Dental caries is very aggressive in primary teeth. That results very easily in infection of the pulp (nerve) of the primary tooth so the dentist will need to perform a special treatment for the nerve very similar to root canal treatment (pulpotomy). This could happen even if the patient does not feel pain or discomfort, even if he/she does not have any symptoms. As soon as the dentist realizes that the bacteria are in the pulp of the tooth (clinical and radiographic findings) he will need to perform a pulpotomy so the patient will avoid swelling or pain in the future.
Despite of what the parents might think, pulpotomy is a very simple procedure. The dentistl places the rubber dental dam after anesthetizing the tooth, cleans the caries with the drill and removes all the oral bacteria. The dentist removes the major part of the tooth nerve that is close to the surface and seals it with a special paste that has antinflammatory and antimicrobial properties, in order to accomplish antisepsis. On top of it, the dentist will place a filling or a crown, like we do on the permanent teeth. Sometimes the patient needs an antibiotics prescription to maximize the results of the pulpotomy.
The parents should be aware that pulpotomy, although it usually has high success rates (85-90%), has some complications as well. If the microbes are already in the root tip, they can cause an abscess or swelling of the area that pulpotomy was performed. We may also have abnormal root resorption of the primary tooth and loss of the tooth. In each case the parents should immediately contact their dentist.
ROOT CANAL TREATMENT
In permanent teeth, when the bacteria reach the pulp (nerve) of the tooth they create intolerable pain that could not be relieved with any pain killers. In this case, the dentist must open the tooth and remove the infected pulp (nerve) from the canal of the root and close it with a special filling material. This is called root canal treatment and could take up 2 or 3 appointments. In children, this usually happens after trauma in the front teeth or really deep cavities in the back permanent teeth. As soon as the patient complains of pain, the parents should contact their dentist immediately.