Endo Quick Tip: Hypochlorite in Action
June 21, 2019
Endo Video Tip: M4 Handpiece
December 6, 2019
I met endodontist Dr. Beth Damas at the recent Dentsply Sirona Key Opinion Leader meeting. Even though there’s much more to her practice than treating children, I was so impressed with her presentation, I am going to start referring to her as The Pediatric Endodontist.
I realized that I unintentionally neglected pediatrics in my practice — and I know that I am not alone. Treating children takes a special person and a whole lot of patience. I see a good amount of children in our practice, mainly for their permanent teeth. However, what about primary teeth?
Dr. Damas opened my eyes to a whole new realm of possibilities. She’s shown me how I can continue to grow in ways that help my community. Therefore, I am dedicating this blog post about a pediatric endodontics case study to her and all the children that she has helped — as well as all the children you and I can help!
I hope you discover that endodontics is not just for permanent teeth. We should be doing it on primary teeth as well.
Addressing the Standard of Care for Pediatric Endodontics
Currently, the standard of care for a mobile or abscessed primary tooth is extraction and space maintainer. But Dr. Damas recommends an alternative.
What if we do endodontic therapy to disinfect the tooth so that it can stay in place until the permanent tooth is ready to erupt? This would decrease the need for the space maintainer? It’s unaesthetic and unhygienic and can be traumatic for a child, not to mention for the parent too. Space maintainers can also lead to caries and staining of adjacent teeth.
There’s another way!
A Pediatric Endodontics Case Study
Here is a case that she presented of a young boy with a necrotic pulp and acute apical abscess. There was presence of some gingival swelling of tooth S. You can see the deep decay on the distal that led to the bacterial contamination of the pulp.
Her first step was to disinfect the tooth just like she would any other root canal. She allowed the calcium hydroxide to sit in the tooth for some time until the swelling resolved and there was no pain to percussion or biting. It was a multi-visit procedure. If you have a case like this, hopefully it only requires two patient visits, but it may require more until you completely control the infection.
Once the tooth was asymptomatic, she obturated it with MTA and placed a final composite restoration, with flowable resin as the base. This radiograph is from 2016.
In 2018, the patient returned for a recall, and you can see that the bone is regenerating. The primary tooth is in good shape, and so is the erupting tooth.
One year later in 2019, the patient returned for yet another recall, and you can see that normal eruption is occurring of the succedaneous tooth, and normal resorption is occurring of the primary tooth. Victory!
Pediatric Endodontics Is Another Way to Save Teeth
I’m so impressed that Dr. Damas thinks outside of the box but she is also able to do all of this without any sedation or nitrous. She simply walks and talks her patient through the process. In short, she’s an inspiration who has opened my mind to even more possibilities as an endodontist.
If you feel that Dr. Beth Damas can be a good resource for you and patients, please check out her bio below and give her a shout! Her practice is in Orland Park, Illinois, so if you are in her hood you should definitely look her up.
Let’s get out there and save some teeth, including for our wonderful pediatric patients!
-Sonia
P.S. If you missed enrolling in E-School with coaching, you can still study independently. This online endodontic continuing education program for general dentists can help you improve revenue, reduce chair time, and boost patient outcomes.
About Dr. Beth Damas
Dr. Beth Ann Damas was born and raised in Lemont, Illinois. In 2005, she graduated as one of only five students with a dual D.D.S. and MS. degree from the University of Illinois College of Dentistry. Upon graduation, Dr. Damas entered the private practice of general dentistry in the Southwest Suburbs of Chicago from 2005 to 2008. Subsequently, Dr. Damas entered the endodontic residency program at the University of Detroit Mercy in Detroit, Michigan. She completed her residency training in 2010.
Dr. Damas is an active member of the American Association of Endodontists, American Dental Association and the Chicago Dental Society. Her expertise includes regenerative endodontics in adolescents, and she has presented this research to various study clubs nationally. Dr. Damas completed her American Board of Endodontics Diplomate certification in 2015, which is the highest academic achievement in the profession.
Dr. Damas resides in Southwest Suburbs with her husband, two young children, and a dog. In her free time, she enjoys spending time with her family, reading, and creating art projects.
17 Comments
Excellent job teaches us a lot…
Thank you for sharing. Did she place the MTA all the way down the roots or just within the chamber?
Dear Dr. Soniya,
Amazing case study. I have been extracting such teeth. This makes me wonder, what irrigant was used. Do you suggest using Hypo in primary teeth as well?
Good article; I’ve had good results with Calcium Hydroxide in one visit, then followed by a Stainless Steel Crown; usually I’ll try to clean debris out of the canals with hand files, place Formocresol pellet for 10-15 minutes, then the Calcium Hydroxide and a Stainless Steel Crown.
Thank you! This is so cool! In this situation almost every dentist would just extract the tooth. Is obturating with MTA what allows the regeneration, I Assume? Or is the the combination of calcium hydroxide and MTA that did it?
Nice result.
Why so many follow up rads, the symptoms and signs were resolving, so how how do you square this with ALARA?
In the absence of signs and symptoms, if the radiograph showed poor resolution, would it have changed your treatment rationale, bearing in mind the crown had formed, so therefore little likelihood of hypoplasia?
Hey there!! The MTA was placed mainly in the chamber, but you want to make sure some of it is expressed in into the canals as well. It is not necessary for it to go all the way down to the apex.
-Sonia
Yes, this case was disinfected just like a permanent tooth, so hypochlorite was used. The primary goal is still to get the tooth disinfected.
-Sonia
Great!! This is just an alternative to the formocresol pulpotomy.
-Sonia
Hi there!! The disinfection with hypochlorite and calcium hydroxide is what allows the bone to regenerate. The MTA is just the method of obturation.
-Sonia
Hi!! I don’t feel that once a year radiographs is too many radiographs. You can still have the presence of infection even without signs and symptoms, the clinical examination is only half of the examination. I think that this case does follow the ALARA principle. Yes, I believe that if there was an asymptomatic lesion that would alter the treatment plan back to an extraction and space maintainer. This case is also a teaching case for this doctor so documentation in order to educate others is paramount. Think of how many teeth are going to be saved just by publishing this case study.
-Sonia
Thanks so much for reading!
-Sonia
everything looks great. my question is the age of the boy and my concern is the amount of bone formation over the permanent dentition thereby delaying normal eruption of the bicuspid.
Do you have any follow up to show the dentition after the age of 12
Dr Sonia, since MTA is not resorbable, how we can obturate a primary tooth with MTA and not jeopardize the permanent eruption?
Thank you for your reply
Great to learn alternative treatment modality.
Thanks, I’m glad this was useful for you!
-Sonia