Pulpotomy

What is a Pulpotomy?

A pulpotomy is a common dental procedure used in pediatric dentistry to help save primary or permanent teeth that are severely decayed or cracked. When a tooth has a carious exposure deep enough that it affects 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, and discomfort when chewing.

To treat pulpitis, a pulpotomy is performed to remove the tooth's dental pulp, quickly relieve pain, and avoid a potential dental infection. 

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 that is present above the gumline. In comparison, a pulpectomy is a similar dental procedure, but instead of simply removing the coronal pulp, it will remove the infected pulp from all parts of the tooth, including the pulp chamber and roots. 

A pulpotomy is performed on teeth that are still “alive.” This means there is no abscess or fistula, no radiographic evidence of bone loss under the roots, and no spontaneous pain. This is why a pulpotomy is also known as a “vital pulp therapy” because it is 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 and is known as irreversible pulpitis. Both procedures attempt to help restore a tooth to its natural function as an alternative to a dental extraction. 

When is a Pulpotomy Necessary?

Several conditions may require pulpotomy treatment. Your dentist will be able to determine if you need a pulpotomy based on your clinical symptoms, your x-rays, and a dental evaluation. 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 

Who is a Good Candidate?

Pulpotomies are traditionally performed on primary molars and are known as “baby root canals,” but it can also be done on adult teeth. A good candidate is a tooth with a deep cavity and inflamed pulp that is capable of healing with the pulpotomy and a medicated filling applied to seal the tooth and avoid any bacteria contamination. Once 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 is important to also 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 Procedure Steps

A pulpotomy treatment can be performed by a general dentist, endodontist or pediatric dentist depending 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 will be needed to evaluate the need for a pulpotomy and to visualize 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 will use an isolation device to avoid contamination of blood or saliva into the infected tooth. This may include an intraoral suction device or rubber dam to isolate 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 and has a high success rate when used in endodontic treatments. 
6. Full coverage: Many patients will require a final restoration like a stainless steel crown to protect the tooth and help maintain the stability and support if the tooth is weakened or prone to fracture. 

Pulpotomy Recovery Timeline & Tips

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

Common Questions and Answers