Is Root Canal Treatment Performed on Children’s Milk Teeth?

Is root canal treatment performed on children’s milk teeth in Izmir?

In Izmir, root canal treatment for children’s milk teeth is frequently done within medical standards to prevent early extraction of the tooth when deep cavities reach the nerve and blood vessel chamber in the center of the tooth (pulp) and cause inflammation. Just like adult teeth, milk teeth have roots and nerves, making this treatment a medical necessity.

There is a very common and deep-rooted misconception among parents in society regarding the anatomy of milk teeth. Many people think that when they hold fallen milk teeth in their hands, they see that they have no roots, leading them to believe that milk teeth are simple structures without roots or nerves, merely held by the gum. However, milk teeth have strong roots that extend deep into the jawbone and contain live nerve cells inside. The reason the root is not seen in a fallen tooth is that it has been slowly dissolved by the emerging permanent tooth. When a milk tooth decays, if bacteria penetrate the enamel layer of the tooth and reach the living nerve fiber within, the tooth becomes infected. If intervention is not made at this stage, the infection spreads to the bone. At this point, instead of extracting the tooth, cleaning the diseased nerves inside to maintain the tooth functionally in the mouth is called “milk tooth root canal treatment”. This treatment, which preserves the child’s chewing pattern, speech and jaw development, is one of the most valuable preventive measures of modern medical approaches.

In which situations is root canal treatment applied to milk teeth?

Pediatric root canal treatment; it is performed in cases where the child experiences throbbing toothache that especially causes waking from sleep, when cavities extend deep enough to reach the nerve chamber of the tooth, when cysts similar to pimples form in the gum, or when the tooth loses vitality (necrosis) due to trauma (falling, hitting).

When the cavities in baby teeth only cause minor dullness or leakage during the initial stage, when this stage is surpassed, bacteria enter the live tissue known as the ‘pulp’ inside the tooth. When the pulp tissue becomes inflamed, it seeks to expand, but since it is contained within a closed bony box, it cannot expand and creates immense pressure. This pressure leads the child to wake up crying, especially at night (due to blood rushing to the head). In some cases, the nerves die completely, and the pain stops, but the infection causes swelling (abscess) in the gums through the root tip of the tooth. In both clinical situations, it is medically impossible to cover the tooth with a standard filling; because the infected nerves beneath the filling continue to produce infection. In these cases, the channels of the diseased tissue must be completely cleaned out.

Why Should an Infected (Abscessed) Baby Tooth Be Saved Instead of Extracted?

An infected baby tooth should be saved instead of extracted because baby teeth serve as natural space holders in the jawbone, allowing the permanent teeth beneath to erupt at the right time and angle. Early extraction can lead to the neighboring teeth shifting into that space, causing the permanent teeth to become impacted or come out crooked.

The most questioned issue by parents is the question, “If a new one will come in place of it, why are we not just extracting it but performing a long procedure like root canal treatment?” The arrangement of teeth in the human jaw has a perfect balance. For example, if a 5-year-old child has an abscess in the back milk tooth and the dentist extracts that tooth, it will leave a huge gap in that area until the age of 11 (i.e., until the underlying permanent tooth erupts). The back teeth are constantly inclined towards forward tipping. The gap will completely close over the months. By the time they reach 11 years of age, the permanent small molar trying to erupt from the jawbone will not find a separate space for itself above. As a result, it remains locked (buried) inside the bone or erupts crooked towards the palate. Additionally, the child cannot eat on that side due to the extracted tooth, leading to facial asymmetry. Root canal treatment is the most rational and necessary medical investment that halts this biomechanical collapse and preserves the bone area down to the millimeter.

What Is Partial Root Canal Treatment (Amputation / Pulpotomy) and When Is It Done?

Partial root canal treatment (amputation or pulpotomy) is performed in cases where decayed bacteria have reached only the nerve chamber in the upper part (crown) of the tooth, but the infection has not yet descended into the root canals and jawbone. In this procedure, only the diseased nerve tissue in the upper part is cleaned, while the healthy nerves within the root are preserved and covered with special biocompatible materials.

The goal in pediatric dentistry is to ensure that the tooth develops naturally by keeping the tissue alive as long as possible. If the cavity is deep but there is no infection (abscess) detected via X-ray at the root of the tooth, the dentist will choose the method of amputation instead of performing a complete root canal treatment. While cleaning the cavity under local anesthesia, the nerve chamber, which is the “heart” of the tooth, is opened. Only the bleeding and infected part of the nerve in this upper chamber is removed with sterile instruments. The nerves in the legs (roots) that go down to the jawbone are healthy and pink; they are not touched. The upper surfaces are sealed with biocompatible (MTA, formocresol, or calcium silicate-based) medical agents to ensure impermeability, and the procedure is completed in the same session with filling or sealing. This method allows for the continued development of the root of the tooth, and when the time comes, it can normally loosen and fall out.

How Does Milk Tooth Root Canal Treatment (Pulpectomy) Differ in Adults?

Milk tooth root canal treatment (pulpectomy) differs from that in adults in that instead of being filled with non-resorbable hard rubber materials (gutta-percha) after cleaning the tooth roots, it is filled with specially designed soft medical materials based on calcium hydroxide or iodoform that can naturally dissolve (resorb) under the pressure of the underlying permanent tooth.

When performing root canal treatment on an adult patient, the primary goal is to seal the tooth inside the jawbone for the entirety of that person’s lifetime. Therefore, solid materials that do not degrade over time, are impermeable to liquids, and never dissolve in the body are tightly packed into the canals. However, performing root canal treatment with such materials on a child results in a medical disaster. In order for a milk tooth to be shed at the right time, the underlying permanent tooth must resorb (dissolve) the root of that milk tooth cell by cell. If there is a non-dissolving plastic (adult filling) in the root canal of the milk tooth, the permanent tooth cannot overcome that barrier and remains stuck in the jaw. For this reason, in pediatric dentistry, after the root canals are washed with special solutions, they are filled with a creamy paste using a syringe. This paste completely dissolves simultaneously with the root of the milk tooth when the underlying permanent tooth moves upwards, thus disappearing. This way, the mechanism for the tooth to shed is not harmed in any way.

How is the Decision for Root Canal Treatment Made at İzmir Avrupadent Clinics?

In the clinics of İzmir Avrupadent, the decision for root canal treatment is made based on the dentist’s visual examination, supplemented with digital radiological (X-ray) analyses. The depth of the infection on the X-ray, the condition of root absorption, and most importantly, the follicular boundaries of the underlying permanent tooth bud are examined in millimeters, and specific plans are made according to Pediatric Dentistry (Pedodontics) protocols.

From the outside, a tooth that appears as a large black hole may not always require root canal treatment or extraction. Conversely, a tooth that looks like a tiny hole from the outside might have a massive abscess at its root. In our diagnostics established in the İzmir location, we rely on radiological data rather than clinical estimates. Low-dose periapical or panoramic X-rays taken before the procedure provide the dentist with a map showing the inside of the bone. The dentist answers the following vital questions by viewing the X-ray: “Has more than half of the roots been absorbed by infection? Has the infection reached the protective membrane (follicle) of the underlying permanent tooth? How long until the physiological shedding time of the milk tooth?” If the tooth is not mobile, the root length is still healthy, and if there is at least 1-2 years until the emergence of the permanent tooth, it is most protective to keep the tooth in the mouth through amputation or pulpectomy rather than extraction. Otherwise, the treatment direction will change when the damage caused to the surrounding tissues of the tooth outweighs its benefits.

Does Root Canal Treatment Prevent the Emergence of Permanent Teeth?

Root canal treatment for milk teeth does not definitely prevent the emergence of permanent teeth; on the contrary, if the correct materials (resorbable fillers) are used and the infection is removed from the bone, it both mechanically protects the eruption path of the underlying permanent tooth and prevents the enamel structure from being damaged (stained) in an acidic environment, thereby supporting the permanent tooth’s emergence safely.

One of the biggest fears of parents, the misconception that a “treated tooth will remain locked in the mouth,” is biologically unfounded. A successfully treated milk tooth continues to adapt to the physiological dynamics within the bone, even when found lifeless in the mouth. The fibers (periodontal ligaments) surrounding the root attach the tooth firmly to the bone in a flexible manner. As the child’s growth timeline progresses and the genetic clock ticks, the permanent tooth waiting in the alveolar bone will begin to move upward. The mechanical pressure created by the permanent tooth stimulates the “osteoclast” cells in the bone, gradually dissolving the root of the milk tooth and the dental material within it. A milk tooth that has completely lost its root begins to wobble, and when the child eats, it will fall out of the mouth without any issues, just like a healthy tooth that has never been treated.

In Advanced Infections, Should Root Canal Treatment or Extraction Be Preferred?

In cases of advanced infections, instances where extraction should be preferred over root canal treatment include situations where the infection has completely eroded the roots of the tooth in the bone, the abscess has physically contacted and started damaging the seed of the underlying permanent tooth, or the tooth has become mechanically loose and completely lost its supporting tissues (bone retention) in critical medical situations.

The fundamental philosophy of dentistry is to preserve the tooth; however, the exceptions to this rule depend on the danger posed by the spread of infection. If an abscess forms in a milk tooth and is left untreated in the jawbone for a long time, it begins to dissolve the bone like acid. When the doctor looks at the X-ray, if they detect that the roots of the tooth are much shorter than normal or that the surrounding bone has turned into a black void (resorption), that tooth cannot be treated with root canal therapy because there is no root wall left to fill its interior. Even more critically, if this inflamed sac reaches the permanent tooth lying just one millimeter below, every second spent there will cause yellow/brown stains and deformities (Turner tooth) on the enamel of the permanent tooth. In this clinical picture, the doctor plans to atraumatically (without causing harm) extract the infected tooth to protect the overall health and the main permanent tooth, and then plans to use “space maintainer” appliances to preserve that void.

Why is a Crown (Coating) Applied After Root Canal Treatment?

The application of a crown (coating) on a tooth after root canal treatment is a physical barrier treatment to protect the tooth from fractures, as the tooth loses the fluid (blood) support from its nerves over time and becomes brittle and lifeless due to a fragile structure. Furthermore, the significant tissue loss caused by the decay does not allow a standard filling to hold.

When a root canal (pulpectomy or amputation) is performed on a milk tooth, all the caries in the crown (chewing) part of the tooth must also be completely cleaned. Once this procedure is completed, usually, only leaf-thin, very weak walls remain around the tooth. Since the nerves and blood vessels inside have been cleaned, the tooth loses its flexibility and becomes brittle like a dried branch. If the dentist finishes the procedure by placing only a standard white filling (composite/glass ionomer) inside this weak tooth, the chewing pressure will push the filling against those thin walls, causing them to fracture and separate from the root. The broken tooth must necessarily be extracted, rendering all the effort of the root canal treatment pointless. To eliminate this risk, pediatric stainless steel or tooth-colored zirconium crowns (caps) are placed on the tooth, covering it 360 degrees. These crowns guarantee the tooth’s lifespan until the eruption age.

How is the Child’s Psychological Adjustment (Cooperation) Ensured During Root Canal Treatment?

During the course of root canal treatment, the psychological adaptation of the child is ensured by communicating techniques that narrate the medical instruments of pediatric dentistry specialists, while keeping the environment free from anxiety. In cases where the fear level is very high or when treating very young children, sedation or general anesthesia (sleeping) methods are presented as a medical necessity to prevent the treatment from turning traumatic.

Root canal therapy involves the use of finer tools compared to a standard filling and is generally a longer procedure. The time that children can remain still in the chair (focus) is quite limited based on their ages. In the Izmir Avrupadent procedures, the practitioner never uses frightening terms like ‘injection, extraction, nerve removal’ when seating the child in the chair. Communication is conducted in a pedagogical language suitable for the child’s world (using the Explain-Show-Do technique). When the tooth is numbed, it is said that ‘sleep medicine was dripped onto the tooth’, and while cleaning the insides of the canals, it is described that ‘tiny bugs inside the tooth are washed away with small brushes and removed.’ However, if the child is completely closed off to treatment, is in pain, and is locking their jaw, forcibly treating that child can lead to both the unintended perforation of the tooth (physical risk) and the child’s lifelong avoidance of the doctor (dental phobia). In these cases, the child is safely put to sleep under the guidance of an anesthesiologist, and all treatment is completed without any pain during sleep.

Does a Tooth That Has Underwent Root Canal Treatment Hurt Again or Decay?

Once the nerves inside a tooth that has undergone root canal treatment are completely removed, the sensitivity to external stimuli such as hot, cold, or sweet (pain sensation) is eliminated; however, if the child’s eating and brushing habits are poor, bacteria can create secondary decays (secondary caries) by seeping from the remaining outer enamel or from the gum line of the crown placed.

The removal of the inside of a tooth does not mean that it remains lifeless like plastic in the dental arch. Yes, the tooth does not have living nerves, which is why it does not hurt when eating ice cream. However, the enamel tissue on the outside of the tooth is still present and has the potential to dissolve in response to carbohydrate acids. More importantly, the supporting tissues (periodontal ligaments) that connect the root canal-treated tooth to the jawbone sustain its vitality. If hygiene is neglected at home after the procedure, and if food particles trapped between the teeth are not removed with dental floss, the plaque that accumulates in that area can cause inflammation of the gums. When the surrounding tissues of the tooth root are damaged, the child may begin to feel a slight pain when applying pressure to the tooth. In summary, the treatment performed protects the tooth from the inside, but mechanical cleaning of the tooth (brushing/flossing) against bacterial acid attacks from the outside must continue with the same discipline under parental supervision.

What Should Home Care Be Like After Root Canal Treatment?

Home care after root canal treatment begins by avoiding solid food until the anesthesia wears off to prevent lip/cheek burns. Following that, the tooth should be brushed twice a day with fluoride toothpaste, dental floss should be used to prevent interproximal cavities, and it is essential to avoid excessively sticky foods to prevent breaking the tooth.

When returning home on the day of the procedure, there is a significant risk; instead of treating the area that’s numb, it’s about heating it up for the purpose of the procedure. Huge white sores (anesthetic traumas) inside the cheeks are a result of these heating effects, rather than fillings or root canals. After the numbness wears off, normal nutrition is resumed with the doctor’s approval. If a crown (cover) has been placed on a tooth that has undergone root canal treatment, the adhesion of that cover to the tooth is ensured with special medical adhesives. Foods that are highly sticky like jelly beans, caramel, or chewing gum can create a strong vacuum effect that displaces this covering. Therefore, eliminating such foods from the diet is essential. Oral hygiene shouldn’t be left to just brushing; parents must definitely apply dental floss to their child’s teeth before bed to rinse away acids that accumulate on the flat surfaces where the teeth touch each other.

How Do Early Diagnoses Eliminate the Need for Root Canal Treatment in Milk Teeth?

Early diagnoses identify microscopic mineral losses (initial caries) starting on the enamel surface before they deepen and reach the tooth’s nerve (pulp) chamber. They resolve the need for serious interventions such as root canal treatment and crowns in milk teeth through fluoride varnish applications or very small fillings.

The key to success in medical science is to prevent diseases from reaching destructive levels, rather than treating them after they have developed. The enamel on milk teeth is very thin; it can sometimes take just a few months for a cavity to start from the surface and infect the nerve chamber. It is very difficult for parents to notice these tiny black dots or white spots resembling chalk (demineralization areas) on their children’s teeth at home. In a child brought for regular dental check-ups at six months, the dentist can detect these hidden leaks without drilling the tooth, using special illuminations and interstitial X-rays. Since the cavity hasn’t reached the nerve, the process is completed using protective agents that only repair the enamel, without performing any anesthesia (injections) or using long drills. Regular dental follow-up is the most valuable medical time management that pulls parents and children out of the challenging circle of root canal treatment.