Primary Teeth (baby teeth) are more prone to dental decay than permanent teeth and they also have large pulp chambers (the area inside the tooth which contains nerves and vascular tissue). Because of this, cavities in primary teeth can reach the inner pulp tissue quite rapidly and necessitate the need for ‘pulp therapy’ to save the tooth. Dr. Hawryluk’s goal is to prevent pulpal procedures altogether. However, when needed we, of course, be using this latest researched based techniques available.
The pulpotomy procedures for primary teeth sometimes reaches the news headlines because the compound formocresol is still permitted and in use in Canada. This substance is considered outdated and possibly harmful. St. Lawrence Dentistry has not used it in over 25 years. Formocresol has been around in dentistry for a long time and slowly dentistry is moving away from it. Dr. Buckey came up with the formocresol formula in 1904 which had 19% formaldehyde and 35% creosol. Unfortunately, it has been shown to be distributed systemically when used in dentistry. Very elegant research in the 1970s and ’80s on canine teeth showed that within 30 minutes of its use some of it will seep out through the apex (end) of the tooth root and be distributed throughout the body. It is a known carcinogen, it is mutagenic, it is able to go to distant body sites when it enters the bloodstream, and it sensitizes the immune system. All in all it the consensus is growing it does not belong in modern dental use. This was considered the gold standard until new and improved products came along. Now we are in a new phase of treating the pediatric dental pulp and there are many better products to choose from.
The key to treating primary teeth is a proper diagnosis, getting a good history of the issue, and doing a complete exam of the area. In addition, the newer healthier products available will ensure the most effective treatments possible for your child’s teeth.
There is a different and better approach used at St. Lawrence Dentistry to treat decay which has reached the dental pulp in primary teeth. We are now in the third generation of treatment modality for primary teeth. Today we get the pulp tissue to use its own innate healing power by using a tri-calcium silicate called Biodentine. With this material, you can put it over the exposed primary pulp and within 30 days you get a ‘dentinal bridge’. So in effect, the pulp heals itself after the initial onslaught of the carious (cavity) pulp exposure. Dr. Hawryluk will consider healing the dentinal bridge for your child if the cavity has not infected your child’s tooth but merely exposed the pulp. Biodentine comes in a powder liquid formula. It sort of has the consistency of ‘bubble gum’ in that it is moldable but has some firmness to it. It provides a great seal and over the pulp chamber and there is no leakage of saliva into the area allowing for great healing conditions.
In a case of an infection of a primary tooth cleaning out the entire root is sometimes an option. This can pose challenges because the anatomy of a primary molar is different compared to a permanent tooth. At the floor of the pulp chamber in primary molars are several hundred to thousands of ‘accessory canals’ which can be seen on electron microscope scans. These run from the floor of the pulp chamber to where the roots of the tooth bifurcate. It is impossible to clean these all out. This means a root canal can be done but necrotic tissue could still be left behind which opens the possibility of non-healing. If there is a possibility this modality of treatment may not work Dr. Hawryluk will discuss the probabilities of success with you (the parent) and decide if its best to remove the decayed primary tooth for your child.
Root canal materials are different for primary teeth because they have to be soft and resorbable (unlike Gutta Percha used in permanent teeth).Dr. Hawryluk has found the best material for completely filling the roots of primary teeth is a material made by ‘Pulp Dent’ which contains zinc oxide eugenol and resin from Canadian Balsam Fir. It is biologically compatible and it will resorb as the root resorbs with the incoming of the new permanent teeth.
Providing the best care and materials possible for your child’s dental treatment is our priority. If you live in the Mississauga area are looking for a new dentist for you or your child please give us a callclick here.
Reference: Viva Learning 2019: Pulp Therapy