Pulpotomy

What is Pulpotomy?

Pulpotomy is a dental procedure used to save decayed, infected teeth. If you or your child has a severe cavity, plus infection in the tooth’s pulp (pulpitis), your dentist may recommend pulpotomy to you.

This procedure is also recommended when repair of a deep cavity exposes the pulp underneath, leaving it vulnerable to bacterial infection.

With pulpotomy, pulp is scooped out and removed from within the tooth’s crown. The crown of the tooth is the part surrounded by enamel that you see above the gum line.

Pulp is the innermost part of the tooth. It’s comprised of:

. blood vessels

. connective tissue

. nerves

A deeply decayed tooth can cause inflammation, irritation, or infection to occur within a tooth’s pulp. This can threaten the life of the tooth, plus affect the gums, and surrounding areas of the mouth.

If your tooth has a deep infection that extends into or near the root, a root canal may be recommended instead of pulpotomy. Root canal procedures remove all of a tooth’s pulp, plus the roots.

When is a pulpotomy needed?

Several conditions may require pulpotomy treatment. Your dentist will be able to determine if you need a pulpotomy based on your clinical symptoms, your x-rays, and a dental evaluation. Some of these include:

. Deep dental caries that has a pulp exposure during a traditional filling

. Pain on a vital tooth that is severely decayed

. Trauma to a tooth that exposes the pulp

. Large amalgam or composite resin restorations that fail

. Cracked tooth syndrome

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Who is a Good Candidate for pulpotomy?

Pulpotomies are traditionally performed on primary molars and are known as “baby root canals,” but it can also be done on adult teeth. A good candidate is a tooth with a deep cavity and inflamed pulp that is capable of healing with the pulpotomy and a medicated filling applied to seal the tooth and avoid any bacteria contamination. Once the surrounding tissue and bone are affected, a pulpotomy is not a good treatment option. The tooth will require a pulpectomy or dental extraction to avoid pain and infection.

It is important to also treat patients who are in good health to avoid potential bacterial infections. Patients with chronic inflammatory conditions or cancer may not be a good candidate for a pulpotomy. 

Pulpotomy in Kids and adults

Because pulpotomy leaves the roots of a tooth intact and able to grow, it’s used primarily in children with baby (primary) teeth, which have an immature root formation.

Baby teeth help maintain spacing for the permanent teeth that will follow, so leaving them intact is often a priority.

Several studies have shown that this procedure can also be used effectively in adults and in children with secondary teeth, provided that enough healthy pulp exists within the tooth to keep it healthy and vital.

Pulpotomy Procedure

Your dentist will take an X-ray of your teeth to determine your need for a pulpotomy or any procedure.

General dentists usually perform pulpotomies or root canals. If a specialist is needed, your dentist will likely refer you to an endodontist.

Your dentist may prescribe antibiotics for you to start taking 3 or 4 days before the procedure and up until several days afterward.

Anesthesia

Small children may require general anesthesia or light sedation for this procedure.

Nitrous oxide, which is commonly known as “laughing gas,” is frequently used during the procedure for light sedation and to help make the procedure more comfortable.

If general anesthesia or light sedation is required, the dentist or endodontist will provide you with written instructions about how to prepare.

These instructions will include restrictions on when to stop eating and drinking. Usually, this timeframe is 6 hours before general anesthesia and 2 to 3 hours before light sedation.

It’s important to note that if general anesthesia is used, an oral surgeon could perform the procedure.

Getting a child ready for Pulpotomy

Preparing for any type of dental procedure can be anxiety-producing, especially for children.

If your child needs a pulpotomy, they may already have a toothache. Let your child know that this procedure will make that pain go away.

Also let them know that the procedure itself will not hurt and only lasts for half an hour to 45 minutes.

Getting yourself ready for Pulpotomy

If you’re the one getting ready for a dental procedure, you may be nervous as well.

Though research indicates that pulpotomies can be successfully performed on adults, your dentist will likely recommend a root canal since you have a more mature tooth structure.

Whichever procedure your dentist recommends, keep in mind that it’s being done so that your tooth can be salvaged.

What to expect

. Before the procedure begins, your dentist will numb the area with a local anesthetic. This injection typically doesn’t hurt, although you may feel a slight, fleeting pinch.

. If anesthesia is being used, it’ll be administered to your child in the dentist’s chair, either through a nose piece for light sedation or via an injection in the arm for general anesthesia.

. The decayed area of the tooth will be removed with a drill.

Your dentist will drill through the tooth’s enamel and dentin layers until the pulp is exposed.

. The infected material within the tooth’s crown will be scooped out and removed.

. The empty space where the pulp was will be filled with dental cement to seal it closed.

. A stainless-steel crown will be cemented onto the existing tooth, which becomes its new outer surface.

Pulpotomy Aftercare

Your tooth, gums, and the surrounding area of your mouth will be sufficiently numbed throughout the procedure so that you don’t feel any pain.

Afterward, children who received anesthesia or light sedation will be monitored for 30 minutes to 1 hour before they can leave the dentist’s office.

During this time, most children bounce back quickly. In some instances, sleepiness, vomiting, or nausea may occur.

You may also notice slight bleeding for several hours.

Avoid eating or drinking while your mouth is numb to avoid accidentally biting your inner cheek.

Once you’re able to eat, stick to soft food, such as soup or scrambled eggs, and avoid anything crunchy.

Recovery

You can expect to experience temporary bleeding, swelling, and numbness for a few hours following the procedure. Many dentists will recommend over-the-counter pain relief like ibuprofen or acetaminophen. It is also recommended to avoid eating until numbness resolves to avoid biting your lip or cheek. If you experience these symptoms longer than 48 hours, you should follow-up with your dentist or endodontist.

When to see a dentist

If your pain is severe, or you continue to feel pain after several days have passed, call your dentist. Intense or persistent pain may indicate that additional treatment is needed.

A certain amount of swelling is to be expected right after the procedure. However, if you experience new swelling, redness, or pain during the days, weeks, or months that follow a pulpotomy, call your dentist. These symptoms may indicate the tooth is infected.

Common Questions and Answers

Is a Pulpotomy the same as a root canal?

While a pulpotomy and root canal both help save a tooth’s function and esthetics, they are not the same. A pulpotomy is when the coronal part of the pulp is cleaned out and disinfected, while a root canal treatment is a more invasive endodontic procedure that will clean out the entire infected pulp of the tooth and roots. A root canal then requires the canals of the roots instrumented, cleaned, dried and filled to prevent any bacteria from entering the tooth.

Is a Pulpotomy painful?

A pulpotomy is not considered any more painful than a traditional filling if you are not already symptomatic or sensitive to hot or cold. If you have clinical symptoms, sometimes a dentist may recommend an antibiotic to reduce inflammation.

Is Pulpotomy done in permanent teeth?

A pulpotomy can be performed in permanent teeth. It is more likely to have a high success rate in baby teeth and an immature permanent tooth that is vital to an older permanent tooth. While it can be done in an older permanent tooth, it is less likely to be successful and may require a traditional root canal treatment.

How long does a Pulpotomy procedure take?

Typically, a pulpotomy procedure takes 30 to 45 minutes, but can take longer if there are any behavioral issues or complications requiring additional radiographs.

Source:

https://www.healthline.com/health/dental-and-oral-health/pulpotomy

https://www.newmouth.com/dentistry/pediatric/pulpotomy/