Pulpotomy in Children: Baby Tooth Nerve Treatment

A pulpotomy is a common pediatric dental procedure that removes the infected portion of a baby tooth's nerve (pulp) while preserving the healthy root tissue. It is often called a 'baby tooth root canal,' though it is less extensive than a traditional root canal. Pulpotomy allows the baby tooth to remain functional until the permanent tooth is ready to erupt, maintaining proper spacing and jaw development.

3 min readMedically reviewed contentLast updated March 26, 2026

Key Takeaways

A pulpotomy removes the infected or inflamed portion of the nerve in a baby tooth while preserving the healthy root.
The procedure is recommended when decay reaches the nerve but the roots are still healthy.
Pulpotomy success rates exceed 90% when performed on properly selected teeth.
The tooth is restored with a stainless steel or white crown after the pulpotomy to protect it from fracture.
The entire procedure (pulpotomy plus crown) is completed in one appointment, typically in 30 to 60 minutes.
Most dental insurance covers pulpotomy for children as a medically necessary procedure.

What Is a Pulpotomy?

The pulp is the soft tissue inside a tooth that contains nerves, blood vessels, and connective tissue. When tooth decay penetrates deep enough to reach the pulp, the tissue becomes inflamed or infected. A pulpotomy removes only the diseased portion of the pulp (in the crown of the tooth) while preserving the healthy pulp tissue in the roots. This is different from a pulpectomy (full root canal), which removes all pulp tissue from both the crown and roots.

By saving the healthy root pulp, the baby tooth can continue to function normally, respond to stimuli, and maintain its connection to the surrounding bone. The treated tooth stays in place until the permanent tooth pushes it out naturally.

When Is a Pulpotomy Needed?

A pulpotomy is recommended when decay has reached the pulp but the infection has not spread to the root tips. Signs that suggest a child may need a pulpotomy include spontaneous toothache (pain without chewing or other stimulation), sensitivity to hot and cold that lingers after the stimulus is removed, visible large cavity, and swelling of the gum tissue around the tooth.

Your pediatric dentist determines whether a pulpotomy is appropriate based on X-rays and clinical examination. If the roots show signs of infection (abscess visible on X-ray, excessive root resorption, or drainage), extraction may be recommended instead of pulpotomy.

What Happens During the Procedure

The pulpotomy procedure is performed under local anesthesia and typically takes 30 to 60 minutes including crown placement. First, the area is numbed. A rubber dam (a thin sheet that isolates the tooth) is placed to keep the area clean and dry. The dentist removes the decay and opens the top of the tooth to access the pulp chamber.

The inflamed pulp tissue in the crown portion is carefully removed. A medicated material (commonly MTA, ferric sulfate, or formocresol) is placed over the remaining healthy pulp stumps to promote healing and prevent further infection. The tooth is then filled and restored with a crown (usually stainless steel for back teeth) to protect it from breaking.

Success Rates and Potential Complications

Pulpotomy has a high success rate, exceeding 90% in properly selected cases. The treated tooth typically remains functional and healthy until it is naturally lost. Factors that affect success include the extent of infection at the time of treatment, the pulp capping material used, and the quality of the final crown restoration.

In a small percentage of cases, the remaining pulp may become infected after the pulpotomy. Signs of failure include pain, swelling, or an abscess forming near the treated tooth. If a pulpotomy fails, the tooth may need a pulpectomy (full nerve removal) or extraction. Your pediatric dentist will monitor the tooth at regular checkups.

Find a Pediatric Dentist

Pediatric dentists perform pulpotomies routinely and have specialized training in treating the dental pulp of primary teeth. Search by location on My Specialty Dentist to find a pediatric dentist near you.

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Frequently Asked Questions

Is a pulpotomy the same as a root canal?

Not exactly. A pulpotomy removes only the infected pulp from the crown (top portion) of the tooth, leaving the healthy root pulp intact. A root canal (pulpectomy) removes all pulp from both the crown and roots. Pulpotomy is a less extensive procedure typically used on baby teeth.

Does a pulpotomy hurt?

The procedure is performed under local anesthesia, so your child should not feel pain during the treatment. Some children experience mild tenderness for a day or two afterward, manageable with children's ibuprofen or acetaminophen.

How much does a pulpotomy cost?

A pulpotomy costs $200 to $400. The crown placed afterward adds another $200 to $600 depending on the crown type. Most dental insurance plans cover pulpotomy and crown placement on baby teeth when medically necessary.

Why not just pull the baby tooth instead?

Keeping the baby tooth preserves the space for the permanent tooth, supports proper jaw development, and maintains chewing and speech function. Early tooth loss can cause neighboring teeth to shift, leading to crowding and alignment problems that may require orthodontic treatment later.

How long does a tooth last after a pulpotomy?

A successfully treated tooth with a good crown typically lasts until it naturally falls out when the permanent tooth erupts. This can be several years depending on the child's age and which tooth was treated.

What are the signs that a pulpotomy has failed?

Signs of failure include recurring pain, swelling, a bump or pimple on the gum near the treated tooth, or loosening of the tooth before the permanent tooth is due. Your pediatric dentist monitors the tooth at regular checkups and can detect problems early with X-rays.