Pulpotomy vs. Pulpectomy—A Pulp What?

Your child has deep decay, dental pain, or an abscessed tooth (or teeth).  Now what?  Step one is to make an appointment as soon as possible with a dentist for evaluation and treatment.  You would not let an infection progress untreated if it was occurring in the toe, bladder, sinus area, or any other area of the body.  Just as in these areas, infection in the mouth or in a tooth can have serious consequences if left untreated. (The Dental Abscess)

Your dentist will take pictures (x-rays) of the tooth, evaluate the tooth, and recommend the best option:  a pulpotomy, a pulpectomy, or an extraction.  In a primary tooth, the abscess is usually a result of tooth decay or caries, but it can be caused from trauma (such as a blow to the tooth from a fall).  He or she may recommend a pulpotomy if the decay or trauma is confined to the crown (the part you see in the mouth) of the tooth, or a pulpectomy if the infection involves the tooth root and sometimes creates and abscess (the x-rays help the dentist to determine this). 

When the infection is limited to the crown of the tooth only and has not spread to the tooth roots, your dentist may recommend a pulpotomy as the treatment of choice.  After putting the tooth to sleep (local anesthesia), he or she will use a drill and/or a hand instrument that will remove all the infected material in the pulp of the crown only.  This means the tooth roots are still vital living tissue, which is why it is sometimes called a “vital pulpotomy”.  The next step will be to apply a special medicament to protect the intact pulp canals of the roots and encourage the root pulp to build a protective layer of dentin that will wall off the canal exposures, fill the tooth with cement, and place a stainless steel crown (or cap) over the tooth for strength (so the tooth does not break due to chewing or biting).

When a newly erupted permanent tooth has deep decay, trauma or infection, a vital pulpotomy may be recommended because the roots of young permanent teeth are not fully formed.  Therefore, the dentist may choose to treat with a pulpotomy until the permanent tooth has fully erupted and matured.  At that time a root canal may be done to complete the treatment.  In both cases, the objective of a pulpotomy is to maintain the tooth by keeping it free of bacteria and infection.  Retaining a primary tooth is important because they are needed to hold the space for the erupting permanent tooth (or teeth).  However, in order for your dentist to be able to do a pulpotomy, the tooth should not be loose, have swelling around it, or have an abscess.  If any of these symptoms are present, he or she may recommend another type of treatment, such as a pulpectomy.

A pulpectomy may be the treatment of choice when the decay or trauma has spread to or involves the roots of the tooth.   In a pulpectomy, the entire pulp material is removed from both the crown and the roots.   This means the tooth is no longer vital, or “living”, which is why this procedure is sometimes known as a “baby root canal”.   Usually, the dentist will prescribe a regimen of antibiotics for 4-7 days prior to treatment to reduce the swelling and/or infection.  After putting your child’s tooth to sleep, he or she will and remove the pulp and nerve tissue from the crown and from the canals of the roots.  Then the pulp chamber and root canals will be thoroughly cleaned and disinfected. Next, he or she will fill the tooth and tooth roots with a resorbable cement, and finish with a stainless steel crown.

However, if the decay process has completely destroyed the crown of the tooth (decay is to the gumline where only the root is left), or if the decay has reached the permanent tooth bud, or if the infection has damaged the supporting bone around the teeth, the best option may be to extract the tooth.  Also, if your child is not able to cooperate, or has certain systemic illnesses, or has been on certain medications, your dentist may opt to extract the tooth.  In that case, he or she may recommend that a space maintainer be placed until the permanent tooth can erupt into proper position and alignment.

Links:
www.simplestepsdental.com
www.dentalresource.org/topic58pulpotomypulpectomy.html



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