Pulpotomy In Primary Teeth

When decay is severe, it may result in what's known as pulpitis. This is painful inflammation of the pulp that sits at the center of the tooth, containing all the nerves and blood vessels that keep the tooth alive.  

Your child's dental professional can perform a pulpotomy procedure to remove the part of the pulp that has been infected by tooth decay. But what exactly is a pulpotomy in primary teeth, and how will you know if it's needed? Let's go over everything you'll need to know about this procedure and possible treatments for pulpitis. This way, both you and your child will feel prepared!

Below the protective layers of enamel and dentin, your child's tooth has an inner layer of pulp that houses the tooth's nerves and blood vessels. When a cavity reaches this layer of the tooth, the pulp can become inflamed and very painful.

Pulpitis can be classified as either reversible or irreversible. If your child has reversible pulpitis, the tooth will be painful to the touch. The pain may come and go, and it can usually be alleviated with over-the-counter pain medication. However, with irreversible pulpitis, the pain may be constant and severe, and may not respond even to painkillers. The tooth might also be mobile.

Your dentist will perform an X-ray to determine the extent of the damage to your child's tooth and whether the tooth can be repaired. Unfortunately, extraction of the tooth may be necessary if it's not repairable. Depending on your child's age and where this particular tooth is located in their mouth, temporary replacement or space management decisions may be necessary for their permanent tooth to erupt properly.

The dentist's next decision is to determine if the tooth's nerve is still alive and can be saved. If so, they may perform a pulpotomy after removing the decay. If the nerve is dead, however, it may require a root canal (pulpectomy and restoration) or extraction instead of a pulpotomy. In some cases, your child's baby tooth may be ready to "shed" or "exfoliate" anyway, as an adult tooth is about to erupt. If this is the case, it makes sense to extract it.

There are two approaches to treating an inflamed nerve from decay. The first is an indirect pulp cap, where the pulp chamber or the upper part of the nerve is not removed. Instead, your child's dental professional will put medication on top of it. This reduces inflammation, prevents the decay's progression, and promotes healing.

The second approach is the pulpotomy. This involves removing the pulp chamber above the area where the nerve extends into the tooth's roots. Medication is also applied to the chamber's base to maintain the nerve's vitality and prevent any further infection. The tooth is then restored to its original shape. A primary molar will usually have a stainless steel crown placed, and a front tooth may receive a form of composite restoration.

To prepare your child for a pulpotomy on their primary teeth, let them know that it's not a long procedure, and they should not feel any pain. They will have anesthesia to numb the area of the mouth where the cavity is already most likely causing pain. Once the procedure is complete, the aftercare is like most standard dental procedures. Ensure your child doesn't eat or drink within the timeframe your dental professional instructs, watch for bleeding, and buy over-the-counter pain medications if your child feels discomfort once the numbness wears off.

A pulpotomy is generally performed on a tooth with pulpitis that is still vital – that is, the tooth is still alive, and it can be treated and saved. The dentist will test this by checking if the tooth still has blood flow, and if the nerves are responding to things like temperature. On the other hand, a pulpectomy is performed on teeth that are no longer vital and cannot be saved. 

During a pulpotomy, only the coronal pulp is removed. That’s the part of the pulp that sits above the gum line. In a pulpectomy, the pulp is removed from the entire tooth, including the roots. The entire pulp chamber is cleaned out, including the nerves. A pulpectomy is normally performed as part of a root canal. After emptying the pulp chamber, the dentist or endodontist (a type of specialist dentist) cleans and disinfects the canals at the roots of the tooth to make sure no decayed pulp tissue or bacteria is left behind. The root system is then filled with a material and tightly sealed to prevent infection, and the tooth is restored with a filling. 

After a pulpotomy, your child may experience some discomfort as the local anesthesia starts to wear off. During this time, you can manage any pain or swelling with over-the-counter pediatric pain medication. A product containing ibuprofen will help with both pain and swelling. Be sure to ask your dentist for a safe, effective and age-appropriate product recommendation, and follow the dosage instructions carefully. 

For the first day or two, give your child soft foods that won’t irritate their tender mouth. Think pureed fruit, soup and mashed potatoes, and steer clear of hard, crunchy or sticky foods. 

Your dentist may want to see your child for a follow-up appointment to check on the tooth, but this is not always necessary if the treatment was very straightforward. However, if you notice any of the following signs of infection, book an urgent appointment and don’t wait until your follow-up:

• Fever.
• Intense or worsening pain that doesn’t respond to painkillers.
• Swelling in the face, jaw or throat.
• Difficulty swallowing or talking.
• Bleeding that is heavy or gets worse.
• Pus or other discharge from the surgery site.

Pulpotomy in primary teeth is a simple and routine procedure with a high success rate. Be sure to follow your dentist’s aftercare instructions carefully to minimize the risk of infection, failure, and the need for retreatment. 

A pulpotomy can weaken the structure of the tooth, so it may be more vulnerable to fracture in the future. The tooth may also appear slightly darker than the other teeth. 

In the long-term, a tooth that has been treated with a pulpotomy is more likely to need future treatment. It’s essential that your child maintains good oral hygiene and dietary habits to reduce this risk and avoid further damage to the tooth and other teeth. 

The best preventive tool for fighting cavities, tooth decay, and pulp inflammation? A stellar oral care routine! For children, fluoride toothpaste and brushing with a soft-bristled toothbrush are necessary for keeping their primary teeth healthy. Additionally, within six months of their first tooth erupting, you should schedule regular appointments with their dental professional for check-ups and professional dental cleanings.

While you do everything you can to make sure your child has a healthy smile, there's still a chance they will develop a cavity. A pulpotomy in primary teeth is never anticipated, but a vigorous oral care routine and regular dental check-ups are crucial to keeping all the layers of your child's teeth healthy. If your child needs a pulpotomy, let them know that it will ease their tooth pain and keep their tooth intact.

Oral Care Center articles are reviewed by an oral health medical professional. This information is for educational purposes only. This content is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your dentist, physician or other qualified healthcare provider.