Expert: Dr. Randolph Myerson - 10/10/2008

Question
QUESTION: My son recently took his 2 1/2 year old daughter to a pediatric dentist because she had a brown spot on one of her front teeth.  The dentist said that this spot is a cavity and that she has cavities on all four of her front teeth.  His recommended treatment is a root canal on each tooth and he wants to do all four during the same visit.  Why would baby teeth need a root canal because of cavities?  Could the cavities not just be filled like adult cavities are filled?  (She had not complained of any tooth pain.)

ANSWER: Dental decay is an infectious process.  When decay progresses deep into a tooth the nerve or pulp of the tooth becomes infected.  Once the nerve is infected a root canal treatment is necessary.  This is true of adult teeth as well as children's teeth.  The process is much faster in children's teeth because these teeth are very small and it doesn't take the decay very long to reach into the nerve.
The question remains whether or not the decay has infected the nerve.  One cannot depend on the presence of pain since this is not always a painful process until the infection is so advanced that even a root canal treatment is no longer effective and the infection has spread well beyond the tooth and into the surrounding bone and gums.
Often x-rays are the only way to determine if the decay is deep enough to require root canal treatment and usually the dentist really won't know until all the decay has been removed to see if the nerve has been exposed.

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QUESTION: Thank you so much for your response. This information is very helpful.

The dentist did not make any x-rays of her teeth.  Should we expect him to make x-rays before any work is done?  

Answer
Unless the decay is large and deep I don't know how the dentist knows that a root canal is necessary based simply on a clinical examination.  An x-ray is necessary to see how deep the decay actually goes.  Of course the final determination will be made after the decay is removed.  I would attempt to take an x-ray before starting the treatment.