IF you have noticed your child's tooth becoming discoloured — usually transitioning from greyish to brown in colour, dental surgeon Dr Naudia Gilzeane said this is often the result of irreversible damage to the tooth often caused by trauma or tooth decay. The tooth is then referred to as non-vital or necrotic.
“When a tooth is described as non-vital or necrotic what is being said essentially is that the tooth is dead which generally occurs as a result of it being irreversibly damaged, sometimes caused by sporting injuries, accidents while children are at play, or very advanced caries,” Dr Gilzeane said.
She pointed out that some other common features which may be noticed when observing non-vital teeth are large fillings or cavities, or in the case where there is a history of trauma, the crown may have fractures.
The damage on teeth as outlined by Dr Gilzeane may be irreversible; however, there are a number of treatment plans that are available. She notes that the treatment plan which is decided on will be dependent on a number of factors, including the age of the child, the particular case presented to the dental practitioner, and the type of tooth or teeth.
“Treatment depends on whether the non-vital tooth is permanent or primary, also as it relates to permanent teeth in children, whether it's a mature permanent tooth or not. Treatment for non-vital primary teeth includes root canal therapy or extraction,” Dr Gilzeane advised.
She underscored that root canal therapy is generally considered in an effort to attempt to preserve the tooth in the mouth in order to maintain the space until the permanent tooth erupts. She said that the procedure will encapsulate the removal of the damaged pulp from the crown and root of the tooth, then cleaning the canals after which they are filled with a resorbable material to allow for its eventual exfoliation.
“In children with non-vital immature permanent teeth, a process called apexification is performed. For this procedure, the damaged pulp is removed from the crown and root canal after which it is cleaned and a filling material is placed that will permit a hard tissue barrier to form at the root apex or actually stimulate this formation,” Dr Gilzeane explained.
Once closure of the root apex is achieved, Dr Gilzeane said that the root canal therapy is completed with a standard root canal filling material and the tooth restored (filled). For mature permanent teeth, however, the pulp is removed and root canal is cleaned and filled followed by restoration of the tooth.
“The practitioner will usually try to preserve the teeth where possible. However, there are instances when restoration is not possible and an alternative treatment is the decided course of action,” Dr Gilzeane said. This is a much easier decision to make with milk teeth since these teeth in children are later replaced by permanent teeth.