According to the U.S. Centers for Disease Control and Prevention, the prevalence of treated and untreated cavities in children has increased over the last four decades. Decay in primary teeth (baby teeth) or immature permanent teeth tends to progress rapidly, often impacting the pulp—the nerves, blood vessels and connective tissue in the center of the tooth. Trauma that impacts pulp is another common problem associated with immature teeth, with research showing almost a third of children experience a dental injury by age 14. In addition, a prolonged toothache can lead to infection in the pulp. Although most people associate endodontic treatment with adults, pulp procedures are used to restore the health of teeth in children. At Advanced Endodontics of New York, we combine advanced technology and a compassionate touch to deliver gentle pediatric endodontics in New York, NY. Our goal is to restore your child’s oral health, save the impacted tooth and protect their permanent smile.
When the outer layers of a tooth are damaged due to cavities or trauma, this can lead to a painful toothache caused by inflammation of the pulp (pulpitis). Pulpitis is typically reversible in early stages, but may become irreversible when left untreated. The health and extent of pulp tissue damage determines whether pulp capping, pulpotomy or pulpectomy is the best approach. Therapies for primary teeth with normal pulp or reversible pulpitis include pulp capping and pulpotomy. A pulpectomy is recommended for nonvital pulp treatment in primary teeth with irreversible pulpitis or infected pulp that also impacts the root canal. At Advanced Endodontics of New York, we ensure your child feels comfortable and safe during treatment. We offer nitrous oxide, which is the gentlest form of sedation and safe for patients of all ages.
Pulpectomies are used when both the pulp chamber and root canal of the tooth are impacted. This procedure is effective for primary teeth with dead pulp or permanent teeth with infected pulp or abscesses. Diseased pulp is completely removed from the tooth, then the canals are cleansed, disinfected and packed with a reabsorbable material. If the tooth is permanent, a non-reabsorbable material is used. The final step is to place a crown over the tooth to provide strength and restore function. The only difference between a pulpectomy and root canal is that the latter also involves sealing the empty space with a rubber-like material called gutta percha.
Tooth decay is the most common preventable chronic childhood disease, impacting four times more children than asthma. An estimated 20% of children aged 5–11 have untreated tooth decay. Primary teeth are necessary for chewing food, integral to speech development and hold the space for proper eruption of permanent tooth. Fluoride treatment can prevent 33% of cavities in primary teeth. Applying dental sealants to the chewing surfaces of molars prevents 80% of cavities. The American Dental Association (ADA) recommends children see a dentist by their first birthday. The ADA also recommends that anyone participating in sports associated with a significant risk of mouth injury wear a mouth guard. Teaching children preventive measures early in life is critical to their oral health and can also prevent the need for pediatric endodontics in New York, NY. To help maximize the health of your child’s teeth throughout childhood and adulthood, follow these additional tips:
Advanced Endodontics of New York has the specialized knowledge, technology, and compassionate touch to restore your child’s teeth gently and effectively.
Pediatric means kids, and endodontics refers to when a child is in pain and the tooth needs a root canal, or the child had a trauma, like running into something and fracturing a tooth. Those kids need root canal therapy. Working on kids is very hard, especially doing a long procedure like endodontics, which is why a specialist is needed. Not every endodontist does pediatric work because it is time-consuming and difficult, but I love doing pediatric endodontics.
Children, primarily, might need root canals because I see a lot of seven-, eight-, or nine-year-old boys who are mischievous and may slam into a pole, fracturing their teeth. It’s a tooth that has just erupted, the roots are not formed, and now they’re in pain. They need a root canal, but they have to live their whole life with this tooth. So, there are many options for patients like that. Pediatric endodontics doesn’t just mean root canal therapy. It includes apexogenesis, regeneration, and more.
Apexogenesis is when the roots are not formed, open at the tip, and if you just perform a root canal, the roots will be weak throughout life. We try to form the root with a procedure called apexogenesis. If it happens on a dead tooth with infection, we can regenerate it, which is called regeneration. These are wonderful procedures with a high success rate. When nothing else works, we can perform a root canal therapy.
No, they’re not the same. Pulpotomy is when a child has decay, perhaps from eating a lot of chips, and the decay touches the nerve. A root canal involves removing the entire nerve, inhibiting root formation because the tooth becomes necrotic. A pulpotomy removes only the infected or inflamed part of the nerve on top, covering it with MTA, which promotes healing. This way, the tip of the root still has live tissue, which promotes healing and root formation.
If your child has pain from drinking cold or hot liquids and it doesn’t go away, the tooth is likely inflamed. Swelling or pus indicates infection. If the tooth is cracked, perhaps by a sibling slamming something into it, pain is a major indicator. Kids will tell you if a tooth is painful when they drink cold water, indicating that the tooth needs to be checked out.
For baby teeth that will eventually fall out, we do not perform a complete root canal. We just remove the inflamed part to keep the tooth until it sheds. However, if there is no successor, like no permanent tooth underneath, we have performed root canals on 22-year-olds with a baby tooth serving as a permanent tooth. In those cases, we do a full root canal.
Root canals are not painful because the patient is numbed. The challenge with kids is the needle, as the sight of it can be scary. Our practice offers sedation and nitrous. If a child is apprehensive, we use nitrous to calm them. For very young kids who can’t stay still, like a 7-year-old, we offer sedation. An anesthesiologist regularly provides sedation for kids and adults, allowing us to perform the procedure successfully.
The duration depends on the tooth. A front tooth is quicker because it has one canal, while a molar takes longer. Sedation can make it quicker, but the sedation itself takes time. Under nitrous, if the patient moves, it varies, but typically it takes no more than an hour and a half.
After treatment, it’s common to feel a little sore for a day or two. The child can take Tylenol syrup if needed, but most of our patients don’t require anything more. If infected, antibiotics are prescribed. Most patients go straight to school after; they just need to wait for numbness to wear off before eating. Soreness may last a day or two, but the pain relief is significant.
The success of treatment is high, but the definition of success can vary.
The cost depends on the treatment. Options like regeneration or apexogenesis are available, and the choice depends on the child’s and parents’ compliance and needs. If sedation is required, it’s a straightforward one-appointment root canal treatment.
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