What Is a Pulpotomy?

A pulpotomy is a dental procedure that treats infected baby (primary) teeth in children. This type of infection happens when tooth decay reaches the pulp inside the tooth. During a pulpotomy, the pulp of the tooth in the crown (the part of the tooth that is visible) is removed and the pulp in the root canal is left intact.

Purpose of Pulpotomy

If your child complains of pain when cold, hot, or sweet things touch their tooth or teeth, it may mean that they have pulpitis. Pulpitis is the inflammation of the pulp and its main cause is untreated cavities (tooth decay). This tooth sensitivity is usually the first sign that your child may have caries.

Your healthcare provider will recommend that your child undergo a pulpotomy if, upon dental examination, it is discovered that your child has caries (tooth decay) that has affected the pulp in the crown.

It is also done when the tooth decay is so close to the pulp in the crown that removing the decay will expose the pulp. This examination can either be by physical examination of the tooth or by X-ray.

If it is discovered that your child has irreversible pulpitis caused by tooth decay—where the pulp in the tooth is severely damaged—then a pulpotomy will not be performed. Instead, your child will have to undergo a pulpectomy or tooth extraction.

Although much less common, a pulpotomy can also be done when your child has sustained serious physical trauma to the tooth. A pulpotomy is usually done so that the tooth and pulp in the root of the tooth can be preserved. 

You may be wondering why your child’s affected tooth isn't simply removed since it is a primary tooth that will eventually be replaced by a permanent one. The reason is that primary teeth help to ensure that the permanent space will be arranged properly and will have enough space to grow when they start to grow.

Literally, "pulpotomy" translates to "to cut the pulp." However, in the medical community, a pulpotomy is used to refer to the entire procedure, including the filling of the space the pulp was removed from with special medication.

A pulpotomy should not be mixed up with a pulpectomy. The latter is performed when your child’s tooth decay has extended past the pulp in the crown to the pulp in the root of the tooth (radicular pulp).

Risks and Contraindications

A pulpotomy is a very safe procedure and there are no serious risks associated with it. Pulpotomies should not be performed if the pulp in the root (the radicular pulp) is not vital. That means that the pulp there should not be infected and should still be healthy at the time of the procedure.

Before the Procedure

Here is how to prepare:

• Timing: A pulpotomy can take anywhere from 30 to 45 minutes, and in some cases, slightly longer.
• Location: The procedure will take place in the dentist’s office.
• What to wear: Since it’s a dental procedure, your child can wear any clothing that feels most comfortable for them.
• What to bring: If your child has one, you can bring along an item that’ll be sure to comfort them after the procedure.

During the Procedure

At least one parent will be able to stay with the child during the procedure.

Throughout the Procedure

The area around the tooth will be numbed with a topical anesthetic, then a local anesthetic will then be injected. Alternatively, your child may be sedated. The option chosen is usually up to the discretion of the healthcare provider.

The dentist will single out the tooth to be treated and remove any tooth decay on or around the teeth to prevent contamination of the pulp. The pulp chamber will then be opened by drilling through the enamel and the dentin.

Once the roof of the pulp is drilled through, it will bleed. This shows that the pulp is still healthy. If the pulp chamber is filled with pus or it’s empty and dry, then the dentist cannot continue with the pulpotomy. They must then either perform a pulpectomy or tooth extraction.

The coronal pulp will then be removed/excavated. When this is done, wet cotton swabs or pellets will be used to stop the bleeding and clean the area. Ideally, this bleeding should stop within a minute or two, or tops five. Different dentists have their own time limits.

If the bleeding doesn't stop after that time then it shows that the pulp in the root is no longer healthy, and has probably been affected by tooth decay. So, a pulpectomy or tooth extraction will have to be performed.

Once the bleeding stops, then the radicular pulp (what of it that can be seen) is treated and covered with special medication. This medication is usually either formocresol, ferric sulfate, or mineral trioxide aggregate (MTA).

After this is done, the pulp chamber of the tooth is sealed with zinc oxide eugenol (ZOE) or some other base. The tooth is then restored. This is usually done with a stainless steel crown.

Post-Procedure

Your child may experience some pain and/or swelling after the procedure. The healthcare provider will likely prescribe pain medication to help with this.

After the Procedure

Your healthcare provider will likely give you instructions on the kinds and temperatures of food your child can eat for the days immediately following the procedure. Your healthcare provider will also likely instruct that your child avoid eating candy or other sticky foods until the stainless steel crown used to restore the teeth falls out by itself.

Other Considerations

In order to prevent other teeth from getting affected by tooth decay, it’s important that you adopt a great oral care routine for your child. Your should you ask your dentist what he recommends as an oral care routine. You should also make sure to take your child in for regular scheduled dental check-ups.

Adult Pulpotomy

An adult pulpotomy is performed in basically the same way as pulpotomies for baby teeth are performed. However, they are not performed very often as root canals are preferred by dentists for treating adult permanent teeth.

A Word From Verywell

It’s natural to be worried whenever your child is about to undergo any medical procedure. However, rest assured that a pulpotomy is practically a risk-free procedure. Your child will be up and active once the anesthesia or sedative used during the procedure wears off. If you have any questions or concerns, remember that it is important to discuss these with your dentist, who should be able to answer these in order to make you more comfortable with the idea of the procedure.