A pulpotomy is a dental procedure that removes damaged or infected tissue from the upper portion of a tooth’s inner pulp while leaving the healthy tissue in the roots intact. It’s most commonly performed on children’s baby teeth, and it’s sometimes called a “baby root canal,” though it’s less extensive than a true root canal. At roughly $210 compared to over $1,100 for a full root canal, it’s a conservative, cost-effective way to save a tooth that still has healthy tissue at its core.
How a Pulpotomy Works
Every tooth has a soft center called the pulp, which contains nerves and blood vessels. When a cavity gets deep enough, bacteria can reach that pulp and cause inflammation. A pulpotomy removes only the inflamed pulp in the crown of the tooth (the visible part above the gumline) and leaves the healthy pulp in the roots untouched. This preserves the tooth’s living tissue and, in the case of baby teeth, allows the tooth to stay in place until it falls out naturally.
This is different from a pulpectomy, which removes all the pulp from both the crown and the roots. A pulpectomy is essentially a full root canal and is reserved for cases where infection has spread deeper into the tooth. A pulpotomy is the less invasive option, used when the damage is limited to the upper chamber.
Who Needs One
Pulpotomies are most often performed on children’s primary (baby) teeth when a cavity has grown large enough to expose the pulp. The procedure is appropriate when the remaining root tissue is still healthy, with no signs of infection spreading beyond the crown. A dentist will typically consider a pulpotomy when a child’s tooth pain is triggered by something specific, like eating or drinking something cold, and goes away once that trigger is removed. That pattern suggests the inflammation is still reversible.
A pulpotomy is not the right treatment when the tooth shows signs of deeper infection. Red flags include spontaneous pain that comes on without any trigger, swelling in the gums around the tooth, unusual looseness not explained by the tooth getting ready to fall out, or visible signs of bone changes on an X-ray. These symptoms point to irreversible damage, and the tooth typically needs either a pulpectomy or extraction instead.
While less common, pulpotomies are also performed on permanent teeth in certain situations, particularly in younger patients whose tooth roots haven’t finished developing. Keeping the remaining pulp alive allows the root to continue growing to its full length, which strengthens the tooth long-term.
What Happens During the Procedure
The dentist numbs the area around the tooth, and in some cases, especially with young children, sedation may be used. Once the area is numb, the dentist removes the decay to access the pulp chamber. The inflamed pulp tissue in the crown is carefully removed, and the dentist checks that the remaining tissue in the roots looks healthy, with normal bleeding that stops within a few minutes. If the bleeding doesn’t stop or there are signs of deeper infection, the dentist may need to shift to a more extensive procedure.
After the damaged pulp is removed, a medicated material is placed over the remaining healthy tissue to promote healing and prevent further infection. The tooth is then sealed, and in most cases a stainless steel crown is placed over a baby tooth to protect it until it naturally falls out.
Materials Used to Protect the Pulp
The material placed over the remaining pulp tissue matters for long-term success. For decades, a formaldehyde-based solution called formocresol was the standard. It works, but concerns about its toxicity and potential to affect developing permanent teeth underneath have pushed dentistry toward newer options.
A biocompatible cement called mineral trioxide aggregate (MTA) has largely replaced formocresol in modern practice. A systematic review and meta-analysis found that MTA produced significantly better overall success rates compared to formocresol, with roughly 3.5 times higher odds of a successful outcome across all studies. At the one-year mark the two materials performed comparably, but over longer follow-up periods MTA pulled ahead. MTA creates a biological seal over the pulp tissue and is well tolerated by the body, making it the preferred choice in most pediatric dental offices today.
Recovery After a Pulpotomy
Recovery is straightforward. If only local numbing was used, the main concern is waiting a few hours for the numbness to wear off before eating, so your child doesn’t accidentally bite their cheek or tongue. If sedation was involved, plan for your child to take it easy for the rest of the day, as the sedation effects can linger for up to 24 hours.
Some mild soreness around the tooth is normal for a day or two. Most children return to their regular routine the next day. The crowned tooth functions like a normal tooth and doesn’t require any special care beyond regular brushing and flossing.
How Well Pulpotomies Hold Up
Pulpotomies have high success rates, especially when the tooth is properly selected for the procedure and modern materials are used. The goal for a baby tooth is simply to keep it healthy and in place until the permanent tooth is ready to come in, which could be anywhere from a few months to several years depending on the child’s age.
The most common reason a pulpotomy fails is that some chronically inflamed tissue was left behind in the roots without being detected. This lingering inflammation can trigger a process called internal root resorption, where the body slowly breaks down the root from the inside. It’s relatively rare, but it’s why follow-up X-rays are important. Other signs of failure include new swelling, a pimple-like bump on the gums near the treated tooth, or recurring pain. If a pulpotomy does fail, the tooth typically needs extraction.
Pulpotomy vs. Root Canal: Cost and Scope
Based on the 2020 American Dental Association fee survey, a pulpotomy averages around $210, while a full root canal on a permanent tooth averages about $1,109. That’s roughly a fivefold difference. An extraction, for comparison, comes in around $190. The cost difference reflects the scope of work: a pulpotomy is a quicker, more limited procedure that preserves the tooth’s living root tissue, while a root canal removes all the pulp and requires the empty canals to be filled and sealed.
For baby teeth, a pulpotomy is almost always preferred over extraction when the tooth can be saved. Removing a baby tooth too early can cause the surrounding teeth to shift, creating spacing problems for the permanent teeth coming in later. The pulpotomy keeps the tooth functioning as a natural space-holder, which is one of its biggest practical advantages beyond just relieving pain.