Pulp necrosis in primary teeth is a common consequence of untreated caries, trauma, or chronic inflammation.
📌 Recommended Article :
Dental Article 🔽 Understanding Pulpal Diseases: Reversible Pulpitis, Irreversible Pulpitis, and Pulp Necrosis in Adults and Children ... Pulpal diseases represent a continuum of inflammatory conditions that range from reversible pulpitis to irreversible pulpitis and finally to pulp necrosis.Early detection is crucial to prevent infection, pathological root resorption, and damage to the developing permanent successor. Understanding accurate diagnostic criteria and selecting the appropriate evidence-based treatment is essential for successful outcomes in pediatric patients.
Advertisement
✅ Etiology of Pulp Necrosis in Primary Teeth
Primary teeth are particularly vulnerable to necrosis due to:
▪️ Extensive caries progression
▪️ Anatomically thinner enamel and dentin
▪️ Traumatic dental injuries
▪️ Bacterial invasion of the pulp chamber
▪️ Chronic pulpal inflammation progressing to necrosis
📌 Recommended Article :
Video 🔽 What is Pulpitis? - Causes, symptoms, diagnosis, treatment, pathology ... It explains the main causes such as deep caries, trauma, and bacterial invasion, and details clinical symptoms like spontaneous pain, thermal sensitivity, and referred discomfort.✅ Clinical and Radiographic Diagnosis
Accurate diagnosis relies on a combination of:
➤ Patient history (spontaneous pain, swelling, trauma)
➤ Clinical signs
▪️ Tooth discoloration (grayish)
▪️ Sinus tract
▪️ Tenderness to percussion
▪️ Gingival swelling
➤ Radiographic findings
▪️ Furcation radiolucency
▪️ Pathological root resorption
▪️ Periodontal space widening
▪️ Loss of lamina dura
In primary teeth, pulp testing methods like thermal or electric tests are unreliable, making radiographic and clinical findings essential.
📌 Recommended Article :
Dental Article 🔽 Pulpotomy vs. Pulpectomy in Primary Teeth: A Contemporary Clinical Guide ... Vital pulp therapy in primary teeth is a cornerstone of pediatric dental treatment. Among the most common procedures are pulpotomy, which conserves some of the radicular pulp, and pulpectomy, which removes all pulp tissue.✅ Management of Pulp Necrosis in Primary Teeth
Once necrosis is confirmed, vital pulp therapies are contraindicated. Treatment options include:
➤ Pulpectomy
The preferred treatment when the tooth is restorable and the infection can be adequately controlled.
Key principles:
▪️ Thorough canal debridement
▪️ Irrigation with 2.5% sodium hypochlorite or chlorhexidine
▪️ Obturating canals with resorbable materials such as iodoform-based pastes (Vitapex/Metapex)
▪️ Final restoration, ideally with a stainless steel crown
➤ Extraction
Indicated when:
▪️ The tooth is non-restorable
▪️ There is excessive root resorption
▪️ Infection compromises the permanent successor
▪️ Patient cooperation is insufficient
➤ Antibiotics
Not routinely recommended unless:
▪️ Facial cellulitis
▪️ Systemic involvement (fever, malaise)
▪️ Spread of infection
📌 Recommended Article :
Dental Article 🔽 Clinical Pulpectomy Protocol: Updated Step-by-Step Guide ... Pulpectomy is a fundamental procedure in pediatric dentistry for treating primary teeth with pulp inflammation or necrosis. Its main goal is to eliminate infection, maintain tooth functionality until natural exfoliation, and preserve dental space.✅ Prognosis
Successful pulpectomy has a 70–85% success rate, depending on canal anatomy, irrigation protocol, and obturation material. Failure occurs when infection persists, when restoration is inadequate, or when premature root resorption affects sealing.
📊 Comparative Table: Pulpectomy vs Extraction in Necrotic Primary Teeth
| Aspect | Advantages | Limitations |
|---|---|---|
| Pulpectomy | Preserves arch space; maintains function; prevents premature tooth loss; avoids malocclusions | Technique sensitive; lower success in multirooted teeth; requires patient cooperation |
| Extraction | Quick relief of infection; avoids complex instrumentation; suitable for non-restorable teeth | Loss of arch space; risk of mesial drift; possible need for space maintainers |
Managing necrotic primary teeth requires careful consideration of the child's age, behavior, the strategic value of the tooth, and the proximity to the permanent successor. Resorbable obturation materials remain essential, as non-resorbable materials can interfere with exfoliation. Current research supports the use of iodoform-based pastes due to superior antibacterial activity and predictable resorption.
📌 Recommended Article :
PDF 🔽 Manual of diagnosis and pulp treatment in non-vital primary teeth ... A correct history, clinical and radiographic evaluation is necessary in these cases to determine the appropriate treatment for these cases (dental extraction, pulpectomy, lesion sterilization tissue repair).🔎 Recommendations
▪️ Use radiographic criteria as the primary diagnostic tool for suspected necrosis.
▪️ Select pulpectomy when infection is localized and the tooth is strategically important.
▪️ Extract teeth with advanced pathology or poor restorative prognosis.
▪️ Avoid antibiotics unless systemic involvement is present.
▪️ Always protect the treated tooth with a stainless steel crown to ensure long-term success.
✍️ Conclusion
Pulp necrosis in primary teeth requires timely diagnosis and evidence-based intervention to prevent complications and safeguard the developing dentition. Pulpectomy remains the treatment of choice for restorable necrotic teeth, while extraction is indicated in severe cases. Proper case selection and modern pediatric endodontic protocols significantly improve outcomes.
📚 References
✔ American Academy of Pediatric Dentistry. (2021). Pulp therapy for primary and immature permanent teeth. AAPD Clinical Guidelines. https://www.aapd.org
✔ Barja-Fidalgo, F., Ribeiro, A., & Pauleto, A. (2011). Clinical and radiographic outcome of primary molars pulpectomies using different filling materials. Journal of Clinical Pediatric Dentistry, 35(4), 359–364. https://doi.org/10.17796/jcpd.35.4.j1471781m0011654
✔ Fuks, A. B. (2008). Pulp therapy for the primary dentition. Pediatric Dentistry, 30(3), 230–236.
✔ Nadin, G., Goel, B. R., & Yeung, C. A. (2003). Pulp treatment for primary teeth. Cochrane Database of Systematic Reviews, (1), CD003220. https://doi.org/10.1002/14651858.CD003220
📌 More Recommended Items
► Myths About Root Canal Treatment
► Pulp Cap and Pulpotomy in Pediatric Trauma Cases
► Apexogenesis: Step by step procedure