Pulpotomy Procedure

A pulpotomy (pulp cutting) is a common procedure in pediatric dentistry. It’s often used to save baby teeth that are severely decayed or cracked.

The pulp is the “living” part of a tooth, containing many nerves and blood vessels. If a tooth has a cavity deep enough to reach the pulp, it can lead to significant pain and sensitivity.

The goal of a pulpotomy is to remove the inflamed pulp while keeping the tooth “alive.” This means only the coronal pulp (in the tooth’s crown) is removed, while the roots aren’t affected. Once the pulp is gone, the tooth is sealed, and a crown is placed on top of it.

How Does a Pulpotomy Affect Baby and Adult Teeth?

Although a pulpotomy is sometimes called a “baby root canal,” it doesn’t affect the tooth roots. A pulpotomy leaves the roots of a tooth healthy.

It’s usually a priority to preserve the pulp tissue in the roots of baby teeth. The baby teeth are placeholders for the permanent teeth to emerge in the future.

In adults, all permanent teeth have already come in, so a complete root canal treatment may not cause any problems. However, permanent teeth with enough healthy pulp can have pulpotomies performed, keeping the root pulp intact.

What are the Steps of a Pulpotomy Procedure?

A pulpotomy can be performed by a general dentist, endodontist, or pediatric dentist. The dental professional performing the pulpotomy treatment may depend on your child’s age and the location of the tooth being treated.

The pulpotomy technique involves the following steps:

• Dental X-ray — An X-ray of the tooth is necessary to evaluate the pulp. It will also help rule out the need for a complete pulpectomy or extraction.
• Local anesthetic — Your dentist will numb the area to avoid discomfort during the procedure.
• Isolation — Many dentists use an isolation device to prevent blood or saliva from contaminating the tooth. This may include an intraoral suction device or rubber dam.
• Removal of decay — The decayed area of the tooth will be removed until the pulp chamber is exposed. The dentist will then amputate the coronal pulp.
• Sealing the tooth — The tooth will be sealed with mineral trioxide aggregate (MTA) or calcium hydroxide.
• Full coverage — A final restoration, such as a stainless steel crown, will likely be needed to protect and support the tooth, especially if it is weakened or prone to fracture.

What is Pulpotomy Recovery Like?

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 (Advil) or acetaminophen (Tylenol).

It’s also recommended to avoid eating until you’re no longer numb to avoid biting your lip or cheek. If you experience symptoms for more than 48 hours after a pulpotomy, you should follow up with your dentist or endodontist. 

What are the Benefits of Pulpotomy?

Pulpotomy can help prevent more serious dental issues down the road, including:

• Infection — Pulpotomy removes infected pulp tissue, preventing the spread of infected tissues to the surrounding teeth.
• Premature tooth loss — Saving baby teeth can prevent complications associated with premature tooth loss, such as misalignment and chewing or speech problems.
• Invasive procedures —  Removing infected pulp can prevent the need for more invasive procedures like extractions or root canals in the future.

When is a Pulpotomy Necessary?

A dentist can determine whether someone needs a pulpotomy using X-rays and evaluations. A pulpotomy may be recommended for the following:

• Tooth decay, dental trauma, or a filling that exposes the pulp chamber
• Large amalgam or composite resin restorations that fail
• Cracked tooth syndrome

These conditions can cause significant pain and tooth sensitivity. They may lead to irreversible pulpitis and eventually an abscess if left untreated.

Who is a Good Candidate for Pulpotomy?

You may be a good candidate for a pulpotomy if your tooth is significantly damaged or decayed but still has some remaining healthy pulp. It’s typically not a good option if there isn’t any viable pulp left or if the surrounding tissues are affected.

The infected tooth will require a pulpectomy (root canal) or dental extraction. This is mainly used to avoid further pain and complications. 

People with chronic inflammatory conditions or cancer may not be good candidates for a pulpotomy. This is because they have a weaker immune system, and the procedure could lead to an infection.  

How Much Does a Pulpotomy Cost?

Most dental insurance policies offer full or partial coverage for pulpotomies. This will lower your out-of-pocket cost.

Without insurance, you can expect a pulpotomy to cost between $80 and $350. X-rays, fillings or crowns, and other additional procedures may make the total cost higher.

Pulpotomy vs. Pulpectomy

Pulpotomies and pulpectomies both aim to save the structure of the tooth. The key difference is that a pulpotomy preserves some of the tooth pulp, restoring a tooth to its healthy state.

A pulpectomy, on the other hand, is part of root canal therapy. It’s performed for teeth that are considered necrotic or dead. The pulp is removed from the canal(s) before the tooth is sealed and restored.

Both procedures allow a tooth to maintain its function and esthetics, eliminating the need for tooth extraction.