In primary teeth, deep cavities can sometimes work their way down close to the roots.  This can cause the pulp to become so infected, that the entire tooth becomes threatened.  Once this condition results, there are only two courses of action: tooth extraction, or pulpotomy. 

A pulpotomy is an endodontic procedure that involves removing the dental pulp from the interior of the tooth.  The term endodontic is based on the Greek words endo (inside) and odons (tooth) and is one of the nine major forms of general dentistry practiced within the United States.  As its name indicates, it deals with working on the interior of teeth. 

A pulpotomy is most commonly done on a primary (baby) tooth that has become infected because of deep decay or a fracture in the tooth surface.  Once this decay reaches past the enamel and dentin and affects the pulp itself, the infection has to be removed. 

Many people wonder why tooth extraction is not an equally viable treatment for an infected primary tooth.  After all, baby teeth fall out and are replaced by permanent teeth.  Does it really matter if a child loses a primary tooth to infected pulp?

The answer is yes.  It is not so much the tooth itself we are dedicated to saving, but the appearance of the rest of the teeth around it.  When a gap results from a tooth extraction, surrounding teeth begin to grow toward that gap and shift into crooked patterns.  This will then require intervention that is much more expensive than a pulpotomy.  Either a space maintainer or dental bridge will be needed.  Otherwise, more than a simple tooth could eventually be lost, and permanent teeth that are emerging will have a much more difficult time growing

A pulpotomy involves removing all coronal pulp tissue from the crown.  The crown of the tooth is the visible portion of the tooth that rises above the gum line.  The pulp in the root canals, however, is left intact so it can continue to nourish tooth roots and nerves. 

The goal of a pulpotomy is to remove only the infected pulp within the crown, preserve as much of the tooth as possible, and leave healthy root canals intact.  Dentists make this procedure as comfortable as possible for children, and complete it in three simple steps: 

1.       The dentist first numbs the tooth and surrounding gum line so the child will feel no pain.

2.       He or she then places a rubber dam around the tooth so that it is isolated from the rest of the teeth.  A rubber dam works like a safety net that prevents tooth debris from falling backward into the throat.

3.       The dentist then creates an opening in the top of the tooth that reaches down into the pulp chamber.  He or she cleans out the nerve tissue and places a medicated packing material into the opening.  This packing may or may not be removed, depending on the state that the tooth is in.

4.       The tooth is then capped with a crown to seal and protect it.