Endodontic considerations in pediatric dentistry: a clinical perspective
Hani F. Ounsi1 Dina Debaybo2 Ziad Salameh3 Anis Chebaro4 Hassan Bassam5
Abstract Despite the best efforts in caries prevention by water and salt fluoridation and systematic controls, caries index remains very high and premature loss of primary teeth is still a current problem. Endodontic procedures such as pulpotomy and root canal treatment aim to preserve the integrity of the dental arch by avoiding early extraction of heavily decayed teeth and subsequently allow for a smoother shift from primary to permanent dentition. Furthermore, retaining primary teeth will also allow for function (i.e., mastication, phonation, and swallowing) and esthetics.
Introduction The deciduous tooth often presents post-carious pulpal implications that require endodontic treatment. The deciduous tooth goes through different stages during which it witnesses changes of anatomical and physiological nature: the root undergoes resorption and the pulp’s reactive potential is diminished or even lost. The tooth has also to be considered within the physiopathological context of the child. The age, general health, and the compliance of the young patient (and sometimes that of the parents) are also factors to be considered before undertaking any treatment procedure.
problems related to the loss of teeth.
Clinically, the choice of pulp therapy is based on semeiology despite the assessment difficulties and imprecision of pulp tests related to deciduous dentition. The choice between pulpotomy and pulpectomy is generally based on the severity of the symptoms clinically and/or radiographically. When indicated, pulpotomy of the deciduous tooth is relatively an easy procedure with generally good clinical results. Pulpectomy on the other hand is a heavier treatment for the child and is more complicated due to anatomical complexities that are not found in the permanent tooth.
The aim of pulp therapy in the primary dentition is to retain the primary tooth as a fully functional part of the dentition, allowing at the same time for mastication, phonation, swallowing, and the preservation of the space required for the eruption of the permanent tooth. Furthermore, maintaining esthetics will avoid psychological
1 Hani F. Ounsi DCD, DESE, MScB, FICD, Research Department, Lebanese University, Beirut, Lebanon 2 Dina Debaybo DCD, MSc, Diplomate American Board of Pediatric Dentistry, Program Directo , Pediatric Dentistry Dental Directo , Boston University Institute for Dental Research and Education, Dubai Healthcare City, UAE 3 Ziad Salameh DCD, MSc , PhD, FICD, Research Department, Lebanese University, Beirut, Lebanon 4 Anis Chebaro DDS, Endodontist, Maidan Dental Clinic, Kuwait 5 Hassan Bassam DDS, Pediatric Dentist, Maidan Dental Clinic, Kuwait
Corresponding Author: Hani F. Ounsi , email: email@example.com
Morphological and physiological properties According to Finn1 and Wheeler2, the main differences between deciduous and permanent teeth are that deciduous teeth are smaller in all dimensions then permanent teeth, and the mesiodistal/buccolingual crown ratio in temporary teeth is larger than in permanent teeth. Their general aspect is more globulous. Furthermore, the cervical thirds of the buccal and lingual walls are more curved than in permanent teeth and they present a narrowing at the CEJ level, and the buccal and lingual coronal walls converge occlusally, which reduces the width of the occlusal table.
The roots of temporary teeth are longer (as compared to the coronal dimension) and thinner than their permanent counterparts and the pulp chamber is larger with accentuated pulp horns, particularly mesial horns of first deciduous molars. The enamel layer is thinner: 1mm
INTERNATIONAL DENTISTRY SA VOL. 11, NO. 2