A pulpotomy is a treatment that saves a baby tooth when decay has reached the nerve. The dentist removes the damaged pulp in the crown of the tooth, leaves the healthy pulp in the roots, places a medicated filling and usually finishes with a crown.
Parents often hear the phrase "baby root canal" and picture something much bigger than it is. A pulpotomy is a focused procedure that relieves pain, stops infection from spreading and keeps the tooth working until it is ready to fall out on its own. Here is what it involves, why it is recommended and what recovery looks like for your child.
Every tooth has a hard outer layer of enamel, a softer layer of dentin beneath it and, at the center, the pulp. The pulp holds the nerve and blood supply. In the crown of the tooth it sits in a chamber, and from there it runs down through the roots.
Baby teeth have thinner enamel and dentin than adult teeth, and their pulp chamber is large compared with the size of the tooth. That means a cavity can travel from the surface to the nerve faster than many parents expect. Once bacteria reach the pulp, the tissue becomes inflamed or infected, and a filling alone is no longer enough to fix the problem.
Some children have clear symptoms, and some have very few. Signs that decay may be close to the nerve include:
Swelling or a fever with tooth pain needs prompt attention. Our guide to whether your child's toothache is an emergency explains how to tell what can wait for a regular visit and what cannot. Just as important, deep decay is sometimes found with no symptoms at all during a routine exam, which is one more reason checkups matter.
The decision starts with an exam and x-rays. Your child's dentist looks at the tooth and reviews the images to confirm that the decay has reached the pulp and that the healthy tissue in the roots can be saved. If you have questions about imaging, our post on dental x-ray safety for children covers how they are used.
If the decay is shallow, a simple filling is often enough. If the infection has spread through the roots, a different treatment may be needed. A pulpotomy sits in the middle: the nerve in the crown is damaged, but the roots are still healthy. Your dentist will explain which situation your child is in and why.
The two treatments are related, which is where the nickname comes from, but they are not the same procedure. Here is how they compare:
For many baby teeth with deep decay, a pulpotomy is the option that keeps the tooth while treating the problem.
It is a fair question, since baby teeth fall out eventually. The answer is that they have important jobs until then. Baby teeth hold space for the adult teeth developing underneath. When one is lost early, nearby teeth can shift into the gap, which can lead to crowding when the permanent tooth tries to come in.
Baby teeth also help your child chew and speak until the adult teeth are ready, and the last baby teeth fall out around ages 12 to 14. Treating the tooth instead of pulling it keeps it in place to hold space and support healthy chewing. Removing damaged tissue early also helps stop infection before it reaches the root or the developing adult tooth below. The same reasoning is behind our answer to whether cavities in baby teeth need to be filled.
First, the tooth is numbed. For children who are anxious or need more extensive care, sedation is available, from nitrous oxide (laughing gas) to oral conscious sedation. You can learn more on our pediatric sedation page.
Once your child is comfortable, the dentist removes the decay, then removes the damaged pulp in the crown of the tooth. The area is cleaned and treated with a medicated filling that protects the healthy pulp in the roots. Most teeth are then covered with a crown to protect them from breaking. Our pediatric pulpotomy page walks through each step.
It helps to prepare your child in simple, calm terms. Tell them the dentist is going to fix a tooth that has a sore spot and make it strong again. Skip scary words like shot, drill or pull, and let our team explain each step in words your child understands. We move at their pace, and you are welcome to ask questions at any point.
A tooth that needed a pulpotomy has usually lost a good deal of its structure to decay, and the remaining walls can be fragile. A crown covers the whole tooth, so it can handle chewing and the bumps of an active childhood without cracking.
Pediatric crowns are built to protect a damaged baby tooth until the adult tooth is ready. Caring for one is simple: brush and floss around it just like a natural tooth, and limit sticky candies that can pull on it. We check it at your child's regular visits to make sure it is holding up well.
Your child may feel some tenderness after treatment. It usually responds to over-the-counter pain relief. Stick to soft foods until the numbness wears off, so your child does not accidentally bite their cheek or tongue. After that, most kids can return to their normal diet.
We will check the treated tooth at future visits. Keep up with brushing twice a day and flossing, and keep sugary snacks and drinks to mealtimes, so the tooth stays healthy until it falls out naturally and the adult tooth comes in.
The tooth is numbed first, so most kids feel little to no discomfort during treatment, and sedation is available for anxious children. Some tenderness afterward is normal and usually eases with over-the-counter pain relief.
It depends on the tooth and your child's needs. Your dentist will give you a time estimate when the treatment is planned.
Yes. A baby tooth treated with a pulpotomy and crown is designed to stay in place until the adult tooth is ready, then come out on its natural schedule.
Stick to soft foods while the mouth is still numb, since kids can easily bite a cheek or tongue they cannot feel. Once sensation is back, most children return to their usual meals, with sticky candy kept to a minimum to protect the new crown.
If your child has a toothache or a deep cavity, our board-certified pediatric dentists can examine the tooth, explain every option in plain language and help your child feel at ease. Request an appointment with 4S Pediatric Dentistry & Orthodontics in San Diego.
