AboutFrederick R. Liewehr DDS, MS, FICD Expertise I can answer your questions about root canal therapy in general. I cannot diagnose your particular problems or recommend treatment without examining you and seeing your x-rays, however.
Experience I am a Board-certified endodontist, former university department Chairman, teach dental residents, and have a private practice.
Question Dr. Liewehr
My 2 yr old experienced trauma to his two front primary teeth in feb. they both slightly chipped and were somewhat loose. i took him to a pediatric dentist who took xrays but saw nothing other than them being loose. she told me to wait and see what happens. i took him in again last week because he complains when i brush his teeth and he asks for all his drinks to be warmed up. i figured he was experiencing pain. they took another xray and saw that his two teeth now have an abscess at the root. but there is nothing visible in the pulp and she didnt say anything else was wrong. she said the only option was extraction and when i brought up root canal she said its not an option because of the abscess. i dont understand why she cant do a pulpectomy. ive been reading up on it and it seems like it is an option. why cant she just drain the infection and go ahead with a pulpectomy? should i get a second opinion? i hate to go through with the extraction. she gave us antibiotic and said to wait. wait for what????
i feel ignorant with this whole situation. please help. i have the xray if you want to look at it.
thanks
Answer A pulpectomy and root canal treatment, filling the tooth with an absorbable mixture of zinc oxide and eugenol (without catalyst) would certainly be a good option. Historically, the concern was three fold: first, posterior primary teeth are difficult to treat for a variety of technical reasons, second, young children usually cannot tolerate the lengthy procedure with multiple radiographs and so forth, and third, many concerns were voiced about the possible adverse effect on the succedaneous tooth (the one still growing inside the bone). In your child's case, the two front teeth are extremely simple to treat, and with electronic apex locators there is no need for multiple radiographs and the risk of instrumenting outside the tooth and damaging the succedaneous tooth bud is minimal to nonexistent with a careful operator. The research is mixed on any effects on succedaneous teeth anyway, and most of it is old and of low scientific value, so that really should not be a concern. The ability of your child to cooperate for any dental procedure, however, is a concern. Nowadays pediatric dentists do a lot of sedating of these kids, and that may be required. We don't do little children in our office, though we sedate adults, because they respond differently to drugs and so forth, and we do not have the training to feel comfortable with it. Probably most endodontiststs feel the same. So, you are absolutely right; you just have to find someone to help you. Antibiotics and "waiting" are definitely not appropriate. When I was department chair at the University, I noticed that the pediatric dentistry department did very little endo; when some was needed, they got our residents to come over. They sedated the kids, our residents did the endo. I tried to teach them about pediatric endo, but they would rather take the teeth out and make space maintainers. Of course, in the anterior teeth, you don't need a space maintainer usually, the kid just goes without teeth. In my judgement, this affects his speech development as well as his looks and what the other kids think of him, so I would agree with you that the teeth should be saved. Good luck.
