Treatment of Pulpitis in Children in Barcelona: SEOP 2026 Protocols
What is Pulpitis?
Pulpitis is the inflammation of the pulpal tissue filling the coronal cavity and root canals. According to the 2026 clinical recommendations of the Spanish Society of Paediatric Dentistry (Sociedad Española de Odontopediatría, SEOP), paediatric pulpitis is considered a separate nosological entity, fundamentally different from the adult pathology. The anatomical features of primary teeth in children living in the Catalan region do not differ from European standards: a thin enamel layer (0.3-1.0 mm), wide dentinal tubules, and high pulp vascularization create conditions for the rapid spread of infection. In the practice of the Barcelona-based Corona Dental clinic, the peak in patient visits occurs in children aged 3-9 years, with no statistically significant gender predisposition — the pathology occurs with equal frequency in boys and girls. The process is most often localized in the primary molars of the lower jaw, which is associated with their anatomy and functional load during chewing.
Causes of Development: From Caries to Iatrogenic Factors
The etiology of pulpitis in children in Barcelona corresponds to the European structure, but takes into account local dietary habits. The main cause (87% of cases according to the College of Dentists of Catalonia) is untreated caries, where bacterial flora (Streptococcus mutans, Lactobacillus) penetrates the thinned dentin into the pulp chamber. The second most significant factor is traumatic injuries, including microtrauma from falls, which is especially relevant for active children. The third, less obvious but important factor is iatrogenic impact: tissue overheating during preparation or the toxic effect of certain filling materials without an insulating liner. The 2026 Spanish protocols specifically emphasize the role of delayed consultation: in Barcelona, where quality dentistry is accessible, late diagnosis is often associated not with a lack of medical care, but with parents' insufficient awareness of the importance of primary teeth for the formation of a permanent bite.
Symptoms and Classification: How to Recognize Pulpitis at Different Stages?
The clinical picture of pulpitis in children varies depending on the form and stage of the process. The Spanish classification (adapted from ICD-10) distinguishes acute and chronic forms. Acute serous pulpitis manifests as paroxysmal pain, intensifying in the evening, with the child often unable to pinpoint the causative tooth. In acute purulent pulpitis, a "heat" symptom appears — pain subsides with cold and intensifies with heat, a reaction to percussion occurs, and gum swelling is possible. Chronic fibrous pulpitis presents with scant symptoms: periodic dull pain when eating solid food. Chronic gangrenous pulpitis is characterized by bad breath, a feeling of fullness in the tooth, and a change in crown color. In the practice of clinic, we often encounter situations where parents seek help only at the stage of exacerbation of the chronic process, when the pain becomes unbearable.
Diagnosis in Barcelona: Precision at Every Stage
The SEOP 2026 diagnostic protocol, applied at the clinic, includes several mandatory stages. Initial examination with probing allows assessment of the depth of the carious cavity and the nature of the pain (at the bottom or at the exposed point). Percussion provides information about periodontal involvement. Instrumental diagnosis is mandatory: periapical radiography allows visualization of the depth of the carious defect, the condition of the periodontal ligament space, and, critically, assessment of the stage of root formation. For primary teeth, this determines the degree of root resorption; for permanent teeth, the stage of incomplete apical formation. In complex clinical cases, electro-odontodiagnosis is applied: pulp excitability readings below 25 μA indicate reversible changes; above 50 μA indicate irreversible inflammation or necrosis. Only after a comprehensive diagnosis does the doctor choose the treatment strategy.
Severity Levels and Choice of Treatment Method
The 2026 Spanish protocols clearly differentiate the approach based on the severity and reversibility of the process. In reversible pulpitis (pulp hyperemia, initial inflammation), the biological method is applied: indirect or direct pulp capping with preparations based on calcium hydroxide or MTA (mineral trioxide aggregate), which allows preserving the vitality of the entire pulp. In irreversible pulpitis of primary teeth with unformed roots, the method of choice becomes vital pulpotomy — removal of the coronal portion of the pulp, preserving the root portion and covering it with a therapeutic paste. For fully formed roots of primary or permanent teeth, vital extirpation is indicated — complete removal of the pulp followed by instrumental treatment and canal obturation. At the Dental clinic, we fundamentally do not use devital methods with arsenic-based preparations, which are still found in some Barcelona clinics but are prohibited by SEOP protocols due to their toxicity and risk of periodontal damage.
Canal Filling: Modern Materials for Children's Teeth
Filling root canals in children has fundamental differences from adult endodontics. Primary teeth with forming roots require the use of resorbable pastes based on iodoform and calcium hydroxide (e.g., Metapex, Vitapex), which provide an antiseptic effect and resorb over time synchronously with the roots. Permanent teeth with incomplete apical formation are filled using temporary obturation with calcium-containing materials until root growth is complete, after which permanent obturation with gutta-percha and sealers is performed. At the Corona Dental clinic, we use lateral condensation and thermophilic obturation methods under apex locator control, and обязательно with a subsequent control X-ray to assess the quality of filling along the entire length of the root canal, including the apical part.
Stages of Pulpitis Treatment in Children in Barcelona: A Step-by-Step Protocol
The treatment procedure at the Dental clinic is strictly regulated. The first stage is premedication and adaptation of the child to treatment, using nitrous oxide sedation (conscious sedation) if necessary, or, under strict indications, general anesthesia in a day hospital setting. The second stage is high-quality anesthesia using cartridge anesthetics (4% articaine with epinephrine or mepivacaine without a vasoconstrictor for young children). The third stage is isolation of the operating field with a rubber dam, which is critically important to prevent canal infection by the microflora of the oral fluid. The fourth stage is preparation of the carious cavity, opening the tooth cavity, amputation or extirpation of the pulp. The fifth stage is instrumental treatment of the canals with manual or rotary Ni-Ti files with constant irrigation with antiseptics (3% sodium hypochlorite, 2% chlorhexidine, EDTA for the smear layer). The sixth stage is drying and filling the canals. The seventh stage is restoration of the crown with glass ionomer cement or composite, restoring the anatomical shape and contact points.
Treatment Outcomes in Children and Clinical Results
With high-quality pulpitis treatment at the Dental clinic, we guarantee resolution of the inflammatory process, complete disappearance of pain, and restoration of masticatory function. For primary teeth, the main result is preserving the tooth until physiological exfoliation, which ensures proper formation of the jaw bones, eruption of permanent teeth in the correct position, and normal speech development. Radiological control at 6 and 12 months confirms the absence of destructive foci in the periapical tissues. For permanent teeth with unformed roots, successful treatment allows root formation to complete in a physiological manner. It is important to understand: a treated tooth requires regular monitoring, as quality endodontics is not an endpoint, but a process of long-term follow-up.
Prevention of Pulpitis in Children in Barcelona
Preventive measures recommended by the College of Dentists of Barcelona include three key directions. First, regular check-ups every 4-6 months from the eruption of the first tooth, which allows detecting caries at the white spot stage and performing remineralizing therapy without drilling. Second, professional hygiene and sealing of the fissures of chewing teeth with special sealants, which reduces the risk of caries by 80-90%. Third, control of eating habits: limiting the frequency of carbohydrate consumption, eliminating nighttime feeding with sugary drinks. At the Dental clinic, we train parents in the rules of caring for primary teeth, demonstrating brushing techniques and selecting individual hygiene products. Remember: the health of your child's permanent teeth is established today, and timely care of primary teeth is the best investment in their future smile.
