Pulpotomy

A healthy tooth has a space inside it called the "pulp space" which is filled with soft tissues - nerves, blood vessels and pink connective tissue. If a tooth gets a large cavity, the bacteria in the decay can damage the pulp, which is often what causes toothache.

A pulpotomy is the removal of a portion of the pulp, including the diseased aspect, with the intent of maintaining the vitality of the remaining pulpal tissue by means of a therapeutic dressing.

Pulpotomy usually is done in children when decay has reached the crown part of the pulp, but the nerve in the root of the tooth is still healthy. The procedure also is done when the pulp is exposed as a result of injury or trauma. The affected part of the pulp can be removed, leaving the healthy part in the root. A successful pulpotomy relieves sensitivity and pain. It also prevents the supporting tissues around the tooth from breaking down.

Damage to the pulp of permanent teeth usually requires a Root Canal Treatment or Endodontic Therapy. The pulp of primary or deciduous teeth, which only have to survive until an adult tooth comes in, and because they have a better blood supply, can sometimes be saved.

Indication for Pulpotomy

If the pulp in the crown of a tooth is injured or decayed, but the pulp in the root is healthy, a pulpotomy may save the nerve inside the root from dying.

For your dentist to do a pulpotomy, the tooth should not be loose or have any swelling or abscesses around it. If there is swelling or an abscess, another type of treatment may be needed.

Pulpotomies can be done in children's baby teeth (primary teeth) or in young permanent teeth. In primary teeth, the procedure is done to keep the primary tooth from being extracted. Extracting a primary tooth before it is ready to fall out can alter the way the permanent teeth come in and may cause problems in the future with the child's bite.

If the pulp of a permanent tooth becomes injured or decayed soon after it emerges, the tooth may require root canal treatment. However, root canal treatment is not done until the tooth's roots are finished growing. In this case, a pulpotomy can be done instead. Root canal treatment can be done after the roots finish developing.

Preparation

X-rays are taken to review the tooth's position and anatomy, and to see whether the root is infected.

A pulpotomy is done using local anesthesia. Sedation also may be used. This can include nitrous oxide or an oral medicine. Sedation may help to calm anxious children or young children who are not able to cooperate.

Pulpotomy Procedure

Primary (baby) teeth in children have relatively large pulp spaces and a cavity does not have to get very large before it reaches the pulp chamber.

When the soft tissue in the pulp chamber is infected (has bacteria in it) or affected (is inflamed), it can be removed by a dentist under local anaesthetic. If the soft tissue in the canals is still healthy enough, a special medicated filling can be put into the chamber in an attempt to keep the remaining pulp (in the canals) alive. The process of removing the pulp from the chamber is the actual "pulpotomy," though the word is often used for the entire process including placement of the medication.

Afterwards the tooth is restored with a regular filling or a stainless steel crown.

Follow-up

• Your child's gums may be sore in the area. Dr. Kaur will check on the tooth during future visits.
• Pulpotomy has a high success rate. However, failures and other problems can occur.
• Some of the medicines used in Pulpotomy can irritate tissues outside of the pulp.
• Your child might feel a temporary burning sensation in the area of the affected tooth.
• If the tooth's entire nerve is infected, the Pulpotomy may fail. We will look for infection during the procedure, but if the nerve is in the early stages of infection it may look healthy.
• If the tooth still hurts after Pulpotomy, root canal treatment may be needed. This will be done to remove the rest of the affected pulp.