Hello doctor, My 2.5 years old son has problem in four teeth (front, above) and doctors are suggesting for RCT (Root Canal Treatment). I have attached the pictures with this query (attachment removed to protect the identity). Here are my questions: Can RCT (Root Canal Treatment) be done for a 2.5 year old child? Will it affect his next teeth (at around 7 years of age)? Is there any alternate for RCT as he is least cooperating? The doctors are saying that, GA (General Anaesthesia) will be needed for RCT. Is it safe?
Hi, Thanks for attaching the pictures. Now I can answer your query in detail: This clinical picture represents a case of 'Nursing Bottle Caries'. That means, kids who take milk feed while sleeping or have the habit of keeping feeder in mouth for long and then sleep without brushing develop this type of caries in upper four anteriors; because of the bacterial colonization, which starts at that surface of tooth during night time. And we can see only those 4 teeth are affected where the feeder rests or cleaning is not done properly, and the rest are fine. This was the diagnosis. Now let me tell you about treatment options: 1. If cavities are not deep and kid has no history of severe pain or swelling then they can be simply restored through fillings. 2. If cavities are deep or tooth colour is changed to brown or black, kid is giving history of pain and tenderness over particular tooth then medicines regime is given as first line of defense. And in this case if the symptoms go away after 3 or 5 days course that is good and 70% chances are that infection has gone away and will not recur. Meanwhile you need to concentrate on brushing habits, not leaving feeder in mouth for long and brushing or rinsing before going to sleep. 3. If symptoms have become severe or even after following the medicines for a week symptoms of pain, swelling in gums or tenderness recur then we will proceed to RCT (i.e named as 'pulpotomy or pulpectomy' in pedodontics, after evaluating the x-ray of teeth) The answer to your questions: (Answer 1- Yes, Pulpotomy (Modified RCT for kids) can be done on 2.5 year old.) (Answer 2- Pulpotomy is a very delicate procedure and pedodontists do it very carefully keeping in mind that they do not hurt the buds of permanent teeth lying below these milk teeth. So do not worry if your dentist is good,the next permanent teeth will not get affected through this procedure).  (Answer 3- No, there is no alternative for this treatment as you can see it is already the last stage or third line of defense to save the tooth.. I know very well kids of age 2-5 are least co-operative. So there are two options left for these conditions:Option 1)  GA(General Anaesthesia) - This is best, as less time will be consumed, work will be done properly without any chances of mishap. Option 2) In some cases where parents do not want to go through GA phase, they are recommended to follow the medicine course whenever symptoms occur. However this is NOT a permanent solution or treatment. (For eg: The kid is given medicines, symptoms get subsided for 2 months then recur, and again same medicine course is given then symptoms get subsided for next 3 months and so on till the kid reach the age 5). From 5 till 7 years of age permanent incisors are expected to erupt, so we want to keep these milk incisors till 5 in place for better alignment of permanent teeth. Typically the patients who cannot afford for GA facility usually go for the second option. (Answer 4- GA(General Anaesthesia) is safe. And no any big complication is reported ever for such cases so you do not need to worry. Be sure your anaesthetist is good and the procedure will go smooth.  Before ending up I would like to share my diagnosis that can be considered as half as I need x-ray of all upper 4 incisors to give final word. Anyways, Just by seeing clinical picture, I think only front 2 incisors need RCT rest 2 does not look deeply infected, there is not much colour change. I do not know about pain symptoms that can be checked clinically. Ask your dentist to re-evaluate, or if you can show me picture of x-ray of your kid then I will confirm the diagnosis online -->  make your son brush teeth after taking feed and before sleeping :)