Tooth Decay: Sometimes a Filling, Sometimes More

Just like adults, kids can experience tooth decay. But baby teeth are a little bit different than adult teeth. The outer layer of their teeth—the enamel—is a bit thinner, and decay spreads quicker throughout the tooth once it starts. If a cavity isn’t caught in time or treated soon enough, it can quickly go deep into the tooth or spread to neighboring teeth.

Baby teeth are the foundation for adult teeth. Kids who have healthy baby teeth are more likely to have healthy permanent teeth too. And if their teeth fall out prematurely due to decay, it can cause other dental issues, such as crowding and bite problems. It’s most beneficial to save the tooth when possible. This involves treating decay as soon as possible.

Signs To Look Out for That Indicate More Extensive Decay

If your child is complaining of tooth pain or that pain is keeping them awake at night, that’s a red flag. If there’s tenderness in the area, if your child experiences pain and difficulty chewing and eating, and especially if there’s swelling in your child’s jaw, those are all indications that it’s time to get the tooth checked out immediately and that more than a filling might be necessary.

Let’s first talk about the structure of a baby tooth.

The baby tooth is composed of four parts. The first part is the enamel, which comprises the outer layer of the tooth. This is not only the hardest part of the tooth, but also the hardest substance in the entire body. The next layer is the dentin. The dentin is softer than the enamel and makes up the majority of the tooth. Inside the tooth is the soft tissue called the pulp, where the nerves and blood vessels live. Finally, the root anchors the tooth in place. The root has all the same layers as the main body of the tooth.

How Tooth Decay Happens

First, plaque that builds up on teeth produces acid that slowly begins to erode the enamel. This leads to dental caries, or cavities: tiny holes in the enamel. At this stage, a simple filling is all the tooth needs to stop the process and save the tooth.

But if the condition is left untreated, these dental caries reach the softer dentin, where the decay process speeds up. Eventually the infection reaches the pulp, and the only way to save the tooth is to clean the infected matter either by a pulpectomy or a pulpotomy. While these two procedures sound similar, they’re actually very different, and which one the tooth needs is dependent on how far the decay has reached into the tooth.

Pulpectomy and Root Canal

If the infection has gotten so deep that it’s infected the roots of a tooth and the tooth has died, it needs a pulpectomy. During this procedure, all of the pulp, including the pulp that is inside the roots, is cleared out, and a root canal is performed. A root canal, then, is the process of filling the empty canals with synthetic material. Whenever a pulpectomy is done, a root canal is required. The two terms are two sides of the same coin. After the pulpectomy and root canal, the tooth will be protected from further infection.


A pulpotomy, on the other hand, is an entirely different procedure than a pulpectomy. “Otomy” and “ectomy” mean different things. While the suffix “ectomy,” means taking something entirely out, “otomy” means cutting into something. In a pulpotomy, only the top layer of pulp is removed.

A pulpotomy is also different from a pulpectomy in that it’s less extensive and is completed in teeth that are still alive. It’s sometimes also referred to as a “baby root canal” as it’s a common restorative procedure used for baby teeth.

When a pediatric dentist performs a pulpotomy, they first administer a local anesthetic. Then they use their high-tech laser or dental drill, depending on what technology their office uses, to gently clean all the decay and bacteria-infected pulp out of the tooth. After the dentist has cleared the infection out, they place a crown for future protection, and the tooth is ready to go.

At Spinnaker Pediatric Dentistry, we conduct our dental work with one of the newest technologies: laser dentistry.

We use laser dentistry, which is less invasive, more accurate, and involves less pain than previous methods involving scraping with instruments. Since the laser only targets the infected tissue, the process is efficient and promotes the natural healing process of the tooth. Since laser dentistry isn’t as invasive, it’s also less anxiety-provoking, which is one of the reasons it’s so great for kids.

Your kid’s smile matters. Taking care of any dental decay and staying on top of oral hygiene are the best ways to ensure your child has the least amount of oral health-related problems down the road.

Talk to your team at Spinnaker Pediatric Dentistry more about baby root canal treatment. And if it’s time for that next routine evaluation and cleaning, don’t forget to book it!