Can my toddler undergo a root canal?

Hi,

Welcome to icliniq.com.

I understand your concern.

This clinical picture represents a case of 'nursing bottle caries'. That means, kids who take milk feeds while sleeping or have the habit of keeping a feeder in mouth for long and then sleep without brushing develop this type of caries in upper four anteriors because of the bacterial colonization, which starts at that surface of the tooth during nighttime. We can see that only those four teeth are affected where the feeder rests or cleaning is not done properly, and the rest are fine. This was the diagnosis. Now let me tell you about treatment options:

1. If cavities are not deep and the kid has no history of severe pain or swelling, then they can be simply restored through fillings.

2. If cavities are deep or the tooth colour is changed to brown or black, the patient is giving a history of pain and tenderness over a particular tooth, then the medication regimen is given as the first line of defense. And in this case, if the symptoms go away after a three or five-day course, that is good, and 70% chances are that the infection has gone away and will not recur. Meanwhile you need to concentrate on brushing habits, not leaving feeder in mouth for long and brushing or rinsing before going to sleep.

3. If symptoms have become severe or even after following the medicines for a week symptoms of pain, swelling in gums or tenderness recur then we will proceed to RCT (i.e named as 'pulpotomy or pulpectomy' in pedodontics, after evaluating the x-ray of teeth)

The answer to your questions:

Answer 1- Yes, Pulpotomy (Modified RCT for kids) can be done on 2.5 year old.

Answer 2- Pulpotomy is a very delicate procedure, and pedodontists do it very carefully keeping in mind that they do not hurt the buds of permanent teeth lying below these milk teeth. So do not worry if your dentist is good,the next permanent teeth will not get affected through this procedure.

Answer 3- No, there is no alternative for this treatment as you can see it is already the last stage or third line of defense to save the tooth.. I know very well that kids aged 2-5 are the least cooperative. So there are two options left for these conditions:

Option 1) GA (General Anesthesia)—This is best, as less time will be consumed, and work will be done properly without any chances of mishap.

Option 2) In some cases, where parents do not want to go through the GA phase, they are recommended to follow the medicine course whenever symptoms occur. However, this is not a permanent solution or treatment. (For eg: The kid is given medicines, symptoms get subsided for 2 months and then recur, and again the same medicine course is given then symptoms get subsided for next 3 months, and so on till the kid reach the age 5). From 5 till 7 years of age permanent incisors are expected to erupt, so we want to keep these milk incisors till 5 in place for better alignment of permanent teeth. Typically, the patients who cannot afford a GA facility usually go for the second option.

Answer 4- GA (General Anesthesia) is safe. And no big complication is ever reported for such cases, so you do not need to worry. Be sure your anesthetist is good and the procedure will go smoothly. Before ending up I would like to share my diagnosis that can be considered as half, as I need an x-ray of all upper four incisors to give a final word. Anyways, just by seeing the clinical picture, I think only the front two incisors need RCT rest two do not look deeply infected, and there is not much colour change. I do not know about pain symptoms that can be checked clinically.

Ask your dentist to re-evaluate, or if you can show me a picture of the X-ray of your kid, then I will confirm the diagnosis online. Make your son brush teeth after taking a feed and before sleeping.

I hope this helps.

Thank you.