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Root Canal or Pull 10 yr olds tooth
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chrismok posted:
My 10 year old had a root canal on #14 two years ago. Evidently they didn't complete the root canal and it is now abscessed. The dentist said in his opinion the root canal was 85% complete and it wasn't sealed properly. He said the last resort is to pull the tooth, but he recommended keeping it because it's a permanent tooth and she's so young. We went back to the endodontist office where the root canal was done. They first said the root canal was complete, and then when I questioned more, they said the root may have been too small at the time for them to work on it. They said the sealing was fine. They thought the tooth was not worth saving because it does have a large filling. The 12 yr molar right behind it is working its way in. If #14 is extracted, does this leave room for the molar to come in at an angle? (This is what happened to me at a young age, and getting a bridge would have meant orthodontia work) Should the tooth be saved even for the short term to be a place holder? The tooth will need to be extracted at some point, and I'd like to have it done before it becomes brittle and shatters during extraction, causing more issues. (Again, I went thru this) She's a special needs kid and has had a lot of random, painful events. I'd like to make this as painless, but as sensible as possible. Is there an argument that will help me know which way to go with this?
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JeffDent responded:
Hi. I find it somewhat odd that the endodontist did not offer to redo the root canal to see if he can get a successful result. Its possible you could request this if you want to try to hang onto # 14 as long as you can. While it is true we try to maintain teeth as much as we can especially for children, in the presence of active infection, often times we are more aggressive with our preferred treatment because such active infection if it does spread, will cause the tooth growing behind it and possibility adjacent teeth to have problems. If # 14 really is unsavable, your best option would be to have it pulled and have a space maintainer placed. Other modalities seem to risk the infection to not heal which may lead to additional problems. If you can accept this risk you may be able to tell your dentist thats the way you want to go, but it probably wouldn't be my personal recommendation. Hope that helps.
 
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chrismok responded:
Just wanted to follow up... I tried to get consults with orthodontists, but no one had appts in the next week. I couldn't let her be in pain that long just for an opinion. I decided to go back to the dentist and see what options he knew of. Even though he originally said he didn't like to pull permanent teeth, he was pretty anxious to pull the tooth, (I think just to get 'er done). He did slow down enough to explain that a space maintainer could be placed. Once he looked in her mouth again, he saw the infection had spread, and it became more clear that the tooth needed to be removed. It was taken out last night - after 3 shots of novocaine, and then finally laughing gas. While I'm happy to have the infection removed, I still wonder if the right thing was done. Thank you for your post - it's good to have confirmation. And yes, I'm annoyed with the endodontist that they didn't offer to redo the canal. I hated the idea of putting her through that, especially knowing the tooth would be extracted at some point anyway. It would have cost as much as the original root canal. I would have fought that, but that was a road I wasn't looking forward to traveling along with the issue at hand.
 
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db2kp responded:
chrismok, Not sure about this, but you mentioned in your first post about a large filling in the tooth or possibly additional decay? Is it possible that the decay went down too far and too close to the roots? In that case, a Retreatment cannot be done, and the tooth requires extraction. That may be why they didn't try to "save" the tooth. But, all in all, you did the right thing for the situation you were in. The space maintainer is a great option.
 
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Courtney_Nicole responded:
You always want to save a childs permanent tooth if at all possible. I can tell you this because I am a dental hygienist and missing teeth are not good especially at such a young age. You should get a second opinion at an endodontist (a dentist that specializes in root canals) sometimes they can go back in and re-treat the tooth then you can go to your general dentist and have a crown (cap) put on the tooth to help it not fracture due to the large filling placed. Pulling a permanent tooth is not easy on a 10yr old especially on a special needs child. If your only option is to have the tooth pulled for insurance purposes then i would have your child put under general anesthesia in the hospital and have all the work that needs to be done (including a cleaning) completed in one setting, it is alot easier on you and your child this way. Hope all goes well! :smile:


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