One of the most common questions paediatric dentists hear is “Can a child get a root canal?”
The answer is not as straightforward as a simple yes or no, and we’ll explore why as we go along.
A better way to put it is this: your child may need pulp therapy, but that does not necessarily mean they are a candidate for conventional root canal treatment.
So, what does that mean?
To answer that question, it’s important to first understand what a root canal treatment is and why it is performed.
Let’s start with a brief overview of root canal treatment.
What Is a Root Canal?
A root canal treatment is a procedure used to save a fully formed permanent tooth that has become severely infected or damaged.
Dental pulp is the soft tissue in the core of the tooth that contains nerves and blood vessels. Deep tooth infections affecting the dental pulp are treated with a root canal treatment.
During a root canal treatment, the infected pulp is removed from the tooth. The root canals are then cleaned, disinfected, shaped, and sealed to prevent future infection. In most cases, the tooth is subsequently restored with a filling or crown to protect it and restore function.
Can a child get a root canal?
Yes, a child can undergo root canal treatment, but only in certain cases.
Unlike adults, who have fully developed permanent teeth, children go through a transition from primary (baby) teeth to permanent teeth as their jaws grow and develop. During this process, they need larger and stronger teeth to support proper function and growth.
0-6 years: Up to around six years of age, children typically have only primary (baby) teeth.
6-12 years: Between the ages of six and twelve, they enter the mixed dentition stage, during which baby teeth and permanent teeth coexist. During this period, baby teeth gradually fall out, newly erupted permanent teeth emerge, and the roots of these permanent teeth continue to develop.
12+ years: By around twelve years of age, most children have a complete set of permanent teeth.
Because children’s teeth are constantly changing and developing, dental treatments in children are carefully tailored according to their stage of development and the affected tooth. A treatment that is appropriate for a fully developed adult tooth may not be suitable for a child’s baby tooth or an immature permanent tooth.
Case 1:
A full-mouth X-ray (OPG) of a 5-year-old child shows all the erupted primary (baby) teeth, as well as all the permanent teeth developing at different stages. By simply looking at the face of a 5-year-old child, you would never realise how closely their permanent tooth buds are developing beneath the gums.
At this stage, if a child develops a deep cavity in a baby tooth, the dentist’s primary goal is to provide treatment that saves the tooth while, most importantly, avoiding any harm to the developing permanent tooth underneath.
So, what are the treatment options if your child develops a deep cavity?
Read our blog on the causes, signs and symptoms and treatment options of dental cavities: Cavities: Causes, Symptoms, Prevention, and Treatment
My Child Has a Deep Tooth Infection. What Treatment Will They Need?
If your child develops a severe tooth infection, treatment depends on whether the affected tooth is:
- A primary (baby) tooth
- A newly erupted permanent tooth (immature tooth)
- A mature permanent tooth
Each type of tooth and the phase of growth they’re in require a different treatment approach.
Read our blog on causes of tooth cavities in children: What Causes Cavities in Children? A Complete parents guide
How Is a Deeply Infected Primary (Baby) Tooth Treated?
There are three common treatment options for baby teeth with deep infections:
Pulpotomy
A pulpotomy involves removing infected pulp tissue from the crown of the tooth while preserving the healthy pulp within the root canals.
Pulpectomy
A pulpectomy involves complete removal of the pulp tissue from both the crown and roots of the tooth. The canals are then filled with a calcium hydroxide-based paste.
Extraction
Extraction involves removing the tooth entirely when the infection cannot be predictably managed with pulp therapy.
Case 2:
In this case, stainless steel crowns are placed after the pulpotomy and pulpectomy procedures on the lower primary molars to protect them from further breakage. Tooth-coloured crowns commonly used in adults are not suitable for primary teeth.
Read more: Cavities Between Teeth: Why They Happen Even If You Brush Every Day
Why Are Pulpotomies and Pulpectomies Used Instead of Root Canal Treatment in Baby Teeth?
Pulpotomy and pulpectomy procedures are specifically designed according to unique anatomy of primary (baby) teeth. These treatments aim to preserve the tooth while allowing the natural resorption of its roots, ensuring that the eruption of the underlying permanent tooth is not disrupted.
Anatomically, primary teeth are smaller than permanent teeth and have:
- Thin enamel and dentine
- Relatively large pulp chambers
- Molars have thin, divergent roots
The roots of primary molars spread around the developing crowns of the permanent premolars beneath them.
The large pulp chambers allow primary teeth to heal more readily following a pulpotomy.
In a pulpectomy, the thin and divergent roots do not provide sufficient space for the extensive mechanical canal cleaning performed during conventional root canal treatment. Instead, the infected pulp is removed using small-diameter files, and the canals are filled with a calcium hydroxide or MTA paste.
Calcium-hydroxide or MTA paste performs two important functions:
- It helps eliminate any remaining bacteria within the root canals.
- It does not interfere with the natural resorption process required for eruption of the permanent successor.
Traditional root canal filling materials are designed to be permanent and resist resorption. Because they do not dissolve naturally, they are unsuitable for primary teeth.
Read more: Pit and Fissure Cavities or Stains: Understanding Key Differences
Can a Newly Erupted Permanent Tooth Have a Root Canal?
Case 3: An 8-year-old child has newly erupted upper permanent central incisors (front teeth). These front teeth are more prone to sports-related injuries. In the event of an injury at this age, the child may require apexogenesis or apexification treatment to allow for continued root development or to manage incomplete root formation.
No. A newly erupted permanent tooth generally should not receive conventional root canal treatment.
Pulp exposure in newly erupted permanent teeth may occur due to:
Sporting and Traumatic Injuries
Traumatic injuries frequently affect newly erupted upper permanent incisors.
Deep Tooth Decay
The first permanent molar erupts around six years of age, behind the second primary molar, and therefore gets cavities more often.
Tooth decay may develop in the first permanent molar because of:
- Interproximal decay in the neighbouring second primary molar
- Poor contact between the two teeth
- Deep pits and fissures on the tooth
- Plaque accumulation in difficult-to-clean areas
What Makes Newly Erupted Permanent Teeth Different?
Newly erupted permanent teeth have short, thin roots with open apices (root ends).
Root development continues for approximately two to three years after eruption. Because their roots are still developing, these teeth are referred to as immature permanent teeth.
This unique anatomy significantly influences treatment decisions.
Treatment Options for Immature Permanent Teeth
The primary goal when treating immature permanent teeth is to encourage complete root development.
Treatment options depend on:
- The condition of the pulp (extent of infection)
- The stage of root development
1. Apexification
Apexification involves complete removal of the pulp tissue, followed by placement of a biocompatible material within the canal.
This material stimulates the formation of a hard tissue barrier at the root end, allowing the canal to be sealed despite incomplete root formation.
2. Apexogenesis
Apexogenesis aims to preserve pulp vitality through a pulpotomy procedure.
By maintaining healthy pulp tissue within the roots, natural root development and closure of the root apex can continue.
Case 4:
An OPG (x-ray) of a 6-year-old child shows an erupted permanent first molar with incomplete root development. The roots are thin, and the apices remain wide open, indicating an immature tooth.
If pulpal infection occurs at this stage, treatment should aim to preserve vitality and promote continued root maturation, allowing the roots to develop fully and the apices to close.
What If a Child Develops an Infection in a Mature Permanent Tooth?
Once a permanent tooth has completed root development, conventional root canal treatment becomes a suitable treatment option.
Permanent teeth with fully formed roots that have experienced pulp exposure due to:
- Deep tooth decay
- Dental trauma
- Cracks or fractures
- Other causes of pulp infection
can be treated using standard root canal therapy.
Why Dental X-Rays Are More Important Than a Child’s Age in treatment planning
A child’s chronological age alone cannot determine whether root canal treatment is appropriate.
Some teeth erupt earlier or later than average, which means age can sometimes be misleading.
Dental radiographs (OPG) provide a clear picture of:
- The stage of tooth development
- Root maturation
- Eruption patterns
- Position of developing permanent teeth
- Extent of infection
These findings allow the dentist to establish an accurate diagnosis and develop the most appropriate treatment plan for your child.
Read our blog on the causes, warning signs and treatment options of a failed root canal: The Science Behind Failed Root Canal Treatments: 7 Causes, Warning Signs and Treatment Options
Signs and Symptoms Your Child May Need a pulp therapy
The following signs and symptoms in a child should never be ignored and warrant immediate treatment:
- Severe pain in the tooth that may worsen at night
- Gum boil or pus draining from the affected gums or tooth
- Bad breath
- Fever accompanied by toothache and swelling
- Lingering sensitivity on hot or cold drinks
- Tooth discoloration
These signs and symptoms may indicate an infection or damage to the dental pulp, and your child may require pulp therapy or a baby root canal to save the tooth and prevent the infection from spreading.
Key Takeaway: Can a Child Get a Root Canal?
A child can receive a conventional root canal treatment only when a permanent tooth has fully developed roots.
Baby teeth with deep infections are usually treated with pulpotomy, pulpectomy, or extraction. Newly erupted permanent teeth require specialised procedures such as apexogenesis or apexification to support continued root development.
The decision is based not on the child’s age, but on the stage of tooth development and the condition of the pulp. Dental examination and radiographs help determine which treatment is best for preserving your child’s oral health and long-term tooth development.