Baby Tooth Pulpitis Treatment in Ukraine

The pulp is the soft tissue inside a tooth that contains blood vessels and nerves. In a primary tooth it takes up more space than in a permanent one: the enamel and dentine are roughly half as thick, the pulp chamber is wider, and its horns sit close to the chewing surface, especially the mesiobuccal horn of the lower molar. The dentinal tubules are wider and shorter, so microorganisms from a carious cavity reach the pulp faster.

As a result, decay in a child can lead to complications within weeks rather than years. A tooth that showed only a small spot at a check-up six months ago may now have inflamed pulp, and this speed is what sets children apart from adults. The second difference is that infection more often spreads not to the root tip but into the furcation, the area between the roots, beneath which the permanent tooth bud lies.

Symptoms can be vague. Classic night-time pain and a lingering reaction to cold do occur, but many cases are chronic and cause almost no complaints: the child simply stops chewing on one side, complains of pain while eating or cannot point to the exact tooth. Sometimes the first sign is a swollen gum, a whitish gum boil (fistula) next to the tooth or persistent bad breath.

Pulpitis is classed as reversible or irreversible. The sensitivity tests used in adults are unreliable in children, who react to the expectation of pain rather than the stimulus itself. So the dentist relies on the history, the examination, the X-ray and how the pulp behaves during treatment. If bleeding stops within a few minutes after the crown part of the pulp is removed, the root pulp is most likely alive; if blood flows heavily and does not stop, the inflammation has gone further.

There is a real reason to treat baby teeth: the second baby molar holds the space for the premolar and guides the position of the first permanent molar, which erupts at about six years of age. Losing it early lets the neighbouring teeth drift and takes space away from the permanent tooth. MediUkraine is a treatment search and coordination service, not a clinic: we choose the clinic and the paediatric dentist, agree the date and support your family, while the treatment approach is decided by the dentist after an examination.

The method depends on whether the pulp in the canals is alive, and this is only confirmed during treatment. After the crown part of the pulp is removed, a moist cotton pellet is placed over the canal openings and the dentist waits a few minutes. If the bleeding stops, the root pulp is considered vital and the tooth is treated by pulpotomy. If blood flows heavily and does not stop, or the canals are already infected, the pulp is removed completely.

When decay is deep but the pulp is not yet exposed, and the child only has a brief reaction to sweet or cold things, the inflammation is considered reversible. In that case an indirect pulp cap is done: the softened dentine is removed, leaving a thin layer over the pulp horn, the floor is covered with a calcium silicate material or glass ionomer, and the tooth is restored with a tight seal. Success depends above all on a well-sealed restoration with no leakage at the margin: if the filling leaks, the inflammation comes back regardless of what was placed on the floor.

Pulpotomy is the main method for irreversible inflammation of the crown pulp. The tooth is anaesthetised and isolated with a rubber dam, all affected tissue is removed, the pulp chamber is opened and the crown pulp is cut away down to the canal openings with a sharp sterile bur or excavator. The bleeding is then controlled, a medicated material is placed over the openings, a liner of zinc oxide eugenol or glass ionomer goes on top, and the crown is restored, all in a single appointment.

The material placed over the canal openings largely determines the outcome. MTA, mineral trioxide aggregate, and calcium silicate cements such as Biodentine give the best results in studies with two-year follow-up; grey MTA can stain the crown grey, so white versions are chosen for front teeth. A cheaper alternative still in use is 15.5% ferric sulphate solution, which acts as a haemostatic agent. Formocresol, used for decades, is gradually being phased out: it contains formaldehyde and more often leads to internal root resorption.

Pulpectomy, complete removal of the pulp with canal treatment, is done when the inflammation has spread into the roots or the pulp has already died. The canals of primary teeth are wide, ribbon-shaped, often curved and joined by lateral branches, while the walls and floor of the chamber are thin, so they are shaped carefully and at low speed. The working length is set 1–2 mm short of the radiographic apex, because the permanent tooth bud lies just beyond it. The canals are rinsed gently with dilute sodium hypochlorite or chlorhexidine, without pressure, so that the fluid does not pass beyond the apex.

The canals of a baby tooth are filled only with pastes that can resorb. Gutta-percha and sealers for permanent teeth are not used here: the root resorbs over time, while insoluble material would remain in the bone and interfere with the eruption of the permanent tooth. In practice zinc oxide eugenol paste, a combination of calcium hydroxide with iodoform, and more complex iodoform formulations are used. They differ in how fast they resorb: zinc oxide eugenol resorbs more slowly than the root and may leave fragments in the bone, while calcium hydroxide with iodoform resorbs faster, sometimes faster than needed. With an iodine allergy, iodoform pastes are not used.

Root resorption is not a complication but a normal process: it begins about three years before the tooth falls out, and how far it has gone determines whether treatment makes sense. If more than a third of the root has resorbed on the X-ray, the tooth is loose, the floor of the chamber is perforated or the crown is so broken down that nothing can hold it, the pulp is not treated and extraction is chosen instead. The same applies to a lesion that has destroyed the bone over the follicle of the permanent tooth.

A word on methods that have been abandoned. Devitalising pastes containing arsenic or paraformaldehyde, once left in the tooth "to kill the nerve", cause uncontrolled necrosis: if the dressing is not sealed, the paste leaks out and burns the gum and bone, and in a baby tooth it ends up too close to the bud of the permanent tooth. Nor does the approach "we'll put in a filling, and if it hurts we'll take the tooth out" work: a sealed tooth with inflamed pulp hurts more, and this usually ends in night-time pain and an emergency appointment.

After a pulpotomy or pulpectomy the tooth becomes more brittle, so the restoration matters as much as the treatment itself. A small defect is closed with composite or glass ionomer, but a molar with two or three broken-down surfaces is more reliably covered with a preformed paediatric crown made of stainless steel: it distributes the chewing load and usually lasts until the tooth is naturally replaced. A large filling on such a tooth is more likely to break off along with the tooth wall, and the tooth then has to be extracted early.

If the tooth cannot be saved, it is extracted and the space is held with a removable or fixed space maintainer. This is not a cosmetic detail: after early loss of a baby molar, the neighbouring teeth tilt into the gap within a few months, and the permanent tooth may not have enough room. The dentist decides whether a space maintainer is needed based on the child's age, which tooth has been lost and whether the first permanent molar has erupted.

For the first two or three hours after the visit the lip, cheek and tongue stay numb, and the main risk is not to the tooth but to the soft tissues: your child cannot feel them and may bite them hard enough to cause a serious wound. Do not let your child eat until sensation returns, offer only room-temperature drinks and remind them from time to time not to bite their cheek.

Moderate tenderness on biting for one to three days is expected: the tissues around the tooth are reacting to the treatment inside it. Give a painkiller at the dose for your child's age, at bedtime if needed. Call the dentist if the pain increases, swelling of the cheek or gum appears, your child's temperature rises, the tooth becomes loose or the temporary filling falls out.

When treatment is split into two appointments, a temporary filling with a medicated dressing stays in the tooth in between, usually for one to two weeks. During this time your child should avoid chewing hard food on that tooth, and the second visit should not be postponed: a temporary filling left too long loses its seal, and bacteria get back into the canals.

The result is assessed in two ways. Clinically, there is no pain, swelling or gum boil, the tooth is not loose and does not hurt on biting. On X-ray, the follow-up image shows no lesion in the furcation and no pathological resorption from inside the root. The first follow-up X-ray is usually taken after 6 months, then after 12, and then once a year until the tooth is replaced.

The honest aim of treatment is to get the tooth to its natural replacement without pain or inflammation, not to preserve it for ever. Some teeth still have to be extracted, when the inflammation returns or the root starts to resorb from within. Only a dentist, after an examination and an X-ray, can predict the outcome for a particular child, which is why follow-up visits should not be skipped even when the tooth is causing no trouble.

After that, prevention is what counts, because pulpitis is rarely a one-off. Brushing twice a day with fluoride toothpaste in the amount appropriate for your child's age, cleaning between the teeth, fewer snacks and sugary drinks between meals, a check-up every six months and fissure sealing of the permanent molars after they erupt achieve more than any treatment of a tooth that is already diseased. If decay has affected several teeth, the dentist plans treatment for all of them, rather than one tooth at a time.