Dentistry/8yr trauma teeth 8 and 9
QUESTION: My 8yo had trauma to teeth 8 and 9 eleven months ago. Her teeth were "new" permanent teeth when one was knocked out and the other knocked loose. They were wired in place for 10 days, we did soft diet for 6months. We have seen our regular dentist regularly to evaluate their progress. We just received discouraging news. There is increased calcification in the area where the pulp should be. An endodontist was recommended. He felt the best plan of action was to root canal them before the route to the root is completely closed. ( hope I am saying this correctly. ). My daughter s 8, she made it throught the trauma so far. Would you recommend sedation for a child this age on these teeth for root canals? How should I prepare her for what to expect? What is a realistic recovery time ? He is a pediatric endo but I would like another opinion.
Thank you for you time.
ANSWER: Hi Lynn,
I'm SO sorry to hear your daughter is going through all this. It's tough on anyone and especially someone only 8 years old.
If your daughter is apprehensive, then sedation may be appropriate. In my office, we do quite well with cooperative 8 year olds, but there is a lot of variation among children. It really shouldn't be any bigger deal than a filling especially when in the hands of a specialist. As for preparing her, I would say as little as possible. I assume the endodontist will want to see her for an examination before starting treatment and I would just let your daughter and endodontist deal with any fears she may have. We often see parents who are MUCH more fearful than the children and THEIR worries affect the kids greatly.
As for recovery time, once again usually not a big deal. We usually see slight soreness, maybe to bite, for a day or two and easily controlled with a Tylenol or something like that. I'm sure she will do just fine.
As an aside, although you didn't ask this, when you get the examination, don't be surprised if the endodontist suggests no treatment. If the only problem is the calcification of the root, the chances of that ever causing problems is about 5-10%. Root canals have a failure rate of 3-5%, so by treating, you aren't getting much of an advantage. Now, this is just general and since I can't exam your daughter or see her Xray, I really can't comment on her specific case. We often deal with resorption post trauma and that's a much bigger issue. There is a lot of information about trauma on our web site www.aae.org. You might want to check it out.
Good luck to your daughter!
Gary Backlund DMD, MSD
---------- FOLLOW-UP ----------
QUESTION: I left out that in addition she has had on going pain with tooth 9 and refuses to use them. The endo did a test with cold sensitivity and there was no response on tooth 8. Both teeth are turning gray and seemingly getting dark over the last 30 days. It was explained to me that the proximal root beds were very disrupted. They appeared all jagged on the ends when compared to 7 and 10.
I have had root canals myself and have no personal issues with the treatments. I don't think I will project my personal fears, my only one is that she will hurt and I hate that she has to go thru this.
I would like her to regain use of the front teeth. I would like to save her teeth for as long as possible. Are these goals and expectations pretty reasonable?
I reviewed your website before I entered my first question. It was very informative and useful. Thank you so much.
Hi again Lynn,
Actually, the fact that the roots are jagged changes things a lot, unfortunately, not for the better. What you describe sounds like resorption. If so, the treatment will be to pack the inside of the tooth with material to stop the resorption. If it does stop and is not too bad already, then the long term prognosis is pretty good. However, these teeth will always be a question mark because we really don't totally understand what turns the process on in some people and not in others. As far as the treatment goes, it will not cause your daughter any more problems than a regular filling in most cases. However, the treatment is prolonged since it may require several "packings" and evaluation appointments in between, but should not be painful, just tedious. You are in the right hands by seeing a specialist and hopefully things will turn out fine. I wish I could help more, but without the benefit of X-rays and an examination, it's hard to give you specific advice about your daughter's teeth.
Gary Backlund DMD, MSD