The 22-year-old male patient had a history of trauma to his maxillary incisors and arrived at my practice with symptoms related to tooth #21. The tooth, opened in an emergency by the patient’s mother, was tender when prodded, with a moderate level of sensitivity on the respective buccal gingiva. Sensitivity tests were negative for the other central incisor (tooth #12 was positive), and a periapical radiograph showed radiolucency in the periapical areas of both of the central incisors. The apices of these teeth were quite wide and the length of teeth appeared to exceed 25 mm.

My treatment plan was as follows: root canal therapy with two apical plugs with a calcium silicate-based bioactive cement. The patient provided his consent for the treatment of the affected tooth and asked to have the other treated in a subsequent visit.

After isolating with a rubber dam, I removed the temporary filling, and then the entire pulp chamber roof with a low-speed round drill. The working length was immediately evaluated using an electronic apex locator and a 31 mm K-type file. The working length was determined to be 28 mm.

As can be seen in the photographs, the canal was actually quite wide, so I decided to only use an irrigating solution and not a shaping instrument. Root canals are usually shaped so that there will be enough space for proper irrigation and a proper shape for obturation. This usually means giving these canals a tapered shape to ensure good control when obturating. With open apices, a conical shape is not needed, and often there is enough space for placing the irrigating solution deep and close to the apex.

I decided to use only some syringes containing 5 per cent sodium hypochlorite and EDDY, a sonic tip produced by VDW, for delivery of the cleaning solution and to promote turbulence in the endodontic space and shear stress on the canal walls in order to remove the necrotic tissue faster and more effectively. After a rinse with sodium hypochlorite, the sonic tip was moved to and from the working length of the canal for 30 seconds. This procedure was repeated until the sodium hypochlorite seemed to become ineffective, was clear and had no bubbles. I did not use EDTA, as no debris or smear layer was produced.

I suctioned the sodium hypochlorite, checked the working length with a paper point and then obturated the canal with a of 3 mm in thickness plug of bioactive cement. I then took a radiograph before obturating the rest of the canal with warm gutta-percha. I used a compomer as a temporary filling material.

The symptoms resolved, so I conducted the second treatment only after some months, when the tooth #11 became tender. Tooth #21 had healed. I performed the same procedure and obtained the same outcome (the four-month follow-up radiograph showed healing).

Editorial note: A complete list of references are available from the publisher. This article was published in roots - international magazine of endodontology No. 04/2017.

ORDO, working alongside the Dental Wellness Trust and the Oral Health Foundation, argues that children’s oral care products are essential items and should be treated in the same way as other zero-rated necessities such as children’s clothing and nappies. The fact of millions of children growing up in relative poverty leads campaigners to say that the current 20% VAT places unnecessary financial strain on households and contributes to widening health inequalities.

New survey data commissioned by ORDO in October 2025 among 2,000 parents in the UK reveals strong public backing for reform. A large majority believe children’s toothbrushes and toothpaste should be VAT-exempt, while half of parents report that the cost of these products has become unaffordable. Almost half say their children have needed medical attention for an oral health issue in the past year, underlining the scale of the problem.

The campaign, called Teeth of Tomorrow, comes against a stark public health backdrop. Government figures show that dental caries remains one of the most common chronic conditions among children, leading to pain, missed school days and long-term health consequences. Hospital admissions for caries continue to place pressure on the NHS, and clear regional disparities arise, as areas such as London and the North West are affected most severely.

To drive change, ORDO has brought together dental professionals, charities and local authorities, and launched a national petition calling on the government to remove VAT from children’s oral hygiene products. The petition aims to secure 10,000 signatures, the threshold required to trigger an official government response.

Commenting on the campaign and the accompanying petition, Barty Walsh, founder and CEO of ORDO, stated that: “ORDO is proud to unite this passionate collective to spotlight a growing issue affecting families nationwide—and to launch a petition calling for meaningful change. The stories we’ve heard from dental professionals, charities and local authorities underline the urgency of the situation: Too many families are struggling to access essential oral care products. Every child deserves the basic tools for a healthy start in life. Oral care isn’t a luxury—it’s a necessity.”

Echoing these remarks, Dr Linda Greenwall, founder of the Dental Wellness Trust charity, commented that: “Preventable dental caries remains the leading reason for hospital admissions among children in the UK. This is a public health challenge that disproportionately affects our most vulnerable families, deepening health inequalities. Poor oral health often leads to significant pain and discomfort for children, impacting their ability to eat, sleep and concentrate at school, and for many leading to a loss of confidence that can affect their social development and wellbeing. Removing VAT from essential oral hygiene products would be a hugely impactful step, and it’s clear that there is overwhelming public support for this move.”

The campaign highlights a clear opportunity for government action to reduce health inequalities and prevent avoidable suffering among children. Removing the tooth tax would be a simple, popular step towards giving every child a fair and healthy start in life.

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