AboutBenjamin Schwartz, D.D.S. Expertise I can answer a range of questions in dentistry, ranging from cosmetic dentistry, fillings, root canals, and comprehensive treatment. Specifically, my fields of interest are in CEREC technology, Invisalign (Invisable braces), and Endodontics (root canals).
Experience
Licensed and full time general dentist. Treated over 200 Invisalign patients and have placed numerous CEREC restorations.
Website and Office Information: ProDent NY
Organizations
American Dental Association
Member of the Academy of General Dentistry
New York State Dental Association
CEREC Doctors
League of Dentists
Publications Schwartz Benjamin, Boczko Fae, McKeon S. Oral Care For The Elderly. Perspectives in Gerontology December 2006
Education/Credentials New York University College of Dentistry - D.D.S.
Woodhull Medical Center, 1 year post-graduate residency program - GPR
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. oh and there is no discoloration
thanks
cindy
Answer Hi Cindy,
It's frustrating to see your son in discomfort, and you only want what's best for him.
A pulpectomy is used to remove the infected nerve from a baby tooth, and then a resorbable material is placed into the roots. This way, the infection will be removed, and when the adult teeth start erupting, they will resorb the baby tooth as expected.
Indications for a pulpectomy are;
- Adequate remaining tooth structure
- Restorable tooth
- Cooperative patient
Contra-indications are;
- Too much bone loss
- Uncooperative patient
- Non-restorable tooth
When a tooth experiences trauma, the impact from hitting the tooth can cause the tooth die, or become non-vital. Then this allows bacteria to grow and start causing an infection. You won't see any discoloration of the tooth, as this can take years before appearing.
Also, on the xray, you won't see anything inside the root. Sometimes, after a long time of leaving an infection present, the root can resorb somewhat. But this usually takes a while before developing, if at all.
Your son should start taking the antibiotics, as they will help to lower the bacterial threshold somewhat. However, he still will need a more definitive treatment.
If the teeth are loose, and there is significant bone loss, then doing a pulpectomy may not be in his best interests. Sometimes, when a baby tooth is traumatized and becomes loose, if left in place, it can ankylose. Which means that it gets very hard like bone, and does not fall out like it should. This then can affect the growing adult tooth, and cause future problems.
However, if the movement on the tooth is minimal, and there is no considerable bone loss, then a pulpectomy may be a viable option.
Without me actually checking your son, I would recommend a second opinion, as it would only help to let you better understand your options.
If the tooth has adequate bone, and there is no fear of trauma to the adult tooth, then you may want to go with the pulpectomy option. However, if there is a fear that the tooth will ankylose, then extraction would be your best bet. Also, if extracted, you don't need to have space maintainer, as the baby front teeth don't shift much and shouldn't cause any orthodontic issues.
I hope this has helped you somewhat.
Please let me know if you need any more information.
