Pulpectomy after injury?

My three year old daughter slipped while trying to walk up a slide backward and fell on her face, cutting her lip. She did not say anything about her teeth (which I checked to make sure were okay), until about a week later, when I was brushing them. At that time she said, "Don't brush my sore tooth." I checked to see if anything was loose, or the gum was injured, but I could not see anything wrong.

About one week later, her left front tooth turned grey. She says it does not hurt, and it does not appear to be loose. However, some kind of trauma has occurred. I have scheduled an appointment with her pediatric dentist; however, I always like to go into an appointment as prepared as possible for any decisions I'll have to make regarding a restoration, etc. (They mentioned pulpectomy on the phone.) Can you tell me what may be occurring with that tooth?

Thank you.

Question:

Dear Parent,

You are correct in your assessment that trauma to the tooth has occurred. Generally, when a tooth has "darkened" in color, it is an indication the nerve in the tooth has "died". This occurs usually because the tooth has been traumatized in some way. It is possible that when the tooth was in the process of "dying", the tooth felt sensitive to your daughter. Occasionally, once the dying process is complete, the tooth is no longer sensitive. With primary teeth in this darkened condition, I discuss various treatment options with the parents which may include doing a pulpectomy (sometimes called a "baby root canal"), extracting the tooth, or just watching the area. Usually, we decide to watch the area with the caveat that if any signs of infection, such as swelling in the area, or complaints of sensitivity are noted, then treatment will be rendered.

For your information, a pulpectomy is most likely the preferred treatment to extraction so your daughter will be able to have her primary tooth for eating, cosmetics, phonetics, and as a space maintainer. Occasionally, pulpectomies are not successful causing the need for an extraction anyway, but it is generally prudent to do the pulpectomy first.

Pulpectomies on primary teeth, especially anterior ones, generally are fairly straightforward and are fairly quick to complete. While some of the details of the treatment vary from dentist to dentist, the general procedure involves drilling a small hole in the back of the tooth to gain access to the nerve chamber. The nerve is then removed via instrumentation and medicaments. Filling material is then placed in the tooth to take the place of the nerve and to close the hole in the back of the tooth. If the tooth is weakened due to loss of tooth structure or fracture lines, some dentists may opt to place a stainless steel crown on the tooth to strengthen it. Some dentists will use the stainless steel crowns with tooth-colored facings for better esthetics.

I recommend discussing the various treatment options given your daughter's particular situation. The pedodontist may want to take a radiograph of the tooth to help determine the extent of the damage. If the radiograph appears to be normal and your daughter is exhibiting no signs of infection or discomfort, no treatment may be necessary.

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