Root canal V extraction

[Newnamenewme13]

Posting here for traffic as I'm panicking a little...
My son is 10 and needs 2 possibly 3 root canal, or extraction... has anyone any experience similar and can you tell me what you decided to do please?
I'm getting so many opinions and he is in a lot of pain, I don't know which is preferable??
Any info very much appreciated

The 7s should a lot in to place hopefully

I am wondering this too. Both myself and DH have had them in the past 3-5 years. He has had two, and I have had one. DD's husband had one last year, and my best friend had one last week. All pain free, but yeah it does take a bit of time, and keeping your mouth/jaw open for what can be 45 minutes is a bit of a ballache. They do let you rest, and close it for a while if/when you need to though.

Re what @sizingissues said - I am shocked to hear that there is pain when they are trying to remove the nerve. There really shouldn't be! You should be 'numbed up...'

I do wonder if the people saying root canals are awful/painful etc, are harking back to the days when they were... (I would say pre 2010s...) These days they're really not. (Well they shouldn't be...) I think it must be a poor dentist who is not doing the job properly if the patient is experiencing pain and discomfort, and I would look into moving dentists. (Like, put your name on another dentist's waiting list - if you can find anyone taking people on!)

My dd has poor enamel and one of her teeth cracked, we opted for extraction at age 11. She has since needed a brace and the gap has closed, she is currently considering having another tooth extracted from the top so that her teeth will be perfectly aligned.

Also a dentist and agree.
Not many 10 year olds are able to cooperate sufficiently with a multi-rooted Endodontic procedure, let alone the restoration afterwards.
If teeth that have only been in the mouth for 3/4 years are already at the point of pulpal involvement, then these teeth are usually deemed 'poor long term prognosis' in a 10 year old child.
There's a window of opportunity for a child needing to have first permanent molars extracting to try and ensure a good long term result with forward drift of the unerupted 2nd permanent molars; so don't spend too much time contemplating this situation OP.
Especially if your child is going to need a referral for GA or Inhalation Sedation for the extractions.

So my kids needed these teeth out. I did end up down a rabbit hole on the internet about removing first molars having an impact on the jaw bone density and jaw line. And general shape of the face. Can any of the dentists on here offer me reassurance on this? I have had many sleepless nights worrying if we did the right thing

PLEASE READ OP - I am a paediatric dentist. I’ve not RTFT. Are these his first adult molars? If so, I would 100% recommend extraction - age 10 is the ideal age for this, and the second molars are in the ideal position to close the gap left by extraction of the first molars. If he has ‘weak teeth’ I assume you’re talking about hypomineralisation - this is a lifetime of fillings, crowns, replacements etc (if the RCT even works) which is not worth it.

Are wisdom teeth visible on his X-ray?

Regarding posters concerned about changes in face shape and bone dentistry - yes and no.

Face changes - no. The way your teeth sit in your mouth, extractions wouldn’t affect this (unless you’re talking about ‘sticky out’ front teeth). Your cheeks are full of tissue and fat and a small space left by tooth extraction wouldn’t affect it. If you were missing multiple units however, this may do.

Bone density - As a child, no. Your baby teeth are relaxed by adult teeth. If, like in the OPs case, we are hoping that adult teeth will shift forward and take space of an extracted tooth, the bone remains. However, if you’re an adult and you lose a tooth, your teeth are not going to move like that of a child as your growth potential is next to nothing, so you are left with a gap and a chunk of bone missing too. This isn’t replaced. But it can be minimised- if you’re dentist is extra careful, chooses the right type of extraction, identifies problems early and prevents bone loss due to infection…

Thanks 18daychallenge so for removing 6.s to replace 7s in a child the overall impact to bone density and face shape is not something of concern then?

I'm so grateful for all the responses, honestly... I need to decide tomorrow so this is really helping me, even more than I realised it would!

It depends where it is. If it's at the back and not that visible I would extract. Root canal is incredibly long winded and awkward. It will be a hard treatment for a child to go through. Unless they can sedate him and do all in one go?

But its not just the one tooth. Its several.
And if more go bad in the next couple of years, then there will be no teeth left to fill the gaps, as it would just be one big gap!

The dental dam is the thing that made it tolerable. The dentist never used one when he attempted RCT twice but, when he sent me to the hospital for the 3rd attempt, they did. Much better than having water and bits of grit ending up in your throat I found.

OP I never found the RCT painful. However, the tooth ended up needing to be removed anyway. I would still always opt for RCT in future rather than straight removal as there is always the chance it will be successful and the tooth can be saved.

No in a nutshell.

Child of 10 with shot first permanent molars v adult with a pulpally involved tooth/ teeth=completely different clinical situations with different UK guidelines and different options for treatment.

Irrelevant for adults to offer advice on their RCT experiences in this situation.

Best to ask your high street dentist for a 2nd opinion and /or an orthodontic opinion.

Root canal V extraction www.mumsnet.com/Talk/_chat/4889526-root-canal-v-extraction?msgid=128996600#128996600

Very recently, why? You're lucky if you re was pain free.

Root canal V extraction www.mumsnet.com/Talk/_chat/4889526-root-canal-v-extraction?msgid=128996464#128996464

Yes and to stick the bleach they use going down the throat.

Funny they never used to use it, years ago when I had root treatment.

This! Don’t worry so much about the procedures, get advice for the best outcome for your child.
And prevention advice.

How is he with dentists?

DD had a scare at the dentist at about that age and ended up with dental phobia (full on phobia, not just doesn't like, and she's normally calm through anything).

However after many years of sedation if she needed anything at all doing, she has just, (10 years later) managed to do a root treatment without sedation.

Adding a pic in case any dentist here can advise better with it! Thanks again everyone

Perfect timing to take them out and make more room for the premolars that haven't come through yet. He's going to need one of the teeth out on the top left too, there's not enough room for all his teeth there. Did he have baby teeth out early too?

This. Ex dentist here. Root filling the sixes at this age is the start of a very long road to eventual extraction.

Reposting this most excellent advice.

Hi OP - yes, this an absolute classic case of MIH and 100% would extract all four. You can read more here: these are the updated guidelines - a bit technical but I think you understand the gist. It looks like your DC has upper wisdom teeth, not yet visible on the lowers but still possible.

Im very surprised any dentist would think RCT is a good option in a 10 year old, for the long and short term.

https://www.rcseng.ac.uk/-/media/fds/guidance-for-the-extraction-of-first-permanent-molars-in-children.pdf

Best of luck X

On that OPT , Can only see one third molar crypt UL8, but that's irrelevant really because I
UR6, LL6, LR6 are radiographically "shot". Possibly need the UL6 out too, depending on the developing occlusion and how it looks clinically. Earlier poster has posted a link to the RCS guidelines,
Sounds like hypoplasia/ hypomineralisation is going on here as well as gross caries. First permanent molars affected with this-hypomineralisation -their structure is comparable to an aero chocolate bar-i.e. you never know when these teeth will collapse "post eruption breakdown."

What you need to know here OP is that OPT radiograph is unequivocal in how knackered the UR6, LR6 and LL6 are. Dental radiographs are 2D and as a rule, always capture a less extensive picture of the true disease process when compared clinically -i.e. inside the mouth.

I'm astonished your high street dentist has offered root canal treatment in this clinical situation. Are you sure that's how the conversation went as regards treatment options?
The overwhelming majority of primary care dentists would either be extracting those 3 FPMs +/- UL6 either under Local anaesthetic or would be doing urgent referrals for GA or IHS in secondary care services. If your child isn't in pain, hard to imagine looking at that radiograph that they would be symptom-free tbh, an ortho opinion re UL6 inclusion in Treatment plan is not outrageous if the child's developing occlusion is not Class 1.

Based on the rad and what you've told us, this is a straightforward re options for treatment.

I know I'm going for extraction now, thanks to all the brilliant advice and info you have all given me... not 1 but 2 dentists recommended rct, trying not to think it's because there is a lot of money made on rct here....