Milk tooth pulpitis treatment. Features of pulpitis of milk teeth in children. Troubleshooting methods. Conservative and radical options

Parents quite often do not pay due attention to the milk teeth of their children. It is generally accepted that care is not required for temporary teeth, and even more so, they do not need to be treated. In fact, children have pulpitis baby tooth, which requires mandatory treatment. Otherwise, there is no guarantee that negative consequences will not occur.

What is pulpitis

Pulpitis refers to a disease of the teeth that affects the body of the pulp. This is a bundle of nerve, blood, lymphatic vascular endings, which are located in the root canals or in the root region of the tooth.

The disease in most cases develops in the lower dairy painters, since children still have rather fragile dentin, which is not able to qualitatively protect the baby's teeth from pathogenic bacteria.

Pulpitis in children

The reasons

Before starting the treatment of pulpitis of milk teeth, it is necessary to understand what caused the disease. Excluding negative factor and having treated the disease, in the future you can not worry about standing teeth in a child. The most common reasons include:

The cause of the development of the disease can be an enlarged pulp, which is quite easy for pathological microorganisms to reach.
Due to the insignificant coating of the tooth with enamel, there is no high-quality protection. oral cavity.
If wide dentinal tubules are diagnosed, this can affect the rapid spread of the disease.
Damage to the tooth during a preventive examination due to the low qualification of the dentist.
Infectious diseases promote the growth of bacteria in the oral cavity.
Self-medication, when a warm heating pad is applied to the child or warm compresses are made.
Intolerance to filling materials.
Damage to the enamel surface due to ingestion medicines, sour and spicy food.
The reason is caries, which was not cured in a timely manner.

Pulpitis develops very quickly and on initial stage may not evoke bright severe symptoms. Therefore, it is necessary timely appeal see a doctor if the child complains of pain and discomfort in the oral cavity.

IMPORTANT:Only pediatric dentist decides pulpitis of a milk tooth to treat or remove

Symptoms

Even if there are no symptoms of the disease, visits to the dentist by the child should be regular. With pulpitis, the symptoms can be varied. It all depends on the course of the disease. Pulpitis is characterized by 2 stages of development.

The development of pulpitis

1. Serous stage

After the start inflammatory process channels are filling up. serous fluid. During this period, very strong pains appear, which are most pronounced during meals or at night. Painful sensations may appear several times. If no measures are taken, then after 6 hours the disease will move to another stage.

2. Purulent stage

It is with this form of the disease that the child is brought to the dentist, since the signs of pulpitis are very pronounced.

In the canals of milk teeth, purulent fluid begins to accumulate, which exits through the cavity of the tooth damaged by caries.
The child experiences very severe pain, which is of a prolonged nature.
The pain may disappear for a while and then reappear.
The child also complains that all his teeth hurt. This is associated with severe pain.
The baby stops eating.
The pain is so strong that it is even impossible to touch the tooth.
Sometimes there is an increase in temperature.
Depending on the severity of the disease, there is an increase in lymph nodes in children.
Appears bad smell from mouth.
Around the diseased milk tooth, tissues become inflamed.
Sensation of expansion and heaviness in the tooth.

IMPORTANT:In children under 2 years of age, such symptoms may not be observed, since at this age the roots have not yet fully formed.

Preparation for treatment

If pulpitis is diagnosed in children of milk teeth, treatment is carried out only in dental clinic. Self-medication is prohibited. It is very important to prepare the baby in advance for a visit to the doctor. Almost all children are afraid to treat their teeth. Therefore, parents should take the issue of preparation seriously.

You can tell your child who a dentist is and why he treats teeth.
Describe the consequences of not receiving treatment.
Do not scare the child with pain and do not discuss negative aspects during treatment.
Parents should not worry, so as not to provoke fear in the baby.
You can take your favorite toy to the doctor.
If the child does not allow a review, postpone the treatment procedure for another day.

Tooth structure

How is pulpitis of milk teeth treated in children

The treatment of pulpitis in children of milk teeth has stages that include various ways in the fight against pulpitis. And only the doctor decides which method will be applied.

traditional method

A child with this type of treatment needs to visit the dentist several times. The procedure algorithm is as follows:

The inflamed pulp is carefully opened.
It is filled with a paste, which includes Shostakovsky's balm and natural dentin.
The paste should stay in the pulp for 1-2 days.
If arsenic is added, this mixture is kept for a week.
At the next visit, the tooth is filled.

Amputation method

This method is to remove the pulp or a certain part of it. Since the procedure for removing the entire pulp is painful, the pediatric dentist may use local anesthesia. With partial removal, only the coronal part is affected. The root remains so that the tooth is protected from the penetration of pathogenic bacteria.

There are several rules that the doctor always adheres to:

To exclude infection of deep tissues, only sterile tips are used.
Before extraction, the tooth area must be treated with a high-quality antiseptic.
In order to stop the blood after removal, the required doses of adrenaline are individually selected.

Devital method

Parents will be interested to know how pulpitis of milk teeth in children is treated in other ways. This method involves the complete removal of tissue inflamed in milk teeth. Treatment consists of several stages. At each stage, the doctor uses a certain dose of the drug to kill the infected tissue. Most often, arsenic paste is used for this.

The paste is left in the oral cavity for a minimum of 1 day and a maximum of 7.
After a while, the cavity is cleaned.
Insert a tampon with healing mixture so that all healthy tissues are saturated with a resorcinol-formalin mixture.
These substances contribute to the growth of permanent and healthy incisors when changing milk teeth.
At the third stage, the tooth is filled.

IMPORTANT:To eliminate stress in a child, safe painkillers are used.

Prevention

You can avoid pulpitis in a child if I follow preventive measures.

To exclude inflammatory processes in the oral cavity, with early age It is necessary to accustom the child to oral hygiene. Children should brush their teeth regularly every morning and before bed.
Parents should only buy children's toothpaste.
Importance also has baby food. It is necessary to minimize the consumption of sweets, chocolate, muffins.
For the purpose of prevention, it is recommended to drink courses of vitamin preparations.

For some reason, some families still think that interchangeable occlusion, or rather, milk teeth, is a coming phenomenon, and therefore caries and pulpitis do not threaten them, and they should not be treated like molars in adults. These arguments are fundamentally wrong and jeopardize healthy smile baby in the future. Why?

What it is

Pulpitis is an inflammatory process that takes place in the pulp of the tooth. It is the main structural unit of the dental organ, located in its cavity. Represents accumulation of nerve and collagen fibers, various cellular elements(odontoblasts, fibroblasts). The whole pulp can be divided into coronal and radicular.

The pulp is the life and nourishment of the tooth. If something happens to it (inflammation), like a whole chewing organ, it cannot fulfill its intended purpose. Not getting enough nutrients, it dies, like a tooth.

Pulp damage in children occurs several times more often than in adult patients.. This is due to the structural features of the pulp and the tooth as a whole in childhood.

enamel ( outer layer) in milk teeth is thin, does not have that amount mineral components which are necessary for sufficient protection against external factors.

The pulp chamber is quite wide, and its sides are located very close to the surface of the enamel, so even a small carious cavity can become an entrance gate for the penetration of infection into the tooth.

In temporary occlusion, the teeth have wide dentinal tubules, through which the infectious agent enters the pulp faster and easier.

In babies, the pulp is not as sensitive as in adults, so the disease is detected at a later date.

Another point in favor inflammation, is weak and not fully formed immune system of the child. She is not able to quickly respond to a foreign pathological stimulus.

Causes and consequences

The reason young children develop pulpitis is undiagnosed and untreated caries. The patient experiences no less torment than an experienced visitor dental office. It is an insignificant hole or, as parents say, a “black dot” that can pass through the enamel, dentin and reach the pulp chamber in a few days.

If the baby's immunity is strong, then visible complications can be avoided.

In other cases, inflammation of the pulp without proper therapeutic assistance can cause such formidable complications like periodontitis and periostitis.

These serious backfire ripen for several months, like a time bomb, and overtake a child in a matter of days.

There have been cases when the symptoms of the disease were drowned out by painkillers.. The infection entered bloodstream causing blood poisoning and death.

Most effective drugs for the treatment of urticaria in children! What medications do doctors recommend, is treatment possible? folk remedies, .

Therapeutic measures

First aid for inflammation of the pulp is never superfluous, but these measures will only postpone the visit to the doctor, but will not solve the main problem: the pain will reappear.

Treatment of pulpitis of both dairy and permanent teeth children go through several stages. The dentist uses the following therapeutic manipulations:

Pulpotomy.
This removal of only the coronal part of the pulp (partial) or the entire pulp (crown and root) is a complete pulpectomy.
The procedure is performed under anesthesia in 1 or 2 visits. However, extirpation is carried out in only those teeth in which the roots have already been formed. Pulpotomy and pulpectomy belong to the vital methods of pulpitis treatment.
Devital amputation.
It takes place at acute course diseases, as well as fibrous pulpitis. With a gangrenous form, the method is contraindicated. During the operation, the pulp chamber is placed a small amount of devitalizing paste (Devit-ARS). Active substance this remedy is arsenic.
Manipulation is carried out under local application anesthesia , using a solution of dicaine 3%. In teeth with one root, the medicine is placed for 24 hours, and with several roots - for 2 days.
After the required time the paste is removed from the tooth and the dead pulp is removed. Resorcinol-formalin liquid is placed into the pulp chamber. This substance does not damage the root growth zone, it allows the roots to form normally.
On the third visit, resorcinol-formalin paste is applied, a special insulating gasket made of cement, installation of a permanent filling made of light-curing polymer.

The devital method of amputation is used for almost any form of pulpitis.

However, with bright inflammatory response (purulent pulpitis) the doctor must achieve a complete outflow of exudate from the dental cavity, so the latter remains open for a while after opening.

The patient is prescribed anti-inflammatory drugs, calcium gluconate, acetylsalicylic acid, plentiful drink.

Forecast and prevention

Forecast pathological condition can be considered favorable if:

the patient promptly applied for help to a medical institution;
the doctor has taken all the necessary therapeutic actions;
all prescriptions of the attending physician were observed.

So that your trips to the dentist with the baby do not turn into painful battles, but are only preventive in nature, you need:

understand that milk teeth in children, like molars, have the same structure and are subject to caries on an equal basis with adults;
to teach a child from small nails to take care of the oral cavity and teeth in particular. Even if there are only 2 teeth in the mouth, they also need proper care;
visit a dentist once every six months;
at the slightest complaint of pain, go to a specialist, and not self-medicate.

How is pulpitis treated in children? You will find answers to all your questions in this video:

Proper dental care in childhood is a guarantee beautiful smile in adulthood! No pulpitis will be terrible if you start taking care of your teeth today.

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Pulpitis is pathological process, in which the neurovascular bundle located in the cavity of the tooth, called the pulp, becomes inflamed. In childhood, pulpitis of milk teeth is diagnosed in 60% of cases from general morbidity, is more complex and faster than in adult patients.

This pattern is due to the fact that milk teeth are the primary set of an unstable structure. They are characterized by looser connective tissue, wide apical and dentinal canals, an enlarged pulp chamber due to insufficient dentin mineralization. For this reason, a child's teeth are vulnerable to any infectious agents, and therefore susceptible to disease.

As dentists note, at the age of 2, pulpitis in a child often affects the milk front teeth, and from 3 to 6 years, inflammation develops mainly in the lower molars.

The inflammatory process in the cavity of the tooth is complex reaction to irritants. In etiological factors children's pulpitis the leading position belongs to anaerobic or aerobic microorganisms that enter the pulpal region from carious foci and kill tissues with decay products. Also, the disease sometimes develops as an independent process, not associated with infection - which is much less common.

There are four etiological factors by nature:

infectious;
traumatic (mechanical);
chemical;
thermal.

A systematized group of reasons why pulpitis of a milk tooth occurs:

a complication of caries, while a slight lesion is enough to start the inflammatory process. Than a running form carious process, the stronger degenerative changes in the morphological structure of the pulp;
acute infectious disease in association with bacteremia. Infection of the pulp occurs by the hematogenous route (through the circulatory system);
various dental errors made during treatment. AT this case there may be several sources of irritation: for example, the doctor eliminated the carious focus and unintentionally touched the neurovascular bundle, incorrectly selected the filling, which led to inflammation. The delicate pulp can be damaged by chemical burns (as a result of antiseptic treatment dental cavity) or thermal nature;
injuries, bruises, falls - typical for a restless, hyperactive child.

A high percentage of the incidence of pulpitis in childhood is due to the peculiarities of the structure of the milk group of teeth and the weak protective reactions of the body to an unfavorable stimulus. Given that the primary source of inflammation is still caries, parents should stop its development on initial stage origin.

Scheme of development of pulpitis.

Symptoms at different stages

The course of pathology can develop in an acute and chronic way, while there is a rapid transition of the disease from an acute onset to chronic stage. Each state is subdivided into additional types and differ in clinical manifestations.

acute form

Acute inflammation temporary teeth is characterized by a very fast pace and intensive development, therefore, in clinical practice This is a fleeting phenomenon, it is diagnosed extremely rarely. Characteristic for age group from 3 to 6 years old. It affects the teeth until the physiological resorption of the roots (resorption). The peculiarity is that visually the milk tooth looks completely healthy or has a slight carious focus.

The symptomatology of the disease is similar at the serous and purulent stages, characterized by a pronounced pain syndrome:

the appearance of sudden pain of an acute nature;
there is an increase in the syndrome in the evening and at night;
pain reaction to temperature changes in food/drinks. Increasing pain on hot and decreasing on cold, indicates the accumulation of pus in the pulp;
it hurts the child when he clenches his jaw, chews, eats. For this reason he refuses to eat;
there is a slight swelling on the cheek from the affected area;
if you ask a child to point to a specific source of anxiety, he will not be able to clearly indicate the place. This is due to the spread of acute soreness to nearby tissues, so the entire half of the jaw hurts. Such a sign indicates the purulent stage of pulpitis;
when probing the submandibular The lymph nodes slightly enlarged;
as a rule, children constantly touch the affected area with their hands, are capricious, try to lie on this side - this makes them feel better.

Severe intoxication joins the listed symptoms, this condition is extremely dangerous for a weakened child.

Acute pulpitis in children has two stages:

serous stage. The development of an inflammatory process is observed, provoking oxygen starvation neurovascular bundle (hypoxia). This mechanism leads to the appearance of purulent exudate / serous fluid that fills the tubules. In this case, the pain syndrome is mostly one-time. Inflammation develops in milk molar with an unformed or absorbable root. This stage is so fleeting that 4 hours after primary signs it changes purulent stage. Often on this stage parents seek medical help.
Purulent stage. The intensity of the flow depends on the maturity of the root of the temporary molar, the condition immune system, enzymatic activity bacteria that provoked the inflammatory process. Every child has clinical picture may vary significantly.

Larisa Kopylova
Dentist-therapist
In some cases, in the background purulent inflammation during the day, complications develop in the form of periodontitis, lymphadenitis, periostitis.
Chronic form
Unlike the previous species, chronic pulpitis is common among children. Occurs as a primary disease, accumulating in a gangrenous or fibrous form, and on the background acute stage pulp inflammation.
The chronic type develops in sealed milk teeth or with extensive carious cavities. Discomfort remains when exposed to irritants, but often the disease has an asymptomatic course, so the child does not complain. It is noted that with a decrease immune protection there is a sharp exacerbation, entailing severe pain and a combination of other symptoms of the acute form of pulpitis.
Chronic pulpitis of temporary teeth in children is divided into three stages with characteristic clinical manifestations.
Symptoms of the fibrous stage (the most common):
pain while eating;
the load during chewing is distributed to the healthy side;
the damaged side is characterized by pronounced plaque;
reaction to cold, rinsing of the mouth is painful.

Manifestations of gangrenous pulpitis:
the causative tooth acquires a gray tint;
absence pain syndrome due to the death of the neurovascular bundle;
sensitivity to hot remains, but discomfort occurs later;
feeling of pressure in the affected area;
Availability fetid odor from the oral cavity.

Symptoms of hypertrophic pulpitis:
this form is characteristic of a severely destroyed dental crown, therefore it practically does not occur in children;
the presence of bleeding during chewing and hygiene procedures;
the cavity is so deep that a pink mass is visible - an overgrown pulp.

A child with chronic pulpitis often has inflamed soft tissues next to the causative tooth, there is the development of periodontitis, which is also characterized by an asymptomatic course. It is possible to reliably determine the inflammatory process with the help of x-rays.
How is children's pulpitis treated?

The doctor determines the methods of treatment of pulpitis in children after assessing the course, establishing etiological factors and clinical form diseases.
Larisa Kopylova
Dentist-therapist
The main task pursued by the treatment of pulpitis of milk teeth in children is the elimination of the inflammatory process and the prevention of complications that may adversely affect the formation of molars.
conservative technique
Conservative treatment is considered as a gentle method of therapy in which the viability of the pulp is preserved.
Indications for carrying out:
early stage of the inflammatory process;
acute partial form of serous pulpitis;
unintentional exposure of the tooth cavity during the treatment of a carious focus, puncture of the tooth;

General procedural steps:
the doctor applies anesthesia and opens the carious cavity;
removes necrotic tissue;
treats the site with antiseptics;
imposes medical paste;
installs an environmentally friendly baby filling.

Surgical methods
If the pulpitis on the milk has deeply pierced the tissues, then the infectious focus must be removed surgically. Surgery reduced to partial amputation or complete.
The essence of the algorithm of these methods is characterized by the following successive steps:
the dentist uses painkillers or performs devitalization (death of the neurovascular bundle);
then the doctor opens and prepares the tooth cavity;
according to the situation: performs amputation or extirpation of pulp tissues;
treats the causal area with antiseptics;
imposes medicinal solutions;
seals root canals;
installs a seal.

Schematically, the surgical treatment of pulpitis of a milk tooth looks like this:
Removal of too contaminated pulp is necessary to prevent inflammation after filling. If you leave the affected tissue and try to cure it in a conservative way, then the situation will lead to extensive inflammation, abscess, fistula.
The technique of vital extirpation - complete removal and subsequent, is less common in the treatment of childhood pulpitis, since it is considered as a cardinal method. It is used if the root system of milk teeth is fully formed, absorbable materials are used for filling. The operation is indicated at the stage of acute diffuse and chronic gangrenous disease.
If the child's condition has not reached criticality, the doctor takes measures to preserve the natural functioning of the baby tooth, so that healthy rudiments form in the future. This process implies the presence of a viable pulp.
Two ways to ensure the safety of the neurovascular bundle:
devital amputation technique - the affected area of the pulp is necrotized. A special arsenic paste is applied to the site. The exposure period of the product takes 1-2 days. Then the dead part of the pulp is removed, and a medical paste is placed in the cavity. Under the influence of the agent, the remaining pulp tissues are mummified, and infectious process no longer distributed.
vital amputation technique - the infected coronal area of the pulp is removed, preserving the root part. This method does not affect the development of the tooth, it continues to form.

With the most severe clinical cases pulpitis accompanied by an abundance of pus, it is necessary to resort to the removal of a milk tooth.
To protect their child from such unpleasant manipulations, parents need to instill in him from a very early age healthy habits, monitor the quality of oral hygiene, explain the importance of brushing your teeth thoroughly and regularly. And to identify and successfully treat the disease at the initial stage, timely preventive examinations by a pediatric dentist will help.

Milk teeth are more prone to pulpitis than permanent teeth. This is due to the structural features of temporary children's teeth:

due to the thin layer of dentin and enamel, the size of the pulp chamber is increased,
loose connective tissue
apical and dentinal canals wide.

These features create all the conditions for the rapid penetration of infection to the pulp. Therefore, the treatment of pulpitis of milk teeth has its own characteristics.

Forms of pulpitis of milk teeth

Pulpitis of temporary teeth can occur in 2 forms: acute and. But the peculiarity of the course of the disease in childhood is that acute form rapidly becomes chronic. Often this happens unnoticed by either the parents or the baby. That is why regular preventive examinations of the child by the dentist are extremely important for the health of children's teeth.

The structure of milk teeth has its own characteristics.

The acute form is manifested by periodic pain in the tooth. Pulpitis is characterized by the appearance of pain without exposure to any irritants, and often the tooth begins to hurt precisely in evening time and at night. The acute form has the following peculiarities:

rapidly flowing stage of focal pulpitis,
the inflammatory process quickly passes from the coronal part of the pulp to the root region,
rapid transition to a chronic form,
inflammation spreads rapidly to periodontal tissues,
the child's body often reacts elevated temperature, noted general intoxication organism.

The chronic form of the disease can rapidly develop from the acute form, but may occur initially. Predominantly develops in milk teeth fibrous form pulpitis, which gradually turns into gangrenous. As a rule, such a process develops in a closed cavity of the tooth.

The main forms of pulpitis of milk teeth:

acute form	Chronic form
Serous	Fibrous
Purulent	Gangrenous
diffuse	hypertrophic
Partial
Exacerbation of the chronic form

How the disease manifests itself: symptoms

Since the acute form of the pathology rapidly becomes chronic, the symptoms of the acute phase may be minor or absent altogether. There may be mild pain in the area of the affected tooth. Chronic pulpitis is manifested by periodic aching pain, which can be joined by the following symptoms:

Pulpitis can be manifested by aching pain.

when tapping and biting,
the mucous around the tooth may turn red and swell,
lymph nodes in the neck are enlarged.

The gangrenous form is manifested by an unpleasant odor from the mouth, a fistula may form in the area of \u200b\u200bthe diseased tooth. With hypertrophic pulpitis observed:

destruction of the crown of the tooth,
pulp growth,
pain during chewing.

The fibrous form of the disease can be asymptomatic, sometimes accompanied by pain when chewing. Because of this, children often chew on one side, avoiding the diseased tooth. As a result, plaque accumulates in an unused area and an inflammatory process of the mucosa can develop.

Features of diagnostics

Expert opinion. Dentist Vernik R.O.: "Regular preventive examinations at a pediatric dentist will reveal pulpitis on early stage and save the milk tooth until it falls out. This is very important, since the premature loss of milk teeth negatively affects the formation of the dentition and the maxillofacial apparatus of the child, and often complicates the eruption of permanent teeth. If the baby loses at least one milk tooth ahead of time, there may be problems with, therefore, adequate and timely treatment all dental diseases plays a very important role."

Diagnosis of pulpitis in children consists of the following steps:

An important stage is the differentiation of pulpitis with diseases that have similar symptoms:

deep,
sinusitis,
periodontitis,
otitis.

How is pulpitis of milk teeth treated? There are two fundamentally different treatment methods diseases:

conservative (with preservation of pulp viability),
surgical (the pulp is removed).

Modern pediatric dentistry thanks to innovative methods diagnosis and treatment makes it possible to keep baby teeth in children even in the most difficult cases, in order to ensure their change is permanent in due time. Consider these two methods of treating pulpitis in children in more detail.

Conservative treatment method

The conservative method can be used for partial acute or fibrotic chronic pulpitis when there has not yet been a complete destruction of the pulp and changes in its structure. At correct diagnosis the dentist manages to keep the pulp viable. Relative contraindications to the use of this technique are multiple caries and some types of somatic pathologies.

Stages conservative therapy:

the doctor removes areas of tooth tissue affected by caries,
the cavity is washed with an antiseptic solution,
a medical paste containing calcium hydroxide is placed in the cavity,
the tooth is covered with a filling.

A conservative treatment method also involves the use of some physiotherapy procedures.

Surgical method

Surgical treatment of pulpitis of temporary teeth involves complete or partial removal nerve (pulp). The method of treatment depends on the stage of pulpitis and its form, as well as the degree of tooth decay. The algorithm of work of the dentist in all cases will be as follows:

anesthesia,
the tooth cavity is opened, all affected areas are removed with a burr,
the pulp is removed
the tooth is treated with an antiseptic preparation,
the doctor puts a medical paste into the cavity,
seal is installed.

There are 3 methods surgical treatment pulpitis in children:

When using this technique, it is necessary to exclude the presence of an inflammatory process of periodontal tissues. The method can be used for any form of pulpitis with a formed root system.

Devital amputation- the essence of the procedure is to use for the affected part of the pulp medicines for necrosis. it special paste, which is laid in the tooth for a while to kill the pulp. In teeth with one root, the paste is placed for a day, in multi-rooted teeth - for two days.

After that, the paste together with the pulp is removed, a swab soaked in resorcinol-formalin liquid is placed in the cavity for several days. During the third visit to the dentist, the child is given a permanent filling. Formed cavity filled with a special substance that prevents further tissue breakdown. For the procedure, application anesthesia is most often used.

Surprisingly, many parents are still convinced that milk (temporary) teeth in a child do not have to be treated, unlike permanent ones. Irresponsible mothers and fathers claim that they do not treat caries in their children just because these teeth will fall out soon anyway. It is not uncommon that they do not treat in a timely manner and pulpitis of milk teeth, even despite severe pain in a child.

Such an idea of the optional treatment of milk teeth is absolutely wrong, moreover, it is a very dangerous ignorance!

If an infection enters the pulp chamber from the carious cavity, pulpitis may develop, which should be treated immediately to avoid the development of complications that pass to the rudiment of a permanent tooth.

A feature of the choice of the method of treatment of pulpitis in the case of unformed roots is the impossibility of using extirpation methods, that is, the complete extraction of the pulp and the processing of channels along the entire length of the root. That is why pediatric dentists prefer biological and amputation treatments for such cases.

Consider first the biological method of treating pulpitis of a milk tooth (conservative). This method involves the preservation of the entire pulp in a viable state, however, it has many contraindications and requires perfect asepsis and antisepsis during work in order to avoid repeated pain.

First, under anesthesia, the carious cavity is cleaned of necrotic tissues, and a therapeutic paste (usually based on calcium hydroxide) is applied to the bottom of the cavity or directly to the opened pulp for several days. After the termination pain put permanent filling on a milk tooth.

Thanks to the biological method of treatment, the tooth remains alive, that is, the preserved pulp allows you to supply its tissues nutrients while maintaining high strength. But a tooth with a removed "nerve" over the years becomes more and more fragile and prone to spalling of the walls that carry the filling.

Amputation methods for the treatment of pulpitis of milk teeth with unformed or absorbable roots are very popular among dentists. The essence of such methods follows from their name - the infected pulp is simply amputated, removed from the pulp chamber.

In this case, both “ancient” methods of devital amputation by the resorcinol-formalin method, as well as modern vital (under anesthesia and without arsenic) amputation techniques with therapeutic coverage of the root pulp with antibiotics, enzymes, calcium-containing drugs, etc. can be used. » are also suitable for the treatment of pulpitis of milk teeth with uncovered root tips.

In the photo - an arsenic-containing temporary filling in the tooth:

It is interesting

Devital amputation is a method of treating pulpitis, which first involves the “killing” of the pulp, and then its mummification with potent and often toxic pastes. To cure pulpitis with this "old" method, not one visit is necessary, but three or even more. Long-term results, taking into account many years of experience in applying this method, most often turn out to be negative.

Possible errors in treatment and how they threaten the child

During the treatment of pulpitis of milk teeth in children medical errors occur more frequently than adult dentistry. This is due to the specific children's reception when the child often prevents the doctor from carrying out all the necessary manipulations with due accuracy and in full. To minimize the severity of errors and for violent children, pediatric dentists can resort to devital amputation by the resorcinol-formalin method, since otherwise the child simply does not give the opportunity to save the milk tooth until its physiological replacement.

In pediatric dentistry, in the treatment of pulpitis of a milk tooth, for example, such an error occurs as an incorrectly supplied paste for pulp devitalization. The most difficult result of such an error is tolerated if the paste is arsenic. If the child does not allow the tooth to be treated with high quality, then it is placed by the doctor not on the opened “nerve”, but on the soft bottom of the prepared cavity, which often not only does not work, but also causes even more severe pain. emergency care in this case is the staging of the paste again.

There are cases of placing a devitalizing paste next to or directly on the gum, since in children the carious cavity is often occupied by an overgrown gum or is located close to the gingival papilla. The consequence of this is severe pain, and upon the arrival of the child to the doctor, a burn is found on the gum caused by the components of the paste. The prevention of such a complication is the observance of the technique of setting the paste, and when receiving a burn, it is required to prescribe anti-inflammatory wound healing gels or pastes.

During the treatment of canals in a milk tooth with pulpitis, bleeding may occur due to the fact that the tops of the roots may not be formed or are already slightly resorbed, and the files for canal treatment (special needles) can be forcefully removed by the dentist beyond the root, injuring adjacent tissues . Stop bleeding even with special drugs can be difficult.

Sometimes an inexperienced doctor can make mistakes such as root perforation and breaking off an instrument in a tooth canal. Since the canals in milk teeth are almost always very wide, the percentage of such complications is very low, but the severity is the same as in the case of permanent teeth in an adult. As a result of perforation of the root of the tooth and breakage of the instrument in the canal, periodontitis or periostitis may subsequently develop due to inflammation of the tissues around the root.

To prevent these complications, a pediatric dentist removes a piece of instrument from the canal accessible way, and the perforations are covered with a special material, for example, "ProRoot MTA". In some cases, for lack of necessary equipment and materials, the doctor simply mummifies the canals with the resorcinol-formalin method.

The photo shows an example of an instrument broken off in the canal of a tooth:

How to prepare your child for treatment

In order for the child not to be afraid of dental treatment (even with severe pain during pulpitis), it is required long before that to carry out the first preventive visit to the pediatric dentist. The success of the first visit depends equally on the dentist and the parents of the baby.

The visit should be introductory. During it, the child gets to know new environment office, with tools, showing only curiosity, not fear, but even for such a visit, preparation is required.

Before going to the dentist, follow these recommendations:

talk to the child before preventive visit 1-2 days before he hears "horror stories" from peers;
tell your child only about positive impressions;
do not overemphasize the importance of the event, as health care is a common procedure;
talk about a future visit to the dentist, like meeting a new friend;
play “the dentist” with the whole family: set an example that you are not afraid of the doctor yourself;
do not use scary dental words;
do not deceive the child that it will not hurt, it is better to say that it may be unpleasant at first, but then the tooth will not hurt;
do not experience fear and panic yourself, then it will not be transmitted to the baby;
the best option for a visit to the dentist is in the morning when the child has had enough sleep, ate well and is active;
it is better if you go to the dentist with your favorite toy so that the child constantly fiddles with something in his hands;
let the doctor find contact with your child without your help;
if the child resists, interferes with the reception, then he should not be intimidated, threatened, begged, etc.
you should try to win the trust of the child, so if the situation is out of control, then it is better to postpone the appointment for the next time.

If the child is initially uncontrollable and anxious, often falls into hysterics, then he should be prepared with medication, relieving him of the upcoming stress. The over-the-counter drug Tenoten for Children is ideal for this. 20 minutes before the treatment of caries or pulpitis of milk teeth, one tablet should be given to the child under the tongue for resorption.

With high or moderate stress, Tenoten relieves tension by causing inhibition mental processes. As a rule, after 20-30 minutes the child allows all the necessary manipulations to be carried out.

In order for the child to feel comfortable in the dental chair, it is necessary to start contacting the dentist for the purpose of prevention. With the proper level of hygiene, timely preventive examinations and quality control of brushing teeth, you can avoid not only pulpitis, but also caries, and save the baby's teeth until their physiological change.