The dental pulp is the soft tissue deep inside every tooth, containing the nerves, blood vessels, and connective tissue. When this tissue is severely damaged by decay or trauma, inflammation and infection can quickly follow. Such extensive infection requires immediate endodontic intervention to save the tooth structure. A pulpectomy is a specific dental procedure designed to thoroughly clean and preserve a compromised tooth when the infection has reached its innermost core.
What Exactly Is a Pulpectomy?
A pulpectomy is an endodontic procedure involving the complete removal of infected or diseased dental pulp. This tissue is extracted from the pulp chamber (in the crown) and the entire length of the root canals. The procedure’s goal is to eliminate bacteria and prevent the infection from spreading into the surrounding bone and gums. This comprehensive cleaning and disinfection is necessary for maintaining the tooth.
This treatment is almost exclusively performed on primary, or “baby,” teeth in children. After the pulp is removed, the root canals are filled with a medicated material. This material is designed to be resorbable, meaning it dissolves naturally over time. This allows the primary tooth root to resorb normally as the permanent tooth prepares to erupt underneath it.
When Is This Procedure Necessary?
A pulpectomy is necessary when deep dental decay or traumatic injury causes irreversible damage to the entire pulp tissue. This damage often presents as irreversible pulpitis or a necrotic pulp, where infection has spread throughout the root canal system. A dentist recommends this procedure when an abscess or other signs of infection are present at the root tip of a primary tooth. The procedure is performed only when the tooth is restorable and not yet close to its natural exfoliation time.
Maintaining the primary tooth is important because it acts as a natural space holder for the permanent tooth developing beneath the gums. Premature loss of a baby tooth can cause adjacent teeth to shift, leading to alignment problems like crowding for the permanent teeth. By saving the infected primary tooth, the pulpectomy ensures proper chewing function and speech development until the permanent successor is ready to emerge.
Key Differences from Other Pulp Treatments
The terms for pulp therapy procedures relate directly to the extent of the infection within the tooth. A pulpectomy involves the total removal of all pulp tissue from the crown and the roots. This is more extensive than a pulpotomy, which is a less invasive procedure. A pulpotomy removes only the infected pulp in the crown portion of the tooth, leaving the healthy pulp within the root canals intact. This partial removal is only possible when the infection is limited to the upper part of the tooth.
The main difference between a pulpectomy and root canal therapy (often performed on permanent teeth) lies in the final filling material. Both procedures remove all the pulp from the root canals. However, a root canal uses a permanent, non-resorbable material to seal the canals indefinitely. In contrast, the pulpectomy utilizes a resorbable material, such as zinc oxide eugenol or an iodoform-based paste. This resorbable filling allows the tooth’s root to be naturally dissolved by the body, avoiding interference with the eruption path of the underlying permanent tooth.
The Treatment Process and Recovery
The pulpectomy procedure begins with the administration of local anesthesia to ensure patient comfort. The dentist creates a small access opening through the top of the tooth to reach the infected pulp chamber. Specialized instruments are then used to carefully clean out and remove all diseased pulp tissue from the chamber and the entire length of the root canals.
Once the canals are thoroughly cleaned and disinfected, they are filled with the chosen resorbable medicated material. The goal is to completely fill the space, creating a seal to prevent re-infection while allowing the material to break down as the tooth’s root naturally resorbs. The treated tooth is then restored, typically with a stainless steel crown, which provides necessary strength and protection for the weakened tooth structure.
Following the procedure, patients may experience minor soreness and sensitivity for a few days. The numbness from the local anesthetic wears off within a couple of hours, and patients should avoid chewing until sensation returns completely. Soft foods are recommended for a brief period, and regular brushing and flossing should be resumed gently. The saved primary tooth will continue to function normally until it loosens and falls out naturally.