Dentistry/ROOT CANAL THERAPY FOR 6 YEAR OLD BOY
My grandson is just 6 years and VERY NAUGHTY.For some problem my dentist has advised RCT for him.But the problem is that he may not cooperate and more trouble may be faced.
Root canal treatment for permanent teeth in children is a complex procedure requiring lengthy
appointments and multiple visits and often requires a full coverage restoration.Whether Sealants can be used or any alternative procedure.With thanks
What is the alternative suggestion.?
Are there are some other options?
There are procedures like Indirect Pulp Treatment-If pulp damage is minimal, it's possible to remove most of the decay (but not the pulp), apply an antibiotic, and then seal the tooth up again; that's referred to as an “indirect” treatment.
Direct Pulp Capping is recommended for “small incidental exposures of the pulp when there is no decay.” Here, the dentist will essentially “cap” the exposure directly using similar materials as mentioned above, to create a dentin “bridge” to seal the exposure.
Pulpotomy-is literally a “partial pulp removal if decay is limited to the upper portion of the pulp, “pulpotomy.is recommended” This involves removing the damaged part of the pulp, stabilizing the remaining healthy portion, and then disinfecting and sealing the tooth.This is probably a “partial” root canal is treatment
Pulpectomy-involves complete removal of all the pulp tissue because it is infected. If pulp tissue is infected through the entire tooth structure, a pulpectomy may be needed, which requires the removal of all pulp tissue.This procedure resembles traditional root canal treatment, with removal of all the infected tissue from the root canals
As I am very much worried for my grandson ,please help with your best suggestions.
Thank you for this question which identifies a common treatment situation.
Since I do not have the benefit of radiographs and a clinical exam it is really difficult to recommend the proper course of treatment.
However, based on the limited information about your grandson, I will discuss the potential issues you raised and give a best estimate of the course of therapy.
Your dentist has stated your grandson needs a root canal. An alternative to root canal treatment is extraction of the involved tooth. This is not the recommended choice of treatment.
When a root canal is necessary, this indicates that the pulp, nerves and blood vessels in your grandsons 6 yr. old molar, (first permanent molar tooth I presume) are irreversibly damaged. Thus therapy needs to address this situation. Therefore, indirect pulp capping usually reserved for primary,(non-permanent teeth), and direct pulp capping when there is a mechanical pulp exposure in non-carious teeth, are not applicable.
An important consideration in evaluating treatment is status of root formation at the apex of the tooth. If full apical root closure has been completed, a one appointment, root canal treatment can be performed. This would incorporate a pulpectomy( which is part of the full root canal procedure) and relates to the instrumentation and removal of the inflamed pulp tissue. After this is performed, with full instrumentation and irrigation, the root canals can be obturated , filled and sealed. Once this is accomplished a core and coronal restoration can be placed. Since leakage is a common cause of root canal failure, the permanent restoration of the tooth is quite important.
The instance where full one appointment root canal therapy is not indicated is when there is incomplete root development. This occurs when root and or root apices at the end of the roots that are not completely closed. In this situation the level of root and apical root closure is critical. This determines the course of proper treatment. The following are two common possible scenarios.
1) If the root apices are wide open, the treatment may be Apexogenesis. This would entail determining how deep the decay and damage is within the crown. If the decay is right on top of the pulp and in removal does not penetrate the pulp or minimally does, the treatment of choice would be the following: Removal of the decay, placement of MTA( mineralized tri-aggregate) or Calcium Hydroxide, then placement of a restoration to seal the crown opening. Depending on the amount of coronal tooth loss, a stainless steel crown might be placed. This procedure is designed to remove the decay and allow for your grandsons' roots to more fully develop. Depending on the stage of the root closure, this process can take 3 months to 2 years. During that time at 6 month intervals, the MTA or Calcium Hydroxide may need to be changed. Thus multiple appointments and check radiographs are needed to evaluate root development. Once root closure is complete, a full root canal needs to be performed and permanent coronal restoration placed.
2) A second situation occurs when the decay and pulp damage is more extensive and the roots are still not fully developed. In this situation a pulpotomy is performed to remove all the inflammed pulp in the coronal portion of the pulp chamber. The vital roots are covered and the pulp chamber is filled with MTA( mineralized tri-aggregate) or Calcium Hydroxide and the tooth is restored while the roots complete their development and apical formation. In some situations the initial instrumentation might require some debridement down the canal openings. Regardless, tooth/root development is followed by radiographs every 3 months. Once the apical closure is complete, the full root canal treatment is performed, followed by a permanent restoration.
Since you are concerned about your grandson's dental experience/ and or behavior, my recommendation would be to go to an endodontist for evaluation. This specialist could also work with a pediatric dentist specialist to develop a proper treatment sequence. If some sedation or premedication is required to manage the fear,or behavior of your grandson, these specialists' would easily be able to facilitate this.
If you are unable to locate these type of specialists', I would consider taking your grandson to a local dental school where they would easily be able to coordinate his care.