January 17, 2019
A pulpotomy is a common endodontic procedure in which the pulp of the tooth is removed. This procedure is most commonly done on primary teeth (baby teeth). A pulpotomy can also be performed on an adult tooth where a root canal procedure is not needed.
When a tooth is injured, decay is present, or there is a crack in the tooth, the nerve (dental pulp) can become irritated, which causes the toothache people most often feel. If the tooth was bumped or hit with a foreign object, which happens often with children, the tooth will either begin to feel better or the nerve in the tooth will begin to die. When the nerve begins to die, the tooth will most often be sore and the tooth will begin to darken. To relieve the toothache and prevent infection, the pulp of the tooth is removed.
If the decay in the tooth is too close to the nerve or into the nerve, the decay is then removed and a pulpotomy is performed. When decay is too close to the nerve or touching the nerve, the nerve is constantly irritated, which leads to a toothache, and eventually, infection will occur in the tooth. The infection is known as an abscess. In order to prevent infection, relieve the toothache, and to save the tooth from having to be extracted, the decay is removed and a pulpotomy is performed.
The pulpotomy procedure
When a tooth is showing signs that a pulpotomy is needed, an x-ray is taken and the tooth is evaluated to determine if the tooth can be treated or if it needs to be extracted.
The area is then numbed. If decay is present in the tooth, the decay is removed. After the decay has been removed, the pulp of the tooth is then removed. Only the top section of the pulp is removed, not the pulp within the roots of the tooth.
After the pulp has been removed, a cotton pellet damp with formocresol is placed in the tooth. The formocresol will sterilize the inside of the tooth as well as “mummify” the remaining pulp. Formocresol is the most common method used, but some dentists may choose to use a laser, Ferric Oxide, electro surgery, or MTA.
The cotton pellet remains on the tooth for a few minutes, then it is removed. Once the cotton pellet is removed, the opening is sealed with a Zinc Oxide and Eugenal material. The most common material is IRM, which is a putty-like material that can be molded to the inside of the tooth and will harden after a few minutes.
Once the material has hardened, a permanent or temporary restoration can be placed on the tooth. For many children, a stainless steel crown is used to protect a primary tooth. Stainless steel crowns are often used because they provide enough protection for the tooth until the tooth will naturally loosen and fall out. A stainless steel crown is also less expensive than a more permanent porcelain crown. If the tooth is a permanent tooth, a porcelain crown may be recommended.
A pulpotomy procedure offers a very good alternative to extracting a tooth, especially a primary tooth. Primary teeth not only help with a child’s ability to chew food and pronounce words, they also serve as space holders for when the adult teeth erupt. If a child begins to loose their baby teeth too early, due to decay, accidents, or disease, other procedures need to be performed to preserve space for the adult teeth. A pulpotomy is one procedure in which the tooth can be saved and still be functional until the tooth naturally falls out. The success rate of a pulpotomy is quite high and the procedure can be completed within one to two visits.