Tuesday, September 12, 2006

What is a Pulpotomy?

A pulpotomy is when the inflamed pulp chamber, usually on a baby molar, is removed, the area is sterilized, and the chamber is sealed. It is sometimes called a baby tooth root canal, but it's not really a root canal and it can be done is some cases in permanent teeth. It is a very common procedure in children and has a reasonably good prognosis of success. It's also fairly easy to do in conjunction with associated procedures.

When a cavity gets really deep, close to the pulp of a tooth or even into the pulp, the pulpal tissue becomes irritated and inflamed. This is usually the "tooth ache" you feel. If the inflammation and infection continues without treatment, the tooth will likely eventually abscess. In baby molars, a pulpotomy is used in the process of trying to save and restore the tooth. First, the decay is removed, and then the pulp chamber (the top part, not the root canals) is removed usually with a high-speed bur or spoon excavator. A small cotton ball damp with formocresol is placed to "mummify" the pulp stumps and to sterilize the area. After a couple of minutes, the cotton ball is removed and the opening is sealed usually with a Zinc Oxide and Eugenol material like IRM. IRM is a putty like material that hardens up after a few minutes. After a pulpotomy on a baby molar, it is usually necessary to place a stainless steel crown to restore the tooth. The most common method to treat pulpotomized teeth is formocresol. Other methods include Ferric Oxide, MTA, electrosurgery and even lasers.

Pulpotomies have reasonably good prognosis. It may buy some time, but cannot save an already abscessed tooth. It is often surprising to me how a seemingly small area of decay can be deep enough to reach the pulp. This is often due to the varied antomy of baby teeth and the rapid progression of decay. Although a very reliable procedure, rarely, a tooth with a pulpotomy will have complications and need to be extracted. This is usually due to the remaining pulp tissue in the root canals giving some kind of trouble.

Bottom line: a pulpotomy is a really good and reliable way to save a badly decayed baby tooth.

More info on: Pulpotomy

39 comments:

Doug said...

What would you suggest after a pulpotomy on a primary molar has lost its crown and become infected...I know it means an extraction...yet it is hollow and will crack when an extraction is attempted. Have you ever packed and refilled a tooth just so it will be stable and only one strong yank is necessary?

Thank you for your time!

Doug said...

Do you extract pulpotomies that have lost their crown, and pack/filling and infection shows up on x-rays? Is it possible to extract after REFILLING to stabilize the primary molar (w/prior pulp) and prevent it from cracking when extracting?

Dr. Dean Brandon said...

Sometimes a baby tooth is harder to extract than any permanant tooth because of things like that. Sometimes you just have to dig for the roots if things bust apart.

You could do what you suggested if you thought it would be easier. ( I don't usually do that , but I would suggest composite as it bonds to the tooth). Hey, anything that helps.

Anonymous said...

My dentist is recommending a pulpotomy on my 4 year old's front tooth. It has suddenly turned grey and we can only assume that he banged in on something..... Is this what you would recommend, if so what will this be like and how will the recovery be? Also can you recomend a pediodontist in Montgomery?

Dr. Dean Brandon said...

You might want to read this post:

My Child's Tooth is Turning Dark

All there (in Montgomery) are great, but I know Dr. Benjamin Cumbus

Anonymous said...

My niece at the age of 4yrs old, just had a pulpotomy 3wks ago. Come sat. her face swelled up. Her pedi. Dr. advised us she needed a pulp due to deep decay. Now we took her back to her pedi. Dr. and they stated her tooth has abscessed now. I don't understand wouldn't the tooth be abscessed before they did he pulp, not after. I mean a pulp is to remove the infected tissue so how can an abscess appear after the treatment was performed?...

Dr. Dean Brandon said...

If you notice, a pulpotomy only removes the upper chamber of infected tissue not down into the root canals. It is rare, but sometimes I have seen teeth with pulpotomies abscess later on perhaps due to that residual tissue. I do not know your particular case, but I suspect the tooth was in pretty bad shape from the start. Baby cuspids seem to do that more often.

Anonymous said...

My 5 year old son had a cavity filled then a week later still had pain, took him back and they did the pulpotomy to see if it was the nerve causing the problem. Two days later he was in excruciating pain.....so emergency second pulpotomy done with the medicated filling. Now a week later hes eating a yougurt(nothing crunchy to eat all day, infact he is now afraid to eat any sugar) and he says it tastes like the dentist office, I smell the filling or medicine on his breath. Dentist calls me back in a huff and says "NO WORRY" "No WORRY", (he gives me no explanation.)
Is this normal, what am I smelling and why?

Dr. Dean Brandon said...

I do not know your exact situation, but I suspect the "smell" or taste is some of the formocresol. It smells pretty medicimy and dentist office like. See my post on "Wow, It smells like a dental office in here". Sorry I can't offer any more advice on that...

Anonymous said...

My daughter had pulpotomies and caps on her two upper front teeth when she was 18 months old (the teeth to either side were removed, too decayed to save). Now at age 4.5yrs our dentist points to dark spots on her x-rays above those two teeth and says there is infection and wants to extract them. Is there any other option? I don't want the jaw bone or permanent teeth to be damaged, but I also feel that removing the teeth might make her an even more picky eater as she would be unable to bite things and make her more self conscious. She has expressed no pain. I'd like to try other treatments first if there are any.

Dr. Dean Brandon said...

If they are abscessed, removal is usually the best option. I have never seen anyone nor any study that shows problems eating if the front teeth are missing. You might consider a pedo partial (fake baby teeth) listed on another post here. Also, she is a little old, but sometimes you can do a "baby tooth root canal"--which is actually a Pulpectomy (not a pulpotomy which she already had). They are not as effective as root canals on permanent teeth, but you could ask.

rod anselmo said...

how much time is approach the pulpotomy intervention? i mean only the time in dentristy room.

Dr. Dean Brandon said...

Pulpotomy, well, since it is done in combination with other procedures (like a crown), the additional time required is probably about 5 to 10 minutes if you include placing the IRM. Of course that would vary depending on a lot of factors, but if the child is cooperative, it's not long.

Anonymous said...

would you be able to see the decay when a pulpotomy is necessary? a dentist i have consulted with about my 4 yr old is reccommending this be done on all over her molars. i can't see any visible decay and he did not do x rays

Dr. Dean Brandon said...

When we diagnose, we make a treatment plan, or what is likely to be needed. Usually large decay is evident (to the dentist and sometimes the parent), but, even with x-rays, it's hard to tell for sure till you get in there. Decay often starts between the back teeth and is hard to see, but based on past experience you can kind of tell based on appearance. The difference between a large filling and a pulpotomy and a crown can be as little as a tenth of a millimeter. Some dentists would rather plan on the worst, "if" the decay gets to the pulp or even too close, then it's best to do a pulpotomy. My guess is that the reason he did not do x-rays was that there may be some cooperation issues going on. That makes diagnosing even harder, so best to err on the side of telling you what might be necessary. Good luck.

pam said...

Mt daughter went to the Dentist to fill a tooth that a previous filling came out from. After doing x-rays we were told to come in the next day to do a composite filling. When my daughter went back to the dentist sitting in the dental chair she thought she was getting the filling instead they informed us that a pulpotomy was done that she should come back in three weeks to do a root canal. Shouldn't something as a root canal be discussed with the patient first and what reason should a root canal be done when told it will be a composite filling. I feel very uncomfortable returning there, how long can she go on with the pulpotomy until i find another dentist.

Dr. Dean Brandon said...

I can't say in your case, but sometimes decay in a baby tooth can go to the pulp and then it turns into needing a pulpotomy. It's hard to tell how deep it will sometimes till you get in there. Baby teeth usually don't need literal "root canals". If it is a permanent tooth, that may be a different story.

Anonymous said...

My daughter is 3 1/2 years old and drank her bottle to long. Her dentist is recomending a pulpotomy and filling on her four front teeth. I see the darkened color on the back of the teeth the front of her teeth are fine. Is this procedure really necessary even though they are her baby teeth and will fall out anyway. Also what is the recoup time and why does her dentist reccomend that it be done at four different visits? I want to do the best thing possible but really don't understand the procedure. Please help!

Dr. Dean Brandon said...

Those teeth don't fall out till 7 or 8 years of age. Sometimes a pulpal treatment is needed. I see many kids in a similar situation. Usually I recommend doing all the treatment at one appointment like under general anesthesia in the hospital. Alternatives include under sedation in the office, but 4 visits, seems like a lot to me, but can be done in certain circumstances I suppose. Most kids cannot sit still too long. If you are not sure, it's ok to ask questions.

Jizz said...

What software is used to view formats "ceph" & "pano" x-ray scans?
Appreciate your help.

Dr. Dean Brandon said...

We use Dolphin Imaging, but there are many others.

PiXie Dust said...

hey doc.. was searching the web on pulpotomy and here i am reading ur blog. i am a dental student.. and guess what i have a lit review on pulpotomy option in endodontics..why should we revisit it?? i mean i read alot.. but is it an option in adults? would it have a good prognosis too? and why arent dentists considering them before pulpectomy???

Dr. Dean Brandon said...

I sometimes use them in permanent teeth, but it has generally been accepted that a full Root Canal will eventually be needed. It can buy you time. The pulpotomy, I have found works quite well in permanent teeth. It certainly can be an interim modality. I am not an endodontic expert, but that is how we generally approach such things.

Anonymous said...

My son is eight and had a pulpotomy on two of his upper molars side by side. We noticed a blister over one of them a few months later. They said at first to extract the one with the blister, but now want to remove both because they are beside each other. The other one has had no blisters. Is this usual? I don't want to extract a tooth if it is not neccesary.

Dr. Dean Brandon said...

A "blister" may indicate an abscessed tooth. --Usually needs to be removed if that is what it is.

Dr. Dean Brandon said...

Oh, the other one, depends on a lot of things. rarely I see infection creeping to an adjacent tooth but it is not typical.

Anonymous said...

My 6 year old has had a pupotomy and now has the blister on the gum (about 6 months later), therefore we are planning on extraction. Dentist didn't recommend a spacer since my daughter "will probably need braces anyways." I never needed braces, so I'm wondering what your opinion is on keeping the teeth in their place until the permanent comes in. If she's as lucky as I was and has straigth teeth, I would rather buy a car intead of braces! I believe the location is the tooth after the eye tooth.

Dr. Dean Brandon said...

The need for space maintainers often depends on the age of the patient. In other words, how long will it be till the new tooth will erupt and whether that is a concern or not. A patient of 6 years old, I would suspect would need something. May want to check out my post on Space Maintainers.

Anonymous said...

Could you give me your opinion on the causes why my 6 yr.old's molar became infected after a simple filling, composite.
also, after antibiotics for 10 days her gums are still swollen and a pupotomy is scheduled. Would it hurt? Does it supposed to hurt?
Thanks for your advice.

Annie

Dr. Dean Brandon said...

If a "gum" is swollen it might be a sign of an abscess. If it is, then the tooth may need to be removed rather than a pulpotomy. The only time I do those on abscessed teeth is to buy a few months while a permanent 6 year molar erupts.

Anonymous said...

My kid is 5 yrs old and also has a bad tooth decay on the lower right molar. The Dentist also recommended this procedure. How long does this pulpotomy procedure take and would the child feel discomfort under the procedure?

Thanks.

Dr. Dean Brandon said...

Takes less time than a small filling, however, if you are doing one you are likely doing a crown as well, so that's a little more time. This is always done when the patient is numbed up with local anesthesia.

Roxy said...

My daughter who is five is going to have therapeutic pulpotomy done on her back tooth,(L)tooth, and then capped with a stainless steel cap,I was wondering if it has to be steel or can the tooth be capped with a white cap?

Dr. Dean Brandon said...

Might want to read my post on "white crowns for baby teeth" Basically, the stainless steel crown is the best solution for that kind of thing.

Anonymous said...

Hello Dr Dean, My six year old daughter was born with bad teeth. At least diagnosed when she got her first front teeth with malformation inutero and malnutrition inutero. Now we've been told she needs to have extensive dental work done on 12 of her teeth and molars. The Pedo said he thinks 3-4 pulpotomies under anesthesia. She was born with low birth weight and at six weighs only 29 3/4lbs. She does see an endocrinologist for this and I think I'm gonna ask his opinion too. But I want to know if you think all this work is really necessary on so many teeth. I feel like the worst parent ever and her
being put under scares me to death.

Dr. Dean Brandon said...

I know you must be concerned. It is certainly necessary to evaluate the health of a patient before anesthesia. Untreated dental disease has risks too. You might find my other posts informative on things like baby teeth why fix them, etc.

Anonymous said...

My 7yr old son has bad tooth decay on his top molar. He was in alot of pain and then I noticed swelling of the gums. I took him to the dentist and she recommends a pulpotomy and crown in about a week from now. She also told me I could choose to have the molar extracted. Is that a better choice?? I know he will have this tooth for a few more years. She prescribed him penicillin to clear up the infection first. She only uses the numbing shot, no oral sedation. He has always been pretty cooperative at the dentist. I don't want this to be a bad experience for him. Any advice would be appreciated. Thank you.

Dr. Dean Brandon said...

If back baby teeth have to be removed (as opposed to fixing them) a space maintainer may be needed. I usually tell parents --don't make a big deal out of dental treatment. Most kids do quite well.- Good Luck.

Dr. Dean Brandon said...

Going to limit comments on this post for now, lots of good comments here.