Pulp therapy is a dental procedure designed to preserve a tooth that has experienced damage or infection in its innermost soft tissue. It addresses issues within the tooth’s core, aiming to save the natural tooth structure rather than requiring extraction.
The Tooth’s Inner Core
Each tooth contains a soft inner core known as the dental pulp. This pulp is a complex living tissue, composed of nerves, blood vessels, and connective tissue. It extends from the pulp chamber within the tooth’s crown down through narrow root canals to the tips of the roots.
The dental pulp is vital for tooth health. Its blood vessels provide nutrients and oxygen to the surrounding dentin. The nerves within the pulp sense temperature changes, pressure, and pain. Additionally, the pulp contributes to new dentin formation, aiding in tooth repair.
When Pulp Therapy Becomes Necessary
Pulp therapy becomes necessary when the dental pulp experiences inflammation or infection, a condition often referred to as pulpitis. The most frequent cause of pulp damage is deep tooth decay, where bacteria from cavities penetrate the hard outer layers of enamel and dentin, reaching the vulnerable pulp tissue. Trauma to a tooth, such as a chip, crack, or fracture, can also expose the pulp to bacteria and irritation. Repeated dental procedures on the same tooth can sometimes contribute to pulp stress, leading to inflammation.
Individuals experiencing pulp damage may notice symptoms such as persistent toothache. Heightened sensitivity to hot or cold temperatures, particularly if the pain lingers, is another sign. Other symptoms include pain when biting or chewing, or swelling around the affected tooth or gums.
Different Approaches to Pulp Therapy
When the dental pulp is affected, dentists determine the appropriate treatment based on the extent of the damage and whether the pulp is still viable. Two primary approaches to pulp therapy are pulpotomy and pulpectomy, differing in how much of the pulp tissue is removed. The choice of procedure also depends on factors like the patient’s age and whether the tooth is primary (baby) or permanent.
A pulpotomy involves removing only the infected pulp tissue in the crown, leaving healthy pulp in the root canals. This procedure is recommended when inflammation is confined to the coronal pulp, often due to deep cavities or minor trauma. Pulpotomies are performed on primary teeth to maintain function until natural exfoliation, preserving space for permanent teeth. It can also be performed on young permanent teeth with developing roots.
Conversely, a pulpectomy is a more extensive procedure where the entire pulp, including both coronal and radicular portions, is removed. This treatment is indicated when pulp damage is irreversible or the pulp tissue has become necrotic due to severe infection or trauma. After pulp removal, the root canals are thoroughly cleaned and disinfected. For primary teeth, canals are filled with a reabsorbable material, allowing natural exfoliation. In permanent teeth, a pulpectomy is the initial step of a root canal procedure, with canals later filled with a permanent material.
After the Procedure
After pulp therapy, mild discomfort or sensitivity around the treated tooth is common for a few days. This can usually be managed with over-the-counter pain relievers. Swelling in the treated area is also possible and typically subsides within 48 hours. Applying a cold compress to the outside of the cheek can help reduce swelling.
Following the procedure, care instructions are important. Dentists recommend a soft diet for the first 24 to 48 hours, avoiding hard or chewy foods until a final restoration is placed. Maintaining oral hygiene, including gentle brushing, helps prevent further issues. A final restoration, such as a filling or crown, is placed to protect the tooth and restore its function. Contact the dentist if severe pain persists, swelling worsens, or signs of infection develop.