"Root canal" is one of the most anxiety-provoking phrases a parent can hear at a dental appointment. Before we talk about what it means for your child, it helps to know that pulp treatment in a child's tooth — particularly a baby tooth — is a significantly simpler procedure than the adult root canal most parents are imagining. The name sounds the same; the procedure is quite different.
What is the pulp, and what happens when it is affected?
Inside every tooth — adult or baby — is a soft core called the pulp, which contains nerves and blood vessels. In a healthy tooth, the pulp does its job quietly. When decay deepens enough to reach the pulp, however, the pulp becomes inflamed or infected. This is when the tooth becomes painful — often worse at night, often triggered by sweet, hot or cold food.
Once the pulp is significantly infected, it will not heal on its own. The options are to treat it (pulp therapy) or remove the tooth (extraction). In most cases, keeping the baby tooth in place — with pulp treatment — is the right choice.
The three types of pulp treatment in children
The AAPD guideline on pulp therapy for primary and immature permanent teeth distinguishes between three procedures, used depending on how deeply the decay has progressed:
- Indirect pulp treatment (IPT): used when decay is very close to the pulp but has not clearly reached it. The deep decay is carefully removed, a protective dressing is placed, and the tooth is sealed. The pulp often recovers fully.
- Pulpotomy: used when decay has reached the top of the pulp (inside the crown of the tooth) but the root pulp is still healthy. The affected portion of the pulp is removed, a medicated dressing is applied, and the tooth is sealed and usually capped with a crown. This is often what is referred to as a "baby root canal" — and it is faster and more straightforward than the adult procedure.
- Pulpectomy: used when the infection has spread through the full length of the root. The pulp is removed from the entire canal system, the canals are cleaned and filled with a resorbable material (so the roots can dissolve naturally when the tooth is ready to fall out), and the tooth is sealed and crowned.
All three are done under local anaesthetic. The child should not feel pain during the procedure.
Why not just remove the tooth?
This is a reasonable question. Extraction sounds simpler, and the tooth will fall out eventually anyway.
The problem is what happens to the space after an early extraction. Baby teeth hold space for the adult teeth forming underneath. When a baby molar is removed years before it would naturally fall out, the neighbouring teeth drift into the gap. The adult tooth then has no room to come through straight — and what might have been a simple filling becomes an orthodontic problem requiring braces or aligners.
If extraction is necessary, a space maintainer is placed to hold the gap open. But keeping the natural tooth in place, if it can be treated, is almost always the better option.
What to expect after treatment
The local anaesthetic will wear off 2–3 hours after the appointment. Your child's lip, cheek or tongue may feel numb until then — remind them not to bite or chew on the numb area.
Some mild soreness in the area for 1–2 days is normal. If pain is significant, does not improve after 48 hours, or if there is visible swelling, contact us.
A crown is usually placed over the treated tooth to protect it — baby teeth that have had pulp treatment are more fragile, and the crown keeps them functional for the years they have left.
Sources: American Academy of Pediatric Dentistry, Guideline on Pulp Therapy for Primary and Immature Permanent Teeth, 2023; Dhar V. et al., Cochrane Review on pulp treatment for extensive decay in primary teeth, 2017.