A pulpotomy is a restorative dental procedure performed on primary (baby) teeth when deep decay has reached the innermost chamber. The procedure involves carefully removing the infected pulp tissue while preserving the healthy parts of the tooth’s interior. This intervention allows the damaged tooth to remain functional until it naturally falls out.
Understanding the Need for Pulp Treatment
A primary tooth is structured with three main layers: the hard outer enamel, the underlying dentin, and the soft center known as the pulp. The dental pulp is a network of blood vessels and nerves that extends from the crown, the visible part of the tooth, down into the roots. When decay progresses through the enamel and dentin, bacteria can eventually reach and infect the pulp chamber, leading to inflammation.
A pulpotomy becomes necessary when the infection causes irreversible pulpitis, meaning the inflammation in the coronal pulp tissue cannot be healed. If the infection were mild and reversible, a simple filling might suffice. The goal of this treatment is to eliminate the infection in the crown while maintaining the vitality of the pulp tissue within the root canals. Retaining the tooth until its natural exfoliation helps maintain the necessary space for the permanent tooth to erupt correctly.
Baby teeth act as natural space maintainers for the developing permanent teeth. Removing the primary tooth too early can lead to shifting of surrounding teeth, potentially causing alignment issues for the adult dentition. A pediatric dentist determines the need for a pulpotomy after assessing the extent of the decay, often using a dental X-ray to confirm the infection has not spread into the root canals. The tooth must also be structurally sound enough to be restored after the procedure.
The Pulpotomy Procedure Explained
The pulpotomy procedure begins with the administration of a local anesthetic to numb the area. Once the tooth is numb, the dentist isolates the treatment area, typically using a thin sheet of rubber called a dental dam. Isolation prevents contamination from saliva and protects the airway from debris during the procedure.
The dentist carefully removes all decay from the tooth structure before creating an opening to access the pulp chamber. Specialized instruments are used to remove only the infected or inflamed pulp tissue located within the crown. The healthy pulp tissue inside the root canals is intentionally left undisturbed during this step.
After the coronal pulp is removed, the remaining pulp tissue at the opening of the root canals is assessed for health, which is often indicated by controlled bleeding. A medicament, such as Mineral Trioxide Aggregate (MTA) or formocresol, is then applied directly onto the remaining healthy root pulp. This material works to disinfect the tissue and encourage stabilization and healing of the preserved pulp below.
This step distinguishes a pulpotomy from a pulpectomy, or full root canal, where all pulp tissue, including the nerve tissue in the root canals, is removed. Once the medicament is placed, the pulp chamber is sealed with a restorative material. This process is focused on preserving the living tissue in the roots, making it a less invasive option than a complete pulpectomy.
Post-Procedure Care and Expected Outcome
Following the pulpotomy, the tooth must be immediately restored to protect the remaining structure and seal the treatment area from bacteria. A full-coverage crown, typically a pre-formed stainless steel crown, is required for restoration. The crown provides a strong, durable seal and prevents the tooth from fracturing, which can easily happen after the removal of internal tooth structure.
The patient may experience mild discomfort or tenderness in the treated area once the local anesthetic wears off. This discomfort is usually managed effectively with over-the-counter pain relievers, such as ibuprofen or acetaminophen, following the dentist’s instructions. Patients should avoid chewing on the treated side until the numbness has completely disappeared to prevent accidental biting of the cheek or tongue.
The tooth should remain functional and asymptomatic until the permanent tooth naturally erupts and replaces it. Success is measured by the absence of pain, swelling, or signs of re-infection in the surrounding gum or bone tissue. Parents should monitor the area for signs of potential failure, such as persistent pain, facial swelling, or the development of an abscess, which would necessitate extraction.