Root canal treatment for children has particular difficulties and considerations. It must be planned in light of the remaining teeth, and the need for balancing or compensating extraction borne in mind.
Diagnosis may be difficult, as may prolonged treatment under local anaesthesia and rubber dam.
Vital pulpotomy techniques with formocresol and/or calcium hydroxide must be carefully executed in line with the UK National Guidelines.
The treatment of the avulsed tooth has been the subject of much research, and practitioners should ensure that they are up-to-date with current treatment modalities.
Although the basic aims of endodontic therapy in children are the same as those in adults, ie the removal of infection and chronic inflammation and thus the relief of associated pain, there are particular difficulties and considerations.
The pulpal tissue of primary teeth may become involved far earlier in the advancing carious lesion than in permanent teeth.
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Exposure may also occur far more frequently during cavity preparation due to the enamel and dentine being thinner than in the permanent tooth, and the pulp chamber, with its extended pulp horns, being relatively larger.
Primary molar root canals are irregular and ribbon-like in shape. Periradicular lesions associated with infected primary molars are usually inter-radicular rather than periapical in site due to the presence of accessory canals in the thin floor of the pulp chamber.
As well as the problems associated with the primary dentition, endodontic treatment of permanent teeth in children may also present difficulties due to the incomplete root development and associated open apices.
°British Dental Journal
°Endodontic treatment for children