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Thursday, November 27, 2014
Tooth # 8 and # 9 on a child root canal?
Hi my child took a fall 2 months ago and damaged his two front teeth. They have been bonded but due to occasional pain was sent to an endodontist. Sensitivity test were done and root canals to both teeth was recommended. I asked was there a more convervative approach and was told I could either do nothing or do the root canal. My child was very sensitive to cold during the exam. I was told there was ligament damage. How was that determined. Xrays do not show. Should both be done at once? I`m really shaken up. My child is 10 years old. I was told he would not be put to sleep and the procedure would take about 45 minutes. He could return to school the next day. What do you think? Do I need a second opinion?
The effects of trauma on teeth is highly varied. The force of the blow seems to be the major factor in determining how much damage is done to the teeth and the tissues supporting the teeth in the bone. When the blow is severe enough to fracture off enamel or the crown of the tooth, some the energy of the blow gets transmitted down the root and can cause ligament and bone damage/inflammation. It is often hard to predict what will happen after that. In most cases the damage is healed, but damage to the ligament of the tooth or even the blood supply of the tooth can lead to changes inside the pulp of the tooth leading to the need for root canal therapy.
If this occurs, the treatment choices do come down to:
- no treatment - which can be a risk since the body may dissolve the root of the tooth away
- root canal treatment - which can reduce the risk of the root being dissolved, but doesn't totally eliminate the potential of this happening
- or extraction of the tooth - which can lead to other dental, physical and psychological problems.
If your endodontist is seeing changes in the root on x-ray and the way the tooth responds to different vitality tests, there may be some irreversible changes occurring around the tooth. The only way to help these heal and save the teeth is have the root canal treatment. If the changes are seen on both teeth, then both would need treatment.
This also needs to be done rather quickly, since I have seen roots of teeth completely dissolve by the body in a matter of months. Having root canals on both teeth at the same time will save you extra trips and reduce the number of times your child will need to be sedated. Once your child recovers from the sedation, they should be able to go back to school with minimal or no discomfort.
If you don't feel comfortable with the answers you are getting from your dentist or the endodontist, feel free to get a third opinion if only for your own peace of mind.
John M Nusstein, DDS
Associate Professor of Endodontics
College of Dentistry
The Ohio State University