Are Multiple Root Canals on a Very Young Child Wise?

Factual Questions
1

This post is in response to the latest internet outrage fodder story to hit the wires. Finley Boyle was a very cute looking three-year old girl who was given a mix of sedatives, including demerol, as part of the preparation for four root canals to be done to her. According to a lawsuit filed, the staff at the dental clinic failed to monitor her vitals until she went into cardiac arrest and lacked the training to do CPR on her. She has suffered unknown but profound brain damage, and is suffering other complications that leave her no real hope of survival. (Details for anyone who wants more information are available here.)

In addition to the insanity of not monitoring vitals while anyone is under general anesthetic I’m utterly baffled by the decision to allow the procedure to go ahead in the first place.

Now, it’s entirely possible that I may be mistaken here - my knowledge of dentistry is scant, to say the least - but my understanding is that a root canal is a last-ditch effort to save a tooth that has become abscessed before the infection can become an even worse problem for the patient. It’s a procedure with a number of limitations, the biggest being that it’s not guaranteed to save the tooth, just a better option than going straight for a bridge for adults.

We’re not talking about an adult here. We’re talking about a three year old girl. Who will be scheduled to grow a spare set of teeth in a few years, anyways. I can see some issues with concerns about how well a three year old would deal with a bridge or dentures, which would be required to keep the space for those adult teeth free for them to grow into as she aged, however, it’s still only a temporary condition.

General anesthesia is always a risk. For adults this is a fact of life, but it’s even more of a concern for children. Because of their lower body mass the difference between a therapeutic dose and a lethal dose for children is a lot harder to judge. Add into that the fact of variations in individual tolerances, the fact that the clinic may not have been properly monitoring this girl’s vitals is even more baffling to me.

However, it all comes back, to me, to the question of why would anyone seriously suggest doing multiple root canals on a child that young?

Can anyone speak to whether this is considered good practice? Or is it as baffling to anyone with actual knowledge and understanding of dentistry as it is for me?
Note: I’m putting this into GQ because the focus of the post is my question, but I considered putting it into The Pit because of the potential for RO. If a mod feels that it would be better at home there, that’s fine.

2

Not being a dentist, I would think that a bridge in a rapidly growing child would need replacing very frequently. And those things cost a bundle.

3

Dentist here, can’t really know about this specific case because the article doesn’t give details. Probably weren’t going to be “root canals”, but rather pulpotomys. Similar but not really the same thing. On adult teeth you remove the pulp, clean the canal(top to bottom) and fill, usually with gutta percha, and have a “root canal”. On baby teeth usually you just remove the top portion of the nerve, place medication in the space and crown or fill the tooth. On baby teeth it is usually just a pulpotomy v. a root canal.

On baby teeth the nerve is much larger proportionally than on adult teeth, it doesn’t take much of a cavity to cause an abcess.

Yes pulling the tooth is an option as opposed to restoring but there can be drawbacks. The baby teeth aren’t just for chewing, but guide the permenant teeth into place. Much more so with back teeth then with front teeth. I

Let’s say on a child they are three years old and have a cavity on their two year molar that is into the nerve causing pain and an abcess.(I see it every day) We can do a pulpotomy and stainless steel crown to save the tooth or pull the tooth. However if you pull it when the permenant molar starts erupting at about age of six it will tend to drift forward into the space where the baby tooth should be. Then about age 11 whe the permenant premolar that succedes the baby tooth erupts it doesn’t have room. Front teeth influence speech, if you pull the top four front teeth ona three year old they will learn to talk witH no teeth. When the permenant teeth come it at six it will change the tongue position and can cause problems. Ever heard a six year old lisp a bit after loosing their teeth. You can end up with a mouthfull of problems down the road pulling baby teeth v. fixing them.

Sometimes you can place a space maintainer for baby teeth if you have to pull them but not always.

I’ve seen plenty of one and two year olds with all there teeth severly decayed. (Baby bottle tooth decay). You can’t just pull all their teeth and say that for the next several years they will just do with out teeth until the perm. ones come in.

4

rsat3acr, thank you for your reply. I had a vague idea that there’d be complications for pulling, but obviously hadn’t clearly recognized the magnitude of the problems. I’d love to hear other people in dentistry and their views, on a similar general basis, but you’ve answered my immediate question.

Thanks again.

5

Glad to help.