A therapeutic pulpotomy is a dental procedure that addresses issues within the pulp, the innermost part of a tooth containing nerves and blood vessels. It aims to remove infected or damaged tissue, reduce discomfort, and preserve the tooth’s vitality and function, allowing it to remain in the mouth until it naturally exfoliates or for continued function in permanent teeth.
Understanding the Need
A therapeutic pulpotomy becomes necessary when deep tooth decay or a traumatic injury impacts the pulp tissue. This occurs when a cavity progresses, extending through the outer layers of enamel and dentin to reach the pulp chamber, causing inflammation. Untreated decay can lead to pain and potential infection, requiring intervention.
The procedure is considered when the pulp in the tooth’s crown shows inflammation, but the pulp within the tooth’s roots remains healthy. Signs include persistent tooth pain, sensitivity to hot or cold temperatures, or swelling around the affected tooth. Addressing these issues promptly can prevent more severe infections or the premature loss of a primary tooth, which could affect speech, chewing, and the alignment of permanent teeth.
The Procedure Explained
The pulpotomy procedure begins with a local anesthetic to numb the tooth and surrounding gum tissue, ensuring patient comfort. A rubber dam is then placed around the tooth to isolate it from saliva and maintain a clean, dry environment during treatment. This step helps prevent contamination of the exposed pulp.
The dentist then removes any existing tooth decay and accesses the pulp chamber by drilling through the enamel and dentin. Once open, the inflamed or infected pulp tissue from the crown portion of the tooth is removed using specialized instruments. Bleeding from the remaining pulp stumps in the root canals is controlled within a few minutes, which indicates the health of the remaining pulp.
After the coronal pulp is removed, a biocompatible medicament is applied to the remaining healthy pulp tissue in the root canals. This material helps promote healing and disinfect the area. The pulp chamber is then sealed, and the tooth is restored with a final filling or, for primary teeth, a stainless steel crown to provide strength and protection.
After the Pulpotomy
Following a therapeutic pulpotomy, a child may experience some discomfort or sensitivity in the treated area, which subsides within a few days. Pain can be managed with over-the-counter pain relievers such as acetaminophen or ibuprofen, as directed by the dentist. Applying a cold compress to the outside of the cheek can also help reduce any swelling that might occur in the first 24 to 48 hours.
Parents should closely monitor their child until the effects of the local anesthetic wear off within 2-3 hours, to prevent accidental biting of the numb lip, tongue, or cheek. A soft, cool diet is recommended for the first 24 hours to minimize pressure on the treated tooth and aid in healing. Good oral hygiene, including gentle brushing around the treated area with a soft-bristled toothbrush and regular flossing, is important for healing and preventing further infection.
A final restoration, often a stainless steel crown for primary teeth, is placed to protect the tooth and prevent future breakdown within 10 days of the pulpotomy. Regular follow-up appointments are important to monitor the tooth’s healing and ensure the procedure’s long-term success. Avoiding hard or sticky foods can help extend the lifespan of the treated tooth.
Pulpotomy vs. Root Canal
While both therapeutic pulpotomy and root canal procedures address issues within the tooth’s pulp, they differ in their scope and the extent of pulp tissue removed. A pulpotomy involves the partial removal of the diseased or inflamed pulp from the crown portion of the tooth, leaving the healthy pulp within the root canals intact. This approach aims to preserve the vitality of the remaining root pulp and maintain the tooth’s natural function.
In contrast, a root canal is a more extensive procedure. It involves the complete removal of all pulp tissue from both the crown and the root canals of the tooth. This is necessary when the entire pulp, including that in the roots, is irreversibly infected or necrotic. After the pulp is removed, the root canals are thoroughly cleaned, disinfected, and then filled with a biocompatible material to seal the tooth.
A pulpotomy is performed on primary (baby) teeth to preserve them until they naturally exfoliate, though it can be indicated for young permanent teeth. Root canal therapy is reserved for permanent teeth with extensive pulp damage, aiming to save the tooth for a lifetime. The choice between these procedures depends on the diagnosis, the extent of the infection, and the type of tooth involved.