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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:
To treat pulpitis, a pulpotomy is performed to:
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.
A pulpotomy treatment can be performed by a:
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:
Several conditions may require pulpotomy treatment.
Some of these include:
Your dentist will be able to determine if you need a pulpotomy based on:
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.
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:
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.
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.
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.
While a pulpotomy and root canal help save a tooth’s function and esthetics, they are not the same.
A pulpotomy is when the coronal part of the pulp is cleaned out and disinfected. A root canal treatment is a more invasive endodontic procedure. It will clean out the entire infected pulp of the tooth and roots.
A root canal requires the roots' canals to be instrumented, cleaned, dried, and filled. This prevents any bacteria from entering the tooth.
A pulpotomy is not considered more painful than a traditional filling if you are not already symptomatic or sensitive to hot or cold.
If you have clinical symptoms, sometimes a dentist may recommend an antibiotic to reduce inflammation.
A pulpotomy can be performed on permanent teeth.
It's more likely to have a high success rate in baby teeth. While it can be done in an older permanent tooth, it's less likely to be successful and may require a traditional root canal treatment.
Typically a pulpotomy procedure takes 30 to 45 minutes. However, it can take longer if any complications require additional radiographs.