Dental pulp is the soft vital center of a tooth.  It’s a tiny organ, rich in blood vessels. The average volume of the pulp in a single adult tooth is about 0.02 -0.08cc, of which 75% – 80% is water. Dental pulp is the consistency of Jello. There are nerves in there, too, and these are why teeth can hurt. The main function of dental pulp is to nourish the dentin layer that surrounds it. The pulp’s nerves also provide valuable feedback about pressure and temperature to the brain.  All baby teeth and permanent teeth have pulp centers. This feedback helps us eat and drink safely, and lets us know when something’s gone wrong with a tooth. When pulp therapy is called for.

WHAT CAN GO WRONG?

A child with infected or injured pulp is likely to feel severe pain. Dental pulp has pretty good physical and immunological defenses, but of course, they’re not perfect. Adults suffer from infections of the pulp, and children’s immune systems, after all, are not fully developed. Infectious bacteria can slip past the outer layer of enamel, and then the dentine layer,  in several ways. Tooth decay is a common route. Cavities are bacterial on-ramps to the pulp core. Cracks or chips in a tooth, too, can open the way. Whatever the details, a child with infected dental pulp needs the immediate attention of a pediatric dentist.

SIGNS AND SYMPTOMS OF PULPITIS

It’s entirely possible that a tooth afflicted with pulpitis will look totally normal to a parent. The child’s distress, however, will be obvious.  Here’s what to look for:

  • Constant unexplained pain.
  • Nighttime pain.
  • Sensitivity to warm and cool food temperatures.
  • Swelling or redness around the affected tooth.
  • Unexpected looseness or mobility of the affected tooth.

TREATMENT GOALS

Our goal is always to save the afflicted tooth. Baby teeth as well as permanent teeth. Extraction is the other, less optimal treatment option. All teeth have a role in a child’s overall oral health and development. Extraction brings on a set of risks and issues including:

  • Distorted jaw development.
  • Crowding of permanent teeth, when baby teeth are extracted.
  • Poor fit between opposing upper and lower teeth (malocclusion)
  • Impacted premolars (painful!)
  • Other orthodontic issues
  • The tongue may posture abnormally.

The procedures we use to save teeth with inflamed or infected pulp are, collectively, called pulp therapy. In discussing a child’s case with a pediatric dentist, parents also hear related terms including root canal, pulpotomy, pulpectomy, and nerve treatment. All are designed to save and restore the tooth.

PULP THERAPY PROCEDURES

The pediatric dentist’s first step is a careful evaluation of the child’s overall dental health, x-rays, and positioning of the tooth. The x-rays enable the dentist to asses the conditions inside the tooth. The child’s age, too, is a factor.

Pulpotomy is the likely procedure choice when the x-rays show the pulp root is healthy. In that case, the dentist removes only the upper, infected pulp and the tooth decay around it. The next step is filling the now-empty space inside the tooth with a therapeutic material that wards off infection.  Finally, the dentist then tops the tooth with a crown. The tooth is then stronger than it was before.

Pulpectomy, in contrast, is a more assertive procedure. Pediatric dentists perform it when the infection and damage are more extensive. This procedure involves removing all of the pulp. Next steps are cleaning out the root canals, and removing any decay. As with pulpotomy, the dentist fills the newly-empty spaces with a therapeutic material. The dentist’s final step is fitting the tooth with a crown. Pulpectomy usually calls for several office visits.

PEDIATRIC PULP THERAPY: SUMMARY

No one wants a child to require pulp therapy.  It is, however, far better than the alternatives. Today’s pediatric dentists use effective local anesthetics that make the procedures pain-free. Moreover, we have a safe and effective sedation option for kids who are nevertheless uncomfortable. Pulp therapy is nothing to fear. We’re all fortunate to live in an age when it’s available, safe, and effective.

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