What If My Child Has a Serious Cavity?

Posted by on January 24, 2014 at 5:10 pm

If your child is experiencing a serious cavity, it may require a root canal. What is a baby root canal and why is it necessary in order to maintain your children’s dental health?

Learn more about the anatomy of a tooth

A baby root canal (also called a pulpotomy) is needed when the hole in the tooth (cavity) is large and has either reached the third and middle part of the tooth called the pulp chamber or has become very close to the pulp chamber.

This procedure performed by a children’s dentist may be necessary even if the cavity has not reached the pulp chamber  because the second layer of the tooth called dentin is made of tubules.

A closer look at cavities

Although these are small tubes, they are wide enough for bacteria to enter and eventually find their way to the pulp chamber, which will lead to the tooth dying, getting an infection or both. This is a leading cause of failure of large restorations in primary teeth. When removing caries (a cavity) one is removing bacteria among other things, but bacteria are small and not all of them can be removed.

A closeup look at bacteria in teeth

A baby root canal involves removing the pulp chamber down to the level of the roots of the tooth. If the pulp at the level of the roots is healthy, a material can be placed that hopefully keeps the remaining pulp in the roots alive.

 Illustration of baby root canal treatment

A common material that is still widely used called formal creosol, derived from formalin, is placed that cauterizes the pulp at the roots. The problem with formal creosol is that it is a proven carcinogen. Formal creosol also can cause significant internal resorption inside the tooth and the result is that tooth just simply disappears – which is a failure of the procedure and the remaining part of the tooth should be removed.

A material recently developed called Mineral Trioxide Aggregate (MTA) can now be used safely for baby root canal therapy for toddlers and young children’s dentistry and has success equal or better then formal creosol with no evidence of negative health effects. [1] MTA has been shown, in some circumstances, to promote the repair of the dentin leading to a layer of healing over the roots referred to as a dentinal bridge from one side of the root to the other. Baby root canal treatment is not 100% effective and even under the best circumstances will have a failure rate of 2-8% and this rate increases the more advanced that cavity is before the root canal was completed.

In pediatric dental care, once a baby root canal has been completed the top part of the tooth called the crown, is no longer vital. These means there is no longer any living material inside the tooth and the crown of the tooth becomes brittle. The tooth becomes easy to break and fracture. For this reason it is best to place a cap on the tooth to prevent this. A cap goes all the way around the tooth and helps to protect it. If the baby tooth that had a root canal completed on it is not going to be in the mouth very much longer because the permanent tooth will be coming in, a regular filling can sometimes be placed.

Illustration of developing permanent tooth


[1] Comparison of Mineral Trioxide Aggregate and Diluted Formocresol in Pulpotomized Human Primary Molars: 42-month Follow-up and Survival Analysis. PEDIATRIC DENTISTRY V35 ND 3 MAY-JUN 13

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