Untimely treatment of dental caries in children leads to the development of pulpitis – an inflammation of the tooth tissue, including blood vessels and nerve bundles. More often the lower molars are affected, but the disease occurs even in the anterior elements. Therefore, pulpitis in children is even more common than in adults. This is due to a number of factors:
- thin weak enamel;
- a large pulp volume;
- wide root canals;
- lower mineralization;
- Weak immunity.
In addition to caries, pulpitis can be triggered by trauma, including poor-quality treatment.
Inflammation runs in an acute form and chronic. Acute occurs less frequently, but has more severe symptoms and occurs in two stages:
- serous. The inflamed pulp fills with serous fluid. The complaints of severe pain in the tooth, which intensify at night and during chewing, appear. The pain is usually non-permanent, appearing once and then subsiding. The process most often occurs in teeth with unformed or resorbed roots. After 5 to 6 hours, the process will enter another stage;
- purulent. Pus forms in the tissues, which begins to melt cells and tissues. The severity of the condition is affected by immunity, the condition of the tooth, and bacterial activity. If the pus has an outlet in the form of a cavity or fistula, the pain is weakly pronounced. If there is no outflow, the pain syndrome is bright and prolonged, intensifying when chewing, eating cold or hot food. The general condition may worsen, and fever appears.
Chronic pulpitis occurs after acute or on its own and is characterized by vague symptoms. Pain may only occur with unfavorable factors – cold or hot, too sweet food. The child begins to chew on one side, an unpleasant odor appears, there is a rasping and pressing sensation.
The danger of this form is that it is almost asymptomatic. Because of this, the inflammation affects more and more tissues. Chronic pulpitis comes in three types:
- fibrous. The mildest and most common form. There is an overgrowth of fibrous tissue, the pulp may bleed, there is occasional pain from mechanical and thermal contact;
- hypertrophic. Develops with severe destruction of the crown of the tooth. There is a pathological overgrowth of pulp tissue, which fills the carious cavity;
- gangrenous. The most severe form, accompanied by pulp necrosis. The tooth becomes gray, there is a bad breath due to the decomposition of tissues.
How to Recognize the Problem and Does Pulpitis Need Emergency Treatment?
Due to the decreased sensitivity of the pulp, inflammatory pain may be mild and not cause much discomfort. However, the destruction of the tissue is rapid. It is important to visit the dentist regularly and not to ignore your child’s complaints of pain during chewing, or when eating cold or hot food.
Treatment for pulpitis should be immediate. The disease is dangerous with complications – periodontitis or periostitis. It can also affect the permanent tooth, which has not yet erupted, and destroy it.
Therapy of milk teeth in general does not differ from the treatment of permanent elements. If the child’s condition is severe, there is a threat of infection spreading through the body, an amputation is performed. In most cases, the tooth is preserved to exclude bite disorders. Therapy is carried out in different ways:
- traditional. It implies treatment in three visits. During the first visit, the nerve is opened, and devitalizing paste with arsenic is applied for 24-48 hours, or without it for up to 7 days. In the second visit, a resorcin-formalin-based pulp mummification mixture is placed in the canals. At the last visit, a permanent filling is placed;
- modern. Passes in 1 – 2 visits. If the child can sit quietly at the doctor’s for a long time and the roots of the tooth are formed, extirpation is performed. The nerve is removed either in the first visit, or after the paste is applied. Then the root canals are carefully treated, infected tissues are removed, an anti-inflammatory paste (e.g. zinc-eugenol) is put in and the filling is closed. The compound will gradually resorb along with the roots as the teeth change;
- Partial vital amputation. The doctor removes the upper portion of the nerve and applies antiseptic and anti-inflammatory medication, which seals the remaining living pulp.
When treating teeth with unformed roots, a different approach is chosen. There are several reasons for this:
- The apex of the roots has not yet closed and there is a risk of infection of the rudiment of the permanent tooth;
- The roots are short and the root canals are wide;
- trauma to the upper zone of the root can lead to abnormalities in its formation;
- it is impossible to remove the entire pulp and perform a complete root canal treatment.
The most common choice is pulp amputation by any method or biological treatment, when the tooth is cleaned of diseased tissues and a paste with calcium hydroxide is put in place for a few days. After that, a filling is placed.
Can Pulpitis Be Left Untreated if the Teeth Are Deciduous?
There is a common belief that baby teeth don’t need to be treated because they will soon fall out. This is the biggest mistake parents make. Untreated pulpitis has irreparable consequences and can even affect permanent teeth:
- Purulent abscess, periodontitis, a life-threatening condition;
- Deep infection affecting the rudiment of the permanent tooth;
- bite disorder due to early tooth extraction due to untimely treatment;
- pain interferes with normal chewing of food, the uneven load on the teeth leads to an accelerated destruction of the remaining elements.
The main method of preventing dental and oral diseases is regular visits to the dentist and early treatment of cavities. It is important to teach your child hygiene and the rules of brushing teeth from the first years of life. Parents should control the diet, which should contain all the necessary substances, limit sweets and give only water to drink at night.