem. Parents, explain to your children positive aspects treatment, tell me, the dentist’s office is a “temporary point”, from where the baby will leave without toothache and return to his usual activities. It is important that the baby comes to good mood, inclined to communicate, and the doctor will deal with the remaining nuances individually, thanks to a whole arsenal of tools.

Resume

Treatment of baby teeth is a mandatory procedure, neglect of which leads to serious complications, long recovery and even fatal outcome. In order not to give the disease a single chance, you need to promptly consult a doctor and undergo dental examinations. Children's clinics practice several methods of treating pulpitis, talk to your doctor and choose suitable option. The hope that the disease will go away while changing teeth is groundless. This attitude can damage the main teeth, which will remain for life. Monitor the baby’s condition, pay attention to complaints and immediately take him to the doctor. In the case of health, it is better to be safe than to miss the moment.

Much more often than in adults, pulpitis of baby teeth occurs in children. We will provide further symptoms, treatment, photos and explain in detail all the nuances of this disease. We will talk about what it is, whether it needs to be treated and how dangerous it is to ignore the problem in this article.

The structure of a baby tooth is slightly different from an adult, permanent one, therefore diseases have their own characteristics, symptoms and treatment. To know how and what to react to if a child complains, what steps to take and what to choose when deciding on treatment, you need to be aware of the following nuances.

What is the peculiarity of pulpitis of a baby tooth?

This disease is considered quite common, because caries in children quickly turns into deep tissue and contributes to the development of more serious problems. Tooth pulpitis in a child is inflammation of the pulp of the mammary unit. The following distinctive features are observed:

A thin layer of enamel and a small volume of dentin practically do not protect inner part from the aggressive effects of bacteria.
An enlarged pulp that occupies more space and is much easier for pathogens to reach.
Wide dentinal tubules contribute to the rapid spread of the disease.
Good drainage of fluid from inflamed areas significantly reduces pain and makes it impossible to detect the problem.

Because of these differences, parents do not always find out in time that active processes of tooth decay are occurring in the child’s mouth. Therefore, it is worth paying attention to any complaints, even the most insignificant ones, that the baby tries to express. Then the diagnosis in the dentist’s office will be carried out on time.

Don't think that similar problem affected only the child who did not brush his teeth well or ate sweets. The causes of the disease can be different:

low immunity;
weak enamel;
the presence of carious cavities;
violation of the processing of the unit during medical intervention during filling, turning or during periodontal treatment.

Whatever the reason, pulpitis develops too quickly and manifests itself poorly. Therefore, you should pay attention to the child’s complaints immediately and visit a doctor on time.

Symptoms and forms of the disease

In pediatric dentistry, the following classification is most often used:

Acute pulpitis, which, in turn, can be:

Focal, that is, partial.
Diffuse or general.

Chronic, which also has its own varieties:

Fibrous.
Gangrenous.
Hypertrophic.

If the cause of the disease was not bacteria, but injury or incorrect actions of the doctor, then it is called traumatic.

Each of them has its own signs and characteristics, on which the chosen method of treatment will depend. Thus, in the acute variant of the development of the disease, noticeable painful sensations from any external irritation. But it happens that the pain appears at night. If the tooth has unformed roots, for example, in a 2-year-old child, then such sensations may not exist at all.

If the pain periodically appears and disappears, then this is most likely partial pulpitis. When it is long-lasting, intense and the child cannot indicate which tooth is bothering him, then perhaps the disease has spread to general form. And if in this case you do not consult a doctor, then it can develop into periodontitis and end in general intoxication of the body.

The stages of the disease do not always pass acute phase, and in the absence of treatment they flow into some other one. It happens that initially pulpitis becomes chronic. Symptoms of the gangrenous form:

In the fibrotic stage, the symptoms of the disease are less pronounced, and the entire process takes place in a closed cavity.

Photo

Treatment of pulpitis in children

The most important thing in the treatment process is to eliminate direct inflammation, remove the pulp or part of it, and prevent the development of possible complications. If you do not pay due attention to this, then in addition to more serious complications in the surrounding tissues, future ones may also suffer. permanent teeth, which will form incorrectly due to this problem.

Often adults, not wanting to go to the doctor, decide to get rid of the disease with the help of folk remedies. In the case of treating pulpitis, it can be calamus, hydrogen peroxide, lemon and various medicinal herbs. And yet, it is not worth conducting experiments and risking the child’s health. Contact your doctor who will diagnose accurate diagnosis and perform the necessary manipulations.

Modern medicine can offer several treatment options for pulpitis in children:

biological;
amputation;
devital.

We will tell you about each of them in more detail.

Biological method

This is normal conservative method and it is considered traditional in pediatric dentistry. No major surgical interventions occur. The doctor carefully opens the inflamed pulp and fills it with a special mixture of Shostakovsky balsam and artificial dentin. In some cases, calmecin is used. After this substance has dried, the usual filling is carried out.

But modern young doctors are increasingly refusing such treatment, as it is fraught with complications, a long recovery process, unnecessary intervention and the possibility of inflammation spreading to the periodontium.

Amputation

Some clinics will immediately offer complete removal of the pulp or part of it. Of course, this procedure is carried out in more than one visit and most often under anesthesia, because it is quite painful.

If they stop at partial removal, then only the coronal part is affected. In this case, the root remains to protect the periapical tissues from various pathogens. In cases where the bleeding cannot be stopped, a decision is made to completely remove the pulp.

For the procedure to be successful, the doctor must adhere to the following rules:

When opening the cavity, use several sterile tips to prevent infection of deeper layers of tissue.
It is good to treat the tooth cavity with an antiseptic.
Using a selected dose of adrenaline, stop bleeding after amputation.

When it comes to pulpectomy, that is, complete removal of the pulp, you need to be especially careful to carry out the procedure so as not to damage the periodontal tissue. They try not to use this method everywhere, as it is painful, complex and time-consuming. However, the doctor decides to treat or remove the inflamed pulp based on various indications.

Devital

This method also refers to the complete removal of infected tissue. But at the same time they act in a softer way. By using special means, which will gradually kill the inflamed tissue, several stages of treatment are carried out.

Applications of arsenic paste and local anesthetics are usually used. But for the gangrenous form, it is recommended to use formalin and phenol. Next, depending on the selected product, it is left in the child’s dental cavity for 1-2 days or 7-14 days. The decision on the duration of this stage is made by the doctor based on clear instructions for a specific drug.

And at the next visit to a specialist, the cavity is cleaned and a tampon with a resorcinol-formalin mixture is placed. This is done in order to saturate healthy tissues with special substances that promote tooth growth. Thus, in addition to treatment, the oral cavity is prepared for the appearance of permanent units.

And only at the third visit to the dentist can we talk about the final stage, when open cavity filling. In order to evoke pleasant emotions in a 4-5 year old child from such long-term treatment, the doctor can offer multi-colored fillings that the baby will like and decorate his teeth.

That is, the whole procedure will be quite lengthy. But at the same time, it is almost painless, it is performed carefully and gently, without stress for the child. It is also very important that painkillers and safe substances are used. Increasingly, pediatric dentists prefer this method of treating pulpitis in children. different ages. It can be used for almost any form of disease.

Complications

Complications can follow, most often, due to the illiterate actions of the doctor during treatment. These include:

Initially incorrect diagnosis. And if the dentist removed only part of the inflamed pulp, the remaining source of infection will continue to destroy healthy tissue.
Too little application of arsenic paste leads to its leakage. If it gets on the mucous membrane, the medicine will quickly cause necrosis, affecting the inside of the cheek, tongue and gums.
If there was too much arsenic or it was used when the roots of a baby tooth began to be reabsorbed, then poisoning and intoxication of the child’s body is possible.
But it is not recommended to pack the medicine too tightly. After all, then you can provoke a burn of the mucous membrane.
Careless actions of the doctor can lead to the development of disease in the healthy part of the tooth or soft tissues underneath it. For example, if the dentist caught the periodontium with a needle during treatment.

Failure to follow the rules can also cause complications. The most serious consequences of pulpitis are periostitis and even acute polio. Therefore, you should contact a pediatric dentist in time and carry out the necessary manipulations, despite the cost of treatment and the fact that baby teeth are temporary units.

Prevention

Is it worth mentioning once again about the most common dental recommendations, which are universal for children and adults and relate to the prevention maximum quantity oral problems:

Video: pulpitis of baby teeth in children.

Additional questions

What to do if a child has a toothache after pulpitis treatment?

Painful sensations may be associated with medical intervention and tissue irritation from medications. If the pain itself subsides over time, then this normal reaction body. If it appears after treatment and its intensity does not subside, you should consult a doctor, since perhaps the procedure was performed incorrectly and something needs to be corrected.

The child’s temperature rose after treatment for pulpitis

An elevated temperature in a child may be a simple reaction to stressful situation. And yet, ignore similar symptom it’s not worth it, as most often this can indicate something serious inflammatory process. You should immediately consult a doctor and re-diagnosis.