Treatment of an Infected Tooth by a Pediatric Dentist
For an infected primary tooth, a pediatric dentist will typically perform pulp therapy (pulpotomy or pulpectomy) to preserve the tooth's function as a space maintainer, or extract the tooth if it cannot be salvaged. 1, 2
Clinical Assessment and Decision-Making
The pediatric dentist will first evaluate for signs of infection, including:
- Crown discoloration (gray appearance indicating pulpal necrosis) 1
- Gingival swelling or parulis (gum boil adjacent to the affected tooth root) 1
- Increased tooth mobility 1
- Radiographic evidence of periapical pathology or root involvement 1
Treatment Options Based on Tooth Type and Infection Severity
For Primary Teeth with Infection:
Pulpotomy (Partial Pulp Removal):
- Indicated when infection is limited to the coronal pulp with potential for radicular pulp recovery 2
- The infected coronal pulp tissue is removed while preserving vital radicular pulp 2
- Success rates are comparable to pulpectomy in primary incisors 3
Pulpectomy (Complete Pulp Removal):
- Recommended for teeth with chronic inflammation involving radicular pulp or complete pulp necrosis with or without periapical involvement 4
- All infected pulp tissue is removed from the crown and root canals 2
- Root canals are filled with resorbable materials (commonly zinc oxide-eugenol paste or Vitapex) 2, 4
- The primary goal is to maintain the tooth as a space maintainer until natural exfoliation 2
Extraction:
- Indicated when the tooth cannot be salvaged due to extensive infection, severe mobility, or compromised structural integrity 1
- Necessary if the infection poses risk to the developing permanent tooth germ 1
For Permanent Teeth with Infection:
Root canal treatment is the standard approach, with special considerations for immature permanent teeth requiring apexification or regenerative endodontic procedures 5
Supportive Care and Follow-Up
Immediate management includes:
- Systemic antibiotics are NOT routinely indicated except in cases of severe spreading infection 1
- Pain management with NSAIDs (ibuprofen) as first-line, or acetaminophen if contraindicated 6
- Soft diet for 10 days post-treatment 1
- Good oral hygiene practices 1
Critical follow-up monitoring for:
- Recurrent infection signs (swelling, parulis formation) 1
- Tooth discoloration indicating treatment failure 1
- Radiographic evidence of continued pathology 1
Common Pitfalls to Avoid
- Delaying treatment of infected teeth can lead to damage of the underlying permanent tooth germ, particularly with primary tooth infections 1
- Underestimating the importance of preserving primary teeth as space maintainers, which prevents mesial drifting of permanent molars 2
- Failing to obtain radiographs to assess the extent of infection and root involvement 1
- Using inappropriate root canal filling materials that resorb too slowly or too quickly compared to the natural root resorption timeline 4
The choice between pulpotomy, pulpectomy, and extraction depends on the extent of pulpal involvement, tooth restorability, proximity to natural exfoliation, and potential impact on the permanent successor tooth 2, 4.