Pain in children’s milk teeth caused by extensive decay: we examine the best ways to treat the dental pulp

Tooth decay is one of the most common diseases in children. Tooth decay in the primary or milk teeth tends to progress rapidly, and it often reaches the pulp. Dental pulp consists of nerves, tiny blood vessels and connective tissue that make up the centre of a tooth. Symptoms of this extensive tooth decay include pain, swelling and abnormal tooth movement.

Dentists often have to perform one of three pulp treatment techniques to resolve the problem:

  1. Direct pulp capping: where a healing agent is placed directly over the exposed pulp. The most common materials used for direct pulp capping are calcium hydroxide, mineral trioxide aggregate, formocresol or an adhesive resin, placed directly over the tooth’s nerve.
  2. Pulpotomy: removal of a portion of the pulp. After a pulpotomy, one of four materials is generally used to fill the cavity: ferric sulphate, formocresol, calcium hydroxide or mineral trioxide aggregate.
  3. Pulpectomy: removal of all of the pulp in the pulp chamber and root canal of a tooth. After a pulpectomy, a material is put into the space created by pulp removal.

This review looks at the three techniques, and the effectiveness of different materials (known as medicaments) for pulp capping, pulpotomy and pulpectomy. Continue reading

Treating tooth decay in baby teeth

pulp treatmentTooth decay in the milk (baby teeth) of children tends to progress rapidly, often reaching the dental nerve (or pulp, the nerves in the centre of the tooth). Dentists normally have to do one of three things:

1. pulp capping – placing a medicament over the exposed tooth pulp
2. pulpotomy – removal of some of the tooth pulp
3. pulpectomy – removal of all of the tooth pulp.

With direct pulp capping and pulpotomy, some of the nerve in the tooth is left and therefore the filling material has to be put into contact with the living pulp tissue. The most common materials used in direct pulp capping are calcium hydroxide, mineral trioxide aggregate, formocresol or an adhesive which allows a filling material to adhere to the tooth. After a pulpectomy, no nerve is left inside the treated tooth, but a filling material is put into the space created by the removal of the pulp and this must not stop the development of the permanent, adult tooth. After a pulpotomy, one of four materials is used to fill the space: ferric sulphate, formocresol, calcium hydroxide or mineral trioxide aggregate. This research investigates the success of these dental nerve treatments in milk teeth. Continue reading