While the boy's family claims medical negligence, we speak to dentists to understand if root canals are necessary for milk teeth and what the risks are.
In a heartbreaking incident, a family in Kerala’s Thrissur is mourning the loss of their three-year-old child who died following a pulpectomy procedure, commonly known as a “baby root canal”. The family has raised concerns of medical negligence.
Police reports said that the child was put on general anaesthesia for the procedure and upon regaining consciousness, he allegedly experienced severe discomfort, accompanied by a significant drop in blood pressure, ultimately leading to the tragic death.
As the investigation proceeds, this tragedy highlights the need for stringent safety measures in paediatric dental care.
A common notion exists that milk teeth need no extra care because they will anyway fall off to make way for the permanent teeth. However, milk teeth are not practice teeth. Damaged milk teeth that aren’t treated can harm the development of permanent teeth.
A pulpectomy is a dental procedure performed to save a decayed or infected milk tooth. It involves removing the diseased pulp tissue within the tooth, with the aim of preserving the rest of the tooth’s structure and preventing further damage or infection.
Speaking to South First, Dr Dharmesh HS, orthodontist and certified implantologist, as well as Director of Geetha Dental Clinic, says, “We need to save the milk tooth to allow the permanent tooth to come into proper position. Milk teeth act as a guide to the permanent teeth. Preserving the natural tooth can help maintain the child’s chewing function, prevent the other teeth from shifting, ensure proper speech development, and space maintenance for permanent teeth.”
When there is a decay of the milk teeth, then, at the initial stages, a filling can be done and they can be saved. However, if the decay is beyond repair, then a root canal of the milk teeth is performed and that is called pulpectomy.
While dental surgeries like these are generally safe, they are not without risks — like any surgery.
Complications can arise from the anaesthesia, the procedure itself, or post-operative care. It’s crucial for dental professionals and parents to be aware of these risks in order to minimise them.
Speaking to South First, Dr Ashwin D, a pedodontist from Kasargod, Kerala, explains that children who are often uncooperative during a treatment procedure are recommended to be put under general anaesthesia (GA). “Also kids with various disabilities are treated under GA,” he adds.
Explaining the process of a planned procedure under GA, Dr Ashwin says, “First, the paediatrician will check the child and assess if they are fit for the procedure. Blood tests and any other required tests are carried out. The child will be admitted the previous day.”
He continues, “Parents are advised not to provide the child with any liquid food at least six to eight hours prior to the procedure and any solid food at least 12 hours before the procedure. It is the anaesthetist who checks the child and plans the dosage of anaesthetic medication, based on the length of the procedure.”
After the procedure, the anaesthetist gives a reversal agent to wake the patient up. During reversal, a patient’s normal reflexes will start becoming active.
“While recovering from the effects of anaesthesia, it is common to feel thirsty or hungry but the patient cannot be given anything for a while. But with children, they usually don’t listen even if you try to convince them. So, out of a sense of caring, parents may give some water or light food. However, this might lead to complications, like difficulty in breathing,” Dr Ashwin explains.
Doctors South First spoke to advise people to ensure that they are going to a certified and experienced pedodontist.
Also, any health issues of the child must be discussed thoroughly with the doctor.
“In the case of Thrissur incident, the reports say that the child had a history of epilepsy. This might have led to some complications during recovery. However, only a postmortem can give the exact cause of death,” says Dr Ashwin.
He adds that it is necessary to discuss any medical history with the dentist, including any allergies or previous reactions to medications. Similarly, parents must be fully informed about the procedure, the materials used, and the post-operative care required.
Dr Ashwin also says that the parents should strictly follow all pre- and post-operative instructions to prevent complications from anaesthesia.
Dr Dharmesh adds that some dentists give local anaesthesia and this is done in a clinical set up. It is called “conscious sedation”, he explains.
However, he adds, “I would always prefer that these kinds of treatments be done in a hospital set-up in the presence of an anaesthetist and a proper ICU.”