Pulpotomy for children

The suffix “otomy” means to cut. Pulpotomy means cutting the pulp. Pulpotomy is the most commonly used dental treatment for root canals in children. Pulpotomy is done to save and preserve a baby tooth when there has been damage to the pulp of the baby tooth.

pulpotomy dentist in Brisbane

Parts of a tooth

As you might already know, your teeth play a significant role in your oral and overall health. Therefore, taking care of your teeth is of utmost importance, and knowing different parts of them can help you understand what happens when they get sick!


First off, let’s take a quick look at the different main layers of our teeth!


Each tooth consists of four major components that play a vital role in the health of your tooth.


Enamel is your body’s hardest substance that works as a protective layer for your tooth. Enamel is the most mineralized substance in your body and covers the most visible part of a tooth above the gum, the crown. Enamel lacks any living cells, so it is unable to repair itself from decay or damage.


Dentin is located below the enamel and extends from the dental crown to the tooth root. Dentin is a living tissue that is comprised of tiny tubules or tubes. The dentin structure is similar to the bone; however, it’s much softer than the enamel. Dentin both surrounds and is nourished by the pulp.

 Tooth pulp

The innermost layer of each tooth is referred to as the dental pulp. It is an unmineralized oral tissue containing specialized cells, living connective tissue, tiny blood vessels, and large nerves.

The dental pulp is located at the centre of the tooth below the dentin. The dentine, which is a mineralized tissue, surrounds the pulp. The dental pulp has a coronal part (crown) and a radicular part.

Coronal pulp’s location: within the crown of the tooth

Radicular pulp’s location: within the root

The pulp is in charge of creating and nourishing the dentin.


Cementum refers to a specialized mineralized substance that covers the surface of your tooth root and is located in the gum socket. It also covers the dentine. Cementum is a little softer and lighter in colour in comparison with dentin.

paediatric dentist for baby tooth nerve

Let’s dig deeper into the “dental pulp”!

As a unique tissue, the dental pulp has a crucial role in providing vitality to the tooth.

The dental pulp has many functions vital for the production and maintenance of our teeth, including:

formative, sensory, protective, nutritive, and reparative activities.

Pulp’s functions

  • Formative: formation of the dentin by odontoblasts
  • Sensory: the stimulation of the pulp caused by pain from trauma to the dentin or pulp
  • Protective: responding to stimuli such as pressure, heat, or cold
  • Nutritive: nourishing the dentin and maintaining the integrity of the pulp, keeping the tooth moisturized
  • Repairative: producing new dentin by the odontoblasts when needed

What may compromise the integrity of the pulp?

Caries, trauma, erosion, and some dental treatments may compromise the integrity of the pulp and cause injuries to the pulp.

Dental Caries

  • dental caries involving the pulp
  • dentin caries with or without symptoms
  • pulpitis (reversible or irreversible)


  • enamel–dentin without pulp exposure
  • enamel and dentin fracture with the exposure of the pulp
  • root fracture
  • displacement injuries also called luxation injuries


  • high levels of acid in a daily diet
  • Gastro-Oesophageal Reflux Disorder (GORD)

Dental treatment

  • badly-sealed restorations
  • excessive dentin removal

What is pulpitis?

Now that we know different parts of a tooth and their functions, it’s time to see what is damaged.


As mentioned before, your tooth enamel cannot be regenerated, and it needs to be protected against bacteria and erosion. Moreover, enamel erosion can start all other dental issues and mean that your tooth is now more prone to cavities or tooth decay. 


Tooth decay or caries can pass through enamel by destroying its minerals and reaching the tooth’s dentin. Because dentin is softer and more sensitive than enamel and not as mineralized, caries will progress faster in dentin than in enamel when they reach this stage. Most tooth sensitivity occurs at this stage since the dentin’s tubules are connected to the nerve ending inside the pulp.

When bacteria have bypassed the other layers and got into your dental pulp, it causes a painful dental condition called “pulpitis,” which is the inflammation of your dental pulp.


Tooth sensitivity means experiencing feelings of pain and discomfort while teeth are exposed to hot or cold foods or drinks, cold air, or sweet foods, and beverages.

What are the most common causes of pulpitis?

Several factors can cause pulpitis, including:

  • Enamel fracture
  • A cracked tooth (cracked tooth syndrome)
  • Trauma to the tooth
  • Injuries to the tooth
  • Deep cavities or tooth decay
  • Grinding or clenching the teeth
  • Some invasive dental procedures

What are the most common symptoms of pulpitis?

Symptoms of reversible and irreversible  pulpitis include:

  • Tooth sensitivity; a sensitive tooth to touch, cold, heat, or sugary foods
  • Intense pain throbbing
  • Inflammation
  • Tooth abscesses
  • Fever
  • Swelling in the face

Types of pulpitis

The inflammation of the dental pulp or pulpitis is either:  reversible or irreversible.

Reversible pulpitis

In reversible pulpitis, the inflammation of the pulp is mild, and the pain is temporary and will disappear when the trigger is gone. The cavity is not too deep yet in this condition, and the pulp is still healthy enough to be saved.

Irreversible pulpitis

Irreversible pulpitis is when the pulp is significantly inflamed, and the infection has damaged the nerve beyond repair.

You will experience severe pain and discomfort in this condition, and the pain is no longer short-lived. The pain lingers with irreversible pulpitis even minutes after the trigger is gone.

Your tooth pulp cannot be saved with irreversible pulpitis.

What is pulp therapy?

Pulp therapy is a dental procedure performed to restore and maintain an affected primary or permanent tooth. Here we will focus on primary teeth. 

What is the goal of pulp therapy?

As mentioned previously, the pulp is in charge of providing our teeth with a blood supply of oxygen and nutrients. Therefore, saving the pulp (pulp therapy) is integral for maintaining the integrity of the teeth and their supporting tissues. 


Pulp therapy is also performed to prevent malocclusion, which may be caused by the premature loss of primary teeth, prevent shortening of the arch length, and provide aesthetics.


Loss of premature primary teeth should be prevented as much as possible since baby teeth are considered space maintainers for permanent teeth that require sufficient space to emerge properly.

What happens if pulp therapy is not provided?

If left untreated, a diseased pulp may cause several inconveniences for the person, such as:

  • pain and discomfort
  • loss of appetite
  • abscess
  • reduced quality of life, including poor eating and sleeping, and lack of concentration
  • poor general health
  • increased risk of losing primary teeth (premature loss of baby teeth)

The decision of treatment for pulp therapy 

Depending on the positioning of the tooth and its ability to be restored, the health status of the pulp tissue, severity of the infection, general health of the kid, the kid’s age, and cooperation level, the dentist will decide to perform pulp therapy or have the affected tooth extracted.


The nature of the treatment will be determined by the amount and location of pulp damage.

The clinical pulpal diagnosis

The clinical pulpal diagnosis may include:

  • the patient’s comprehensive medical history
  • reviewing the patient’s past and present dental history
  • reviewing the patient’s signs and symptoms
  • evaluating the affected area and asking the patient about their chief complaint
  • performing some sensibility tests
  • extraoral examination
  • intraoral soft and hard tissues examination
  • taking radiographs

Extraoral examination

The extraoral examination can include the following:

  • infection of facial tissues (facial cellulitis)
  • facial swelling
  • facial redness
  • complete or incomplete eye closure
  • difficulty opening the mouth

Intraoral examination

The intraoral examination may include the following:

  • abscess and sinus tract formation
  • swollen vestibule
  • presence of proximal caries lesions between the patient’s teeth
  • mobility
  • A percussion-sensitive tooth

Vital Pulp Therapy Vs. Non-Vital Pulp Therapy

Vital Pulp Therapy is mainly performed to maintain the tooth’s vitality and preserve the pulp tissue.

The treatment is expected to result in pulp healing and reparative dentin formation. Vital pulp therapy (VPT) is usually done when an appropriate coronal seal can be provided.

Non-Vital Pulp Therapy

During non-vital pulp therapy, the entire pulp will be removed from the tooth. Pulpectomy and tooth Extraction are two forms of non-vital pulp therapy.

Types of vital pulp therapy:

Indirect pulp capping

The procedure is performed on a tooth with a deep carious lesion close to the pulp with no signs of visible exposure and pulp degeneration.

The purpose of indirect pulp capping is to:

  • protect the pulp from further injury
  • retain the tooth
  • stop the carious lesion from progressing (prevent cavities from getting bigger)
  • encourage root development

Indirect pulp capping procedure

a single-visit 

  1. The dental expert will remove as much of the carious lesion as possible without exposing the pulp.
  2. A protective layer of sedative material will be placed over the dentin layer in the deepest aspect of the preparation.
  3. The dentin will be covered with a seal, and a filling will be used to seal the tooth.

Indirect pulp capping procedure

a single-visit 

  1. The dental expert will remove as much of the carious lesion as possible without exposing the pulp.
  2. A protective layer of sedative material will be placed over the dentin layer in the deepest aspect of the preparation.
  3. The dentin will be covered with a seal, and a filling will be used to seal the tooth.

two-step procedure

  1. During this procedure, all carious enamel will be removed; however, the carious dentin near the pulp will be left in place.
  2. The tooth will be covered with a seal and a provisional restoration. (a temporary filling)
  3. The dental expert will remove the remaining caries and the provisional restoration on the second office visit and add the filling.

Indirect pulp capping materials

The dental expert may decide to use one of the following materials for indirect pulp capping:

  • resin-modified glass ionomer
  • dentin-bonding agent
  • calcium hydroxide
  • mineral trioxide aggregate
  • glass ionomer

An indirect pulp cap can prevent more invasive procedures such as tooth extraction or a pulpotomy.


Indirect pulp capping can be completed in one or two appointments.


While direct pulp capping is performed, if the tooth pulp has been completely exposed, indirect pulp capping will be done to treat an unexposed pulp.


Pulp cap treatment is preferable to most people since it’s less expensive and invasive than root canal therapy.

Direct Pulp Capping

Direct pulp capping is typically done in case a pulp with no inflammation is exposed. Therefore, the treatment won’t be performed in case of a carious exposure of pulp.


Direct pulp capping is not recommended in primary dentition.

The direct pulp therapy procedure

  1. The dental professional will remove the exposed pulp tissue by drilling the cavity.
  2. The site will then be cleaned. (irrigation with sterile, isotonic saline will be used to stop the bleeding)
  3. The exposed pulp will be covered by a paste of calcium hydroxide or bio-silicate material and water to prevent bacteria from entering the pulp.
  4. Then the dentist will use cement to cover the capping material.
  5. In the end, the dental expert will place a temporary or permanent filling on the tooth.


Pulpotomy refers to a dental procedure performed to treat a badly decayed tooth with an inflamed coronal pulp.

Suppose tooth decay has extended to the pulp (pulpitis). In that case, your dental professional may decide to carry out pulpotomy to remove the infected pulp from the tooth’s crown and save the decayed tooth.

During a pulpotomy, the pulp in the root canal is left intact, and the pulp within the crown is removed.

Pulpotomy is a  vital pulp therapy for primary teeth when the pulp root is intact and not decayed and destroyed by trauma or caries.

Pulpotomy is primarily performed on baby teeth since the procedure does not affect the tooth’s root, and the roots can grow.

What is the difference between a pulpotomy and a pulpectomy?

The difference between a pulpotomy and a pulpectomy is described by Dr Ellie Nadian a Paediatric dentist in Brisbane. If the infection has affected the pulp in the root (irreversible pulpitis), the pulp in the tooth is severely damaged and cannot be saved by pulpotomy. In this case, dentists may need to have the tooth extracted or perform a pulpectomy to remove all of the pulp.

During a pulpectomy, the pulp in the root of the tooth will be completely removed.

A pulpectomy is a type of non-vital pulp therapy for primary teeth that is performed when the entire pulp, including pulp in the roots, is removed because of severe infection in the tooth or traumatic injury.

Can pulpotomy be performed on permanent teeth too?

Pulpotomy is often done to treat a decayed primary tooth; however, it can also be performed for secondary teeth for children and adults as long as there is enough healthy pulp in a tooth to keep it vital.

What does the procedure involve?

Your paediatric dentist in Brisbane will usually start by discussing sedation options for your child and offers the best choice before beginning the procedure.

Here you can see a typical pulpotomy procedure in a dental clinic:

  • First, a topical anesthetic will be administered to numb the area around the tooth, and then a local anesthetic will be used.
  • After singling out the target tooth, the dental expert will remove the decayed area of the tooth using a drill.
  • Then the dentist will drill through enamel and dentin to open the pulp chamber and expose the pulp.
  • Next, the infected part of the pulp in the crown will be scooped out and removed with a spoon excavator.
  • The remaining pulp and tooth will be sterilized with special medication.
  • Then dental cement will be used to seal the remaining tooth.
  • After sealing the tooth’s pulp chamber, a right-sized stainless steel crown will be used as an outer surface to restore the tooth.

Who is a good candidate for a pulpotomy?

If the inflamed pulp is confined only to the crown and has not affected the pulp in the root, the patient may be a good candidate for a pulpotomy. Therefore, if your child’s tooth is too damaged to be saved, the dentist will have to extract the tooth, and pulpotomy will no longer work out. 


Besides, your little one needs to be in proper overall health to qualify for a pulpotomy. Unfortunately, kids with chronic health conditions such as leukemia or immunosuppressive diseases do not qualify for a pulpotomy treatment because they are more susceptible to bacterial infections. 

What is the difference between a pulpotomy and a root canal?

While pulpotomy and root canal therapy are both dental procedures performed to save a tooth, the two differ in some ways. 


Pulpotomy is performed to save a tooth with reversible pulpitis when the infection has not damaged the pulp in the root, and only the decayed part of the pulp within the crown is removed; so the tooth and a part of the pulp are still savable.


During root canal therapy, both the nerve and all the infected pulp inside it will be removed. Root canal therapy is a more invasive dental procedure than pulpotomy and is mainly performed on secondary teeth for adults.


During a pulpotomy, the root pulp is left untouched.

There will be cleaning, shaping, or filling the hollow canal after root canal therapy while none is needed after a pulpotomy.

Is pulpotomy safe?

Pulpotomy is considered a safe dental procedure with minimal risks and complications. Pain and discomfort are common side effects of the procedure, which your kid’s pediatric dentist will usually manage by prescribing appropriate OTC pain relievers.

Is pulpotomy painful?

To make sure your kid will go through little to no pain during the procedure, dental experts will use a local anesthesia injection or some form of sedation as an alternative before they begin the treatment.

How long does it take to have a pulpotomy at the dentist?

Although the length of the procedure may vary from person to person, a typical pulpotomy may take between 30 to 45 minutes. 


Your child will be monitored for 30 minutes to 1 hour in the office before being released if they have received anesthesia or light sedation.

Slight bleeding and discomfort are natural after a pulpotomy.

It is recommended to have a soft diet for a couple of days following pulpotomy treatment on a tooth