Expert: Dr. Randolph Myerson - 10/9/2008

Question
My 3 year old daughter has some condition where the smallest amount of bacteria in her teeth cause it to decay very rapidly. With this said, she has 6 cavities. All 4 of her 2 year molars are pretty bad. 2 of them possibly have nerve involement. The pediatric dentist I saw recommened we put her under anesthesia and do a root canal, where they would remove the pulp and do something to the roots. Then put caps on all 4 of them. A friend of mine said her daughter had a cavity and the 1st dentist recommended the same thing but the second said no way we don't do baby root canals anymore! WHat is your opinion. With the extensiveness of her decay, is it a case by case decision? My dentist also said the by pulling them and puting spacers in they are high maintenance, and have to stay til the 12 year molars come in and there will probably be more problems...ANy thoughts??

Answer
Those 2 year primary molars should remain in place, if at all possible, until the permanent 6 year molars are fully in place.  They are necessary in order to guide the 6 year molars into position.  If they are lost before the 6 year molars are in position then the permanent teeth will come in improperly, blocking out other permanent teeth and causing significant bite problems for your daughter.  Once the 6 year molars are in proper position then the 2 year molars can be extracted if necessary and a space maintainer can be inserted to prevent some of those bite problems from developing.  The key here is to save those 2 year molars until at least the six year molars have emerged. Usually, however, successful nerve treatments will save those 2 year molars until they are ready to fall out normally.   
In all cases where the nerve of the tooth has been infected by decay, the only way to preserve that tooth is to do a nerve treatment.  Maybe your friend's dentist doesn't do nerve treatment on primary teeth but pediatric dentists certainly do and that's because a nerve treatment and a crown are the only way to effectively preserve the tooth once the nerve has been infected.
As for the general anesthetic, that is certainly an acceptable way to complete all the treatment in a single visit.  There are, however, certain risks that must be considered with a general anesthetic and these you must discuss with the anesthesiologist before the treatment is done.  As an alternative, some pediatric dentists will attempt treatment using sedation in the office.  This is a less risky but more limited approach and would probably require multiple visits to complete all the treatment.  Sometimes sedation is not as complete as would be desired and the child will still fuss during the appointment.  This could limit the success of the treatment.
You should obtain as much information as possible regarding these options and make a decision as soon as possible.  Delaying the dental treatment any further lessens the chance of a successful outcome.