A pulpotomy is a dental procedure in which the coronal pulp of the tooth is removed and the pulp in the root canal is left intact. It is mainly performed on primary teeth (on children) and is used to treat tooth decay that has extended to the pulp.
Symptoms and Diagnosis
If your child complains of pain when cold, hot or sweet things touch their tooth/teeth, it may mean that he/she has pulpitis. Pulpitis is the inflammation of the pulp and its main cause is untreated caries (tooth decay). This tooth sensitivity is usually the first sign that your child may have caries.
Your doctor will recommend that your child undergo a pulpotomy if, upon dental examination, it is discovered that your child has caries 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 it (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 ensure the permanent teeth will have enough space when they erupt, keeping them in their proper alignment.
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.
Pulpotomies are generally performed on baby teeth, but they can also be performed on permanent teeth as an emergency measure.
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 as at the time of the procedure.
Generally, a pulpotomy procedure takes about 30-45 minutes to complete. The area around the tooth will be numbed with a topical anesthetic, then a local anesthetic will then be injected.
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. She/he must then either perform a pulpectomy or tooth extraction.
The coronal pulp will then be removed/excavated. When this is done, cotton pellets soaked with medication will be used to stop the bleeding and clean the area. Ideally, this bleeding should stop within 5 minutes.
Once the bleeding stops, the pulp chamber space is filled with medication. Afterwhich, a filling will be placed on top of the medication to restore the shape and function of the tooth.
Your child may experience some pain and/or swelling after the procedure. The pain usually subsides after 1-3 days. Please note that the numbness from the anaesthesia takes about 4 hours to wear off from the time the it is administered. During this time, try to avoid eating any solid food as your child may accidentally bite down on their cheeks or tongue (as they are still numb) and develop ulcers later on.
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. You should ask your dentist what he/she recommends as an oral care routine. You should also make sure to take your child in for regular scheduled dental check-ups.