Pediatric Endodontics – The Big Deal About Little Teeth

As a dental professional, you likely spend countless hours of your day reminding patients of the need to care for their adult teeth. But equally important to oral health is whether a solid foundation for the adult tooth was kept in place during the primary tooth phase. February is National Children's Dental Health Month, reminding clinicians, parents and children about the important role primary teeth play.

Working with children presents some unique challenges in dentistry, particularly in endodontics when the procedure is so intricate, explains endodontist Dr. Beth Damas. In her busy practice just outside Chicago, IL, Dr. Damas regularly treats children. Through her years of experience, she has found that treating children requires a much different approach than treating adults. "To make a child feel comfortable, you have to invest more time in communicating and addressing their concerns," said Dr. Damas. She recommends scheduling a consultation appointment prior to the actual procedure to establish a rapport with both the patient and the guardian and allow them to build trust and feel comfortable asking questions.

When communicating with children, Dr. Damas stresses the importance of explaining things slower and in much more detail. She chooses words that are less scary for children and avoids technical terms they won't understand. A rubber dam for example, can be explained as a rain coat to protect the child's mouth throughout the procedure.

A Three-Step Approach for Communicating with Children

During the procedure, Dr. Damas utilizes a three-step approach for introducing instruments and explaining each step to the patient. 

  1. Show – Show the patient the instrument or device.
  2. Tell – Explain its purpose using words the child will understand.
  3. Do – Perform the procedural step while keeping the child engaged.

In the following video, Dr. Damas offers examples of how to implement the show, tell, do approach throughout the procedure and outlines other tips for easing a child's concerns during a root canal treatment. 

Why Pediatric Endodontics?

Pediatric endodontics strikes a chord with Dr. Damas, as it is a way to positively impact the patient's perception of dentistry at a young age which helps establish good habits for long-term oral health. “If you can make the procedure a good experience for the child, you can turn around their otherwise negative view of going to the dentist or doctor – and as they grow up they're going to continue on that path because you helped relieve their pain and fixed their tooth,” Dr. Damas said.

In addition to relieving their pain, endodontic treatment can help a child feel more confident about their smile by avoiding extraction and the need to place a space maintainer. This was precisely the case for Dr. Damas when a seven-year-old patient presented with a necrotic tooth. The patient had a delayed eruption pattern and the parent did not want to have the tooth extracted and have a space maintainer placed for an extended period of time. Thus, Dr. Damas performed a pulpotomy to save the primary tooth.

The tooth was accessed, cleaned and calcium hydroxide was placed temporarily. When they came back for a second visit, there were already signs of healing. The calcium hydroxide was removed; ProRoot MTA was packed on the coronal portion of the root and pulpal floor and the tooth was restored with composite. According to Dr. Damas, the clinical advantage here is that it allows the natural exfoliation and eruption pattern to continue, but for the patient and parent it also avoids the need for a space maintainer, making it an excellent alternative to extraction.

Pre-op Radiograph First Visit Post-op Second Visit Post-op
Pre-Op Radiograph
(Click to enlarge)
First Visit Post-Op
(Click to enlarge)
Second Visit Post-Op
(Click to enlarge)

For cases such as this, Dr. Damas trusts ProRoot MTA as a filling material because it creates an excellent seal that cooperates with the root’s natural healing process. When used in pediatric pulpotomies, the product’s biocompatiable seal is ideal for replacing pulp in the chamber to prevent infection from reaching the roots.

These benefits can also be seen in this case from Dr. Damas involving an eight-year-old patient with a very unusual tooth #7. The patient had a Dens en dente tooth or essentially a tooth within a tooth. The affected part was treated with ProRoot MTA. The other part of the tooth was vital and thus was left alone since the MTA is biocompatible enough to allow for continued root development. In the recall x-ray, Dr. Damas notes evidence of the root thickening and closing of the apex.

Pre-op Radiograph - Dens En dente Tooth #7 Post-op radiograph
Pre-Op – Dens en Dente Tooth #7
(Click to enlarge)
Post-Op
(Click to enlarge)
Six Month Followup Radiograph One Year Followup Radiograph
Six Month Followup
(Click to enlarge)
One Year Followup
(Click to enlarge)

Share Your Support for Little Teeth

Support National Children's Dental Health Month all throughout February by sharing on social media how your practice has helped further care for children's oral health – whether it is an area of your office designed to be child-friendly, a monetary donation or providing education at local schools. Share your stories and tag Dentsply Sirona Endodontics on Facebook or Twitter. For each story shared, Dentsply Sirona will make a donation to America's Tooth Fairy, the National Children's Oral Health Foundation.


Dr. Beth Ann Damas graduated in 2005 as one of only five students with a dual DDS 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 on the subject to various study clubs nationally. In 2015, Dr. Damas completed her American Board of Endodontics Diplomate certification.