Pulpotomy Primary Teeth

Primary teeth serve as natural space maintainers for the permanent teeth developing beneath them. Premature loss of a primary molar can cause adjacent teeth to drift, permanent teeth to become impacted, and significant orthodontic crowding. Pulp therapy preserves the tooth's function and space-holding role until natural exfoliation at the appropriate age.

A pulpotomy removes the infected pulp tissue from the crown of the primary tooth while preserving the healthy pulp in the roots. A medicament (MTA, Biodentine, or ferric sulfate) is placed over the root canal openings, and a stainless steel crown is placed to protect the tooth. The procedure takes about 30 minutes and the tooth remains functional.

A pulpotomy removes only the coronal pulp and preserves the root pulp when it is healthy. A pulpectomy removes all pulp tissue from the crown and root canals — it is performed when the infection has spread into the roots. Pulpectomy fills the canals with a resorbable paste that dissolves as the permanent tooth erupts.

No. The procedure is performed under local anesthesia, and your child should not feel pain during treatment. For anxious children or those too young to cooperate, IV sedation provides a safe, comfortable experience. Post-operative discomfort is mild and typically managed with children's ibuprofen for a day or two.

A stainless steel crown is a pre-formed metal cap that covers the entire primary tooth after pulp therapy. It is needed because the tooth has been weakened by both the cavity and the access opening for the pulpotomy. The crown protects the tooth from fracture and prevents bacteria from re-entering the treatment site. It falls out naturally when the baby tooth exfoliates.

Pulp therapy on primary teeth is most common between ages 3 and 10, when primary molars are most susceptible to deep cavities. Young permanent teeth (ages 6 to 15) may need pulp therapy after trauma or deep decay. The exact timing depends on the child's cavity risk, oral hygiene, and dental development.

The resorbable paste used to fill primary tooth canals (typically zinc oxide-eugenol) dissolves gradually as the permanent tooth develops and the primary tooth root resorbs. By the time the baby tooth is ready to exfoliate, the filling material has largely resorbed, allowing normal shedding and permanent tooth eruption.

Yes. If a primary tooth abscess is left untreated, the infection can damage the developing permanent tooth bud located directly beneath it — potentially causing enamel defects, malformation, or eruption problems. This is one of the most important reasons to treat primary tooth infections promptly rather than simply waiting for the tooth to fall out.

Yes. IV sedation is administered by a trained provider who continuously monitors your child's vital signs, oxygen saturation, and breathing throughout the procedure. It provides a calm, comfortable experience and is particularly appropriate for very young children, anxious children, or those needing treatment on multiple teeth in one visit.

Apexogenesis is the continued development of an immature permanent tooth root after vital pulp therapy. When the pulp is preserved through pulpotomy with MTA, the vital root pulp continues to deposit dentin (thickening the root walls) and guides the root apex to close normally. This produces a strong, fully developed tooth — the best possible outcome for an immature permanent tooth.

Reimplant the tooth immediately if possible (hold it by the crown, not the root), or store it in milk, and get to our office within 30 minutes. Time is critical for the survival of the periodontal ligament cells. We provide emergency treatment for dental trauma including splinting, root canal treatment, and long-term monitoring for complications.

Signs include toothache (especially at night), sensitivity to hot or cold, swelling of the gum near a specific tooth, a darkened tooth, pain when chewing, and a pimple-like bump on the gum. However, some children show no symptoms until the infection is advanced. Regular dental checkups with radiographs detect deep cavities before they reach the nerve.

Formocresol is a traditional medicament that was the standard for primary tooth pulpotomy for decades. While it remains effective, concerns about its formaldehyde content have led most pediatric endodontists to prefer biocompatible alternatives like MTA, Biodentine, and ferric sulfate. At our office, we use MTA and Biodentine as our primary pulpotomy materials.

A successfully treated primary tooth remains functional until its natural exfoliation time — which varies by tooth but is typically between ages 9 and 12 for primary molars. Published studies show pulpotomy success rates exceeding 95 percent with MTA at 24-month follow-up, and most treated teeth survive until normal shedding.

Yes. Pulpotomy, pulpectomy, and stainless steel crowns on primary teeth are covered under pediatric dental benefits in most insurance plans. Many plans cover pediatric dental at 100 percent under preventive and restorative categories. We verify your child's benefits before treatment and explain any expected out-of-pocket costs.