Pediatric Dentistry in Barcelona: Modern Protocols and Safety
A child's dental health is the foundation for the proper development of their dentofacial system and overall well-being. In Spain, and especially in Barcelona, some of the strictest protocols in pediatric dentistry are applied, in line with the standards of the European Academy of Paediatric Dentistry (EAPD). Many parents mistakenly believe that treating baby teeth is unnecessary because they are temporary. However, according to data from the Official College of Dentists of Catalonia (COEC), untreated caries in primary teeth is the main cause of damage to the permanent tooth germs in children under 7 years of age. The infectious process quickly spreads to the bone tissue, causing the development of cysts or disrupting the enamel mineralization of permanent teeth. At our clinic, «Corona Dental», we strictly follow Spanish protocols for 2026 to keep every tooth alive and healthy. The first consultation always includes an examination and the creation of a prevention plan, even if the teeth appear healthy at first glance. We pay special attention to the earliest age: the first visit is recommended at 1 year old, when the first teeth erupt. This not only allows us to assess the situation but also helps build a positive attitude towards the dentist in the child.
The Most Common Problems: From Baby Bottle Caries to Enamel Hypoplasia
In our daily practice, we encounter various diseases, many of which are age-specific. In children under 2-3 years, we often diagnose so-called baby bottle caries (early childhood caries). It develops due to prolonged contact of sugary drinks (juices, compotes, milk) with the enamel, especially if the child falls asleep with a bottle. It primarily affects the upper front teeth. Another common pathology is enamel hypoplasia, a congenital underdevelopment of dental tissues. It manifests as white or yellowish spots, pits, or grooves on newly erupted teeth. Unlike caries, hypoplasia does not always require immediate filling if the surface is smooth, but it does need dynamic monitoring and meticulous hygiene. In destructive forms, where the enamel is absent or destroyed, the only correct solution is aesthetic restoration with composite materials or protection with a crown. In any case, upon noticing a spot on a child's tooth, it is important not to self-diagnose but to consult a specialist. Often, parents confuse initial caries and hypoplasia, and the treatment methods for these conditions are radically different.
Pulpitis in Children: A Hidden Threat and Its Accurate Diagnosis
Pulpitis is the inflammation of the neurovascular bundle, the pulp, inside the tooth. In children, this process is insidious: due to structural features — wide dentinal tubules and a loose connective tissue structure — it develops rapidly and is often asymptomatic until the infection reaches the root system. In Barcelona, a classification by severity is accepted: acute serous pulpitis (reversible), acute purulent pulpitis (irreversible), and chronic fibrous pulpitis. The main cause is advanced caries, less often trauma. If your child complains of a dull ache for no apparent reason, or if pain occurs with sweet or cold stimuli and disappears after the stimulus is removed, this may indicate an initial stage. You should also be alert to bad breath or if the child starts chewing on one side. Diagnosis at our facility always includes visiography — a digital X-ray with minimal radiation exposure. In complex cases, when periodontitis or a cyst is suspected, cone beam computed tomography (CBCT) is performed for a three-dimensional assessment of the roots and surrounding tissues. To detect caries at its earliest stages, we also use laser fluorescence (Diagnodent device), which is especially important when planning treatment without drilling.
Modern Protocols for the Treatment of Pulpitis in Children
The therapeutic approach depends on how deep the process has gone and whether the tooth is primary or permanent. In 2026, in Catalonia, the standard for treating pulpitis in primary teeth is the method of vital amputation or pulpotomy. It is a gentle technique where only the coronal part of the pulp (the infected part) is removed, while the radicular part remains vital. A biocompatible material is applied to the stump. We use both classic Biodentine and its modern analogues, such as Pulpotec, which stimulate the formation of secondary dentin and hermetically seal the entrance to the root canals, preventing the spread of infection. The procedure is performed under local anesthesia: first, a topical gel with benzocaine is applied to the gums to make the injection completely painless, then the anesthetic is administered using ultra-thin 30G needles (carpule syringes). It is important to know: we strongly advise against using gels containing lidocaine (e.g., Kalgel, Kamistad) to soothe teething in infants, as they can cause heart rhythm disturbances and convulsions. For these purposes, there are safe plant-based products or special teethers. The stages of pulpitis treatment include preparation of the carious cavity, amputation of the pulp, placement of a pulp dressing (Biodentine/Pulpotec) and an insulating liner, followed by restoration of the coronal part with a light-cured composite.
For permanent teeth in children with immature roots, more complex protocols are applied aimed at preserving root growth: the vital extirpation method using MTA (Mineral Trioxide Aggregate) or Biodentine. These materials ensure a hermetic seal of the apical foramen. In irreversible forms of pulpitis, such as acute purulent, complete removal of the pulp (extirpation) is performed. This is followed by thorough mechanical and chemical preparation of the canals under the control of an apex locator, which determines the length of the root canal with fraction-of-a-millimeter precision, critical in children. Canal filling is performed with materials based on calcium hydroxide (to stimulate root growth) or gutta-percha (for formed roots). We perform all endodontic procedures using an operating microscope, which guarantees the highest precision and allows us to save even the most challenging teeth. The treatment of periodontitis in children requires an even more meticulous approach, as the infection has already spread beyond the root apex, and here the microscope and CBCT are essential conditions for success.
Innovative Methods: Treatment Without Drilling and Fissure Sealants
Not all cases require a drill. For superficial caries at the white spot stage, especially in children and adolescents, we successfully apply the ICON infiltration method. It is a "treatment without drilling" technology: a special gel dissolves the superficial enamel layer in the spot area, after which a liquid polymer infiltrant is applied, which "seals" the porous enamel and stops the caries progression. The procedure is quick, painless, and requires no anesthesia. However, the method is only effective at the earliest stage, which is why regular check-ups are so important. Another crucial preventive procedure is fissure sealing. The deep natural grooves (fissures) on chewing teeth are ideal places for plaque accumulation. Invasive and non-invasive sealing with special flowable composites allows us to close these "traps" and reduce the risk of caries by up to 80%. This procedure is especially relevant for children aged 5-6 (first permanent molars) and 11-13 (premolars and second molars). In combination with professional cleaning and remineralizing therapy (fluoridation, calcium applications), fissure sealing creates a reliable barrier against caries for many years.
Restoration and Prevention: The Final Stage and Home Care
Once the infection is eliminated, it is critical to properly restore the anatomical shape of the tooth. For the chewing tooth group in children, the optimal choice is often metal crowns (nickel-chromium or stainless steel), especially after pulpitis treatment, as the tooth becomes more fragile. This is the standard recommended by the American Academy of Pediatric Dentistry and accepted in Spain. The crown is cemented in a single session with a special cement (e.g., Fuji) without aggressive preparation, which allows for complete preservation of the remaining tooth structure. For the frontal group, the front teeth, we use zirconia crowns, which have ideal translucency and biocompatibility, or highly aesthetic restorations with light-cured composites using a layering technique to mimic natural enamel. In cases where the tooth cannot be saved and extraction is necessary, we always discuss with parents the options for pediatric prosthetics (temporary appliances) to avoid the shifting of adjacent teeth and malocclusion issues. Missing teeth, especially in the anterior region, can lead not only to aesthetic discomfort but also to speech impediments, as well as improper jaw development and gastrointestinal problems due to poor chewing.
The treatment outcome is monitored at 3, 6, and 12 months. The follow-up program always includes a visual assessment of the marginal seal of the filling and radiographic control to evaluate the condition of periapical tissues. However, the main success factor is proper home care. Even if the child brushes their teeth on their own, parents must assist or re-brush until the age of 7-8, using manual or electric toothbrushes with pressure control. In Barcelona, with its mild climate and accessibility to seafood (which can be high in fluoride), it is important to monitor the fluoride levels in drinking water to avoid fluorosis. Therefore, we only make any prescriptions after a thorough diagnosis and analysis of the child's lifestyle. Remember: healthy baby teeth are the guarantee of a beautiful smile and proper digestion for your child in adulthood. Regular visits to the dentist (the recommended interval is every 3-4 months) will help identify problems at their earliest stage and solve them in the most comfortable way.
