Concerns about treatment of deep cavities

My son had deep cavities in two of his baby teeth. The dentist, without consulting us, simply told us that root canal was needed to save both teeth, and my husband agreed. Then a couple of months later, the dentist told us the root canal couldn't save the teeth and that the they had to be pulled. Again, my husband agreed to let him do that. My question is: is it possible that a pediatric dentist with 20 years experience was not able to tell whether the decayed baby teeth could be saved after examining them? Another question is: should one feel pain in the tooth root canal after work has been performed? After the root canal, my son told me that he felt pain in teeth with temporary fillings. The story does not end here, however. After extraction the dentist told my husband that spacers are needed and again he put two spacers in. My question is: are spacers necessary in a 7 yr old kid? The two extracted teeth are the ones on both corners of the mouth. At this same time, my son has a permanent tooth coming with little space to go to between the teeth, one of them is next to where the spacer is put.

Question:

When evaluating the treatment possibilities for primary teeth with deep decay, it is important to take into consideration several factors. These include the age of the child, the proximity of the permanent tooth, the severity of decay, and the cooperation of the child. If the decay is close to or into the pulp (nerve plus blood vessels) of the primary tooth, generally, it is necessary to choose between doing the "baby" root canal or extracting the tooth. If the child is close to loosing the tooth or if the decay is too severe, the first option is extraction. If the child is to keep the tooth for several more months to years and the tooth is not too severely broken down, the first option would be the root canal. One good reason for choosing the root canal option is that one function of the primary teeth is to hold the place for the permanent teeth. This space-holding becomes even more critical with the posterior primary teeth.

While a majority of the time the "baby" root canal is successful, occasionally it does fail. This is noted by continued pain or infection in the tooth after the root canal is performed. Sometimes, in these cases, I have had success by opening up the tooth and cleaning it out again. Other times, the only cure is to extract the tooth.

Once a primary tooth is extracted, space maintenance becomes a concern if it is to be a while before the permanent tooth is to erupt. This is especially important when the primary molars are extracted prematurely. In this case, I always recommend a space maintainer be placed; otherwise, the primary teeth may drift causing spatial problems with the permanent teeth. Occasionally, crowding problems are destined to occur anyway simply because of space problems which already existed. For this, I would recommend consulting an orthodontist. It could be that an appliance needs to be fabricated which not only maintains the space, but also utilizes your son's growth potential to expand the arch to create more space.

I do understand your concerns. Without having originally seen your son's teeth and judging from your description, it does sound as if the proper order of treatment was followed. If crowding of his teeth still seems to be a problem, please consult an orthodontist. Best of luck.

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