Pulpotomy

What is a Pulpotomy?

A pulpotomy is a common dental procedure used in pediatric dentistry. It's used to help save primary or permanent teeth that are severely decayed or cracked.

When a tooth has a carious exposure deep enough to affect the coronal pulp or “nerve” of the tooth, it can lead to pulpitis.

Pulpitis is a condition where the pulp's inflammation can lead to:

• Pain
• Sensitivity to hot or cold
• Discomfort when chewing.

To treat pulpitis, a pulpotomy is performed to:

• Remove the tooth's dental pulp
• Quickly relieve pain
• Avoid a potential dental infection 

Kids and Adults

A pulpotomy leaves the roots of a tooth healthy and able to grow. As such, the procedure is primarily used in children with baby (primary teeth). These teeth have an immature root formation.

Baby teeth allow for spacing for the permanent teeth that will follow the procedure. Leaving them intact is usually a priority.

Studies have shown that a pulpotomy can also be used in adults and children with secondary teeth.7 This is as long there is enough healthy pulp within the tooth.

Pulpotomy Procedure Steps

A pulpotomy treatment can be performed by a:

• General dentist
• Endodontist
• Pediatric dentist

The dental professional performing the pulpotomy treatment depends on the patient's age and the tooth being treated.

The pulpotomy technique involves the following steps:

1. Dental x-ray — A dental x-ray of your tooth is necessary to evaluate the need for a pulpotomy and to see if decay is in the pulp. It will also help rule out the need for a pulpectomy if you have bone and tissue loss.
2. Local anesthetic — Your dentist will numb the area to avoid discomfort during the procedure.
3. Isolation — Many dentists use an isolation device to prevent contamination of blood or saliva into the infected tooth. This may include an intraoral suction device or rubber dam to separate the tooth from the rest of the mouth.
4. Removal of decay — The decayed area of the tooth will be removed until the pulp is exposed. Once the pulp chamber is exposed, the coronal pulp will be amputated. A cotton pellet using ferric sulfate or formocresol will be used to help control bleeding.
5. Sealing the tooth — The infected pulp will be scooped out and the remainder of the tooth sealed with pulpotomy medicaments like mineral trioxide aggregate (MTA) or calcium hydroxide. Clinical studies show that MTA is a biocompatible material used to restore tooth structure and bone.³ It has a high success rate when used in endodontic treatments. 
6. Full coverage — Many patients require a final restoration like a stainless steel crown to protect the tooth. This also helps maintain stability and support if the tooth is weakened or prone to fracture. 

When is a Pulpotomy Necessary?

Several conditions may require pulpotomy treatment.

Some of these include:

• Deep dental caries that has a pulp exposure during a traditional filling
• Pain on a vital tooth that is severely decayed
• Trauma to a tooth that exposes the pulp
• Large amalgam or composite resin restorations that fail
• Cracked tooth syndrome 

Your dentist will be able to determine if you need a pulpotomy based on:

• Your clinical symptoms
• Your x-rays
• A dental evaluation

Who is a Good Candidate?

A good candidate is someone with a tooth with a deep cavity and inflamed pulp. It should be able to heal with the pulpotomy and a medicated filling applied to seal the tooth. This filling also helps to avoid any bacterial contamination.

If the surrounding tissue and bone are affected, a pulpotomy is not a good treatment option. The tooth will require a pulpectomy or dental extraction to avoid pain and infection.

It's also important to treat patients who are in good health to avoid potential bacterial infections.

Patients with chronic inflammatory conditions or cancer may not be a good candidate for a pulpotomy.  

Pulpotomy vs. Pulpectomy

The goal of both a pulpotomy and pulpectomy is to save the tooth and maintain it for function and esthetics. There are a few differences between the treatments depending on the tooth’s condition and a person’s clinical symptoms. 

A pulpotomy will remove the coronal or top portion of the pulp of the tooth.

The coronal pulp is the part above the gumline.

A pulpectomy is a similar dental procedure. However, instead of simply removing the coronal pulp, it removes the infected pulp from all tooth parts. This is including from the pulp chamber and roots. 

A pulpotomy is performed on teeth that are still “alive.”

This means there is no:

• Abscess or fistula
• Radiographic evidence of bone loss under the roots
• Spontaneous pain

This is why a pulpotomy is also known as a "vital pulp therapy." It's essentially restoring a tooth to its healthy state.

A pulpectomy is completed for teeth that are considered necrotic or dead.

This condition is when a tooth experiences spontaneous pain and bone loss. It's known as irreversible pulpitis.

Both procedures attempt to help restore a tooth to its natural function as an alternative to dental extraction. 

Pulpotomy Recovery Timeline & Tips

You can expect to experience temporary bleeding, swelling, and numbness for a few hours following the procedure. Many dentists recommend over-the-counter pain relievers like ibuprofen or acetaminophen.

It's also recommended to avoid eating until numbness resolves to avoid biting your lip or cheek. If you experience these symptoms longer than 48 hours, you should follow up with your dentist or endodontist. 

How Much Does a Pulpotomy Cost?

Most dental insurances cover portions or the entire pulpotomy procedure. This will lower your out-of-pocket cost.

You can expect a pulpotomy to cost $10 to $350 without any dental insurance.

Common Questions and Answers