What Is a Pulpotomy?
A pulpotomy is a procedure where the dentist removes the diseased or infected pulp tissue from the crown (top part) of a baby tooth, while leaving the healthy pulp in the roots intact. The pulp is the soft tissue inside every tooth that contains nerves, blood vessels, and connective tissue. When a cavity in a baby tooth grows deep enough to reach the pulp, the tissue becomes inflamed or infected. A pulpotomy removes the damaged portion and preserves the rest.
After removing the infected pulp, the dentist places a medicated material over the remaining healthy pulp to promote healing and prevent further infection. The tooth is then typically restored with a stainless steel crown to protect it and restore its function. The crown stays on until the baby tooth falls out naturally.
When Is a Pulpotomy Needed?
A pulpotomy is needed when decay in a baby tooth has reached the pulp but the infection has not spread into the roots. The dentist evaluates this using X-rays and clinical signs during treatment.
- A cavity has become deep enough to expose or nearly expose the nerve of a baby tooth
- The child has had pain, sensitivity, or swelling around a baby tooth
- An X-ray shows decay extending close to or into the pulp chamber
- The tooth is still important for spacing and function (the permanent replacement is not expected soon)
Why Save a Baby Tooth Instead of Pulling It?
Parents sometimes ask why a dentist would perform a procedure on a tooth that will eventually fall out anyway. The answer is that baby teeth serve important functions until the permanent teeth are ready. A baby molar may need to stay in place for several more years before the permanent premolar underneath is ready to erupt.
Extracting a baby tooth too early can lead to shifting of adjacent teeth, loss of space for the permanent tooth, and potential orthodontic problems. A pulpotomy saves the tooth, maintains the space, and avoids the need for a space maintainer. It also preserves the child's ability to chew and speak normally.
Pulpotomy vs Root Canal: What Is the Difference?
A pulpotomy and a root canal both treat infected pulp tissue inside a tooth, but they differ in how much tissue is removed and when each is appropriate.
Pulpotomy (Partial Pulp Removal)
A pulpotomy removes only the pulp tissue from the crown of the tooth, the chamber at the top. The pulp in the root canals is left in place because it is still healthy. This procedure is performed almost exclusively on baby teeth. It is less invasive than a root canal and works well when the infection has not spread beyond the crown of the tooth.
Root Canal (Complete Pulp Removal)
A root canal, also called endodontic therapy, removes all the pulp tissue from both the crown and the root canals of the tooth. The empty canals are then cleaned, shaped, and sealed with a filling material. Root canals are the standard treatment for infected permanent teeth. They are occasionally performed on baby teeth (called a pulpectomy in pediatric dentistry) when the infection has spread into the roots, but this is less common than a pulpotomy.
When Extraction Is the Better Option
In some cases, neither a pulpotomy nor a root canal can save the tooth. Extraction may be recommended when the infection has spread extensively into the roots and surrounding bone, the tooth has too much structural damage to restore, or the permanent tooth is close to erupting and the baby tooth will be lost soon anyway. If a baby tooth is extracted early, the dentist may recommend a space maintainer to hold the gap open for the permanent tooth.
What Happens During a Pulpotomy Procedure
A pulpotomy is typically completed in a single appointment lasting 30 to 45 minutes. Here is what happens step by step.
First, the dentist numbs the area around the tooth with local anesthesia. If the child needs additional help relaxing, nitrous oxide (laughing gas) or oral sedation may be used. The dentist then isolates the tooth, usually with a rubber dam, to keep the area clean and dry.
Next, the dentist removes the decay and opens the top of the tooth to access the pulp chamber. The infected pulp in the crown is removed using specialized instruments. The dentist checks the remaining pulp in the root canals to confirm it is healthy (indicated by normal-colored tissue and controlled bleeding).
A medicated material, commonly MTA (mineral trioxide aggregate) or formocresol, is placed over the remaining healthy pulp. This material helps the pulp heal and forms a protective barrier. The tooth is then built up with a base material and restored with a stainless steel crown for strength and protection.
The entire process is done while your child is numb, and they should not feel pain during the procedure. Some children experience mild soreness for a day or two afterward, which can be managed with over-the-counter children's pain medication as directed by your dentist.
Sedation Options for a Pulpotomy
Many children tolerate a pulpotomy well with just local anesthesia (numbing). For children who are anxious or very young, additional sedation options are available.
Types of Sedation Used
- Nitrous oxide (laughing gas): A mild sedative inhaled through a small mask on the nose. It helps the child relax while remaining awake and responsive. Effects wear off within minutes after the mask is removed.
- Oral sedation: A liquid medication given before the appointment to help the child feel drowsy and calm. The child remains conscious but may not remember much of the procedure. Requires specific pre-appointment instructions (fasting).
- General anesthesia: Used in a hospital or surgical center for very young children, children with extensive treatment needs, or children who cannot cooperate with other forms of sedation. The child is fully asleep during the procedure.
How the Dentist Decides on Sedation
The pediatric dentist considers your child's age, anxiety level, the amount of treatment needed, and your child's medical history when recommending a sedation approach. For a single pulpotomy on a cooperative child, nitrous oxide and local anesthesia are often sufficient. For multiple procedures or a very anxious child, oral sedation or general anesthesia may be safer and more effective.
Pulpotomy Success Rates and Recovery
Pulpotomy success rates in baby teeth are high. Clinical studies generally report success rates between 85% and 95%, depending on the materials used and the extent of infection at the time of treatment. Success is defined as the tooth remaining free of infection and symptoms until the permanent tooth is ready to replace it.
Recovery after a pulpotomy is typically quick. Your child may have some numbness for 1 to 2 hours after the procedure. Mild soreness or sensitivity at the site is common for a day or two. Soft foods are recommended for the rest of the day. Most children return to their normal routine the following day.
At follow-up appointments, the dentist will take periodic X-rays to confirm that the treated tooth remains healthy and that the permanent tooth underneath is developing normally. If signs of recurring infection appear, the dentist will discuss next steps, which may include retreatment or extraction.
Pulpotomy Cost and Insurance Coverage
A pulpotomy typically costs between $150 and $400 per tooth. A stainless steel crown, which is usually placed after the pulpotomy, adds an additional $150 to $350. Total cost for the combined procedure generally ranges from $300 to $750 per tooth.
Most dental insurance plans cover pulpotomies on baby teeth as a necessary restorative procedure. Medicaid and CHIP programs cover the procedure for eligible children in most states. If sedation is used, there may be additional charges that vary based on the type and duration of sedation.
Costs vary by location, provider, and the complexity of the case. Ask your child's dental office for a treatment estimate and verify coverage with your insurance provider before the appointment.
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