Pulpotomy Treatment

The dental pulp is the innermost part of a tooth, and contains living connective tissues, blood vessels and nerves. The nerves within the pulp provide sensation to the tooth. Pain and other symptoms may indicate inflammation from things such as dental caries (tooth decay). A pulpotomy is a dental procedure carried out on a baby molar. It involves the removal of diseased parts of the tooth and pulp tissue, within the crown part of the tooth. The aim of it is to preserve good tooth structure and dental pulp, in order to maintain the tooth in a healthy and functional state until it is ready to fall out naturally and be replaced by the permanent tooth

A pulpotomy is done when there is dental decay affecting half way or more into a baby tooth as seen on an x-ray. Sometimes a large break in the tooth can be seen when looking in the mouth. X-rays show how deep the hole is as well as the remaining root lengths and root area. An examination and pain history of the tooth is needed to assess whether the tooth can be saved or not. There needs to be a decent amount of tooth structure and root length left for a pulpotomy and metal crown to be placed well.

1. Your child will be made comfortable in the dental chair, where they can watch something on the ceiling TV

2. Topical anaesthetic is placed on the gum to make the dental injection more comfortable. Their teeth and soft tissues will be numb for about 2-3 hours after the injection

3. A rubber dam is placed - a rubber sheet with holes placed over the teeth to isolate the tooth we will be working on. A metal ring holds it placed on the teeth. This step helps to protect the gums and tongue, control saliva, and reduce the risk of swallowing something

4. Infected tooth structure and soft decay are removed with hand-pieces. The top part of the pulp is cleaned out and medication is placed to control bleeding

5. The tooth is filled with a special material and a white filling is placed on top

6. The pulpotomy takes 1 hour to complete

What are the steps in placing a stainless-steel crown?

1. The tooth is prepared with a handpiece and shaped smaller to allow the crown to fit nicely over the tooth

2. The correct size of the crown is selected and cemented on.

3. The preparation and placement take 30-45 minutes.

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Are the pulpotomy and crown done together?

Ideally, yes. Once the pulpotomy is completed the tooth should be prepared for the crown placement in the same visit. When done together the procedure takes about 90 minutes. Alternatively, the pulpotomy can be done in a one-hour visit and then a second visit can be booked to prepare the crown placement. If done at a separate appointment an injection of local anaesthetic will be needed for comfort to numb the tooth and gums.

Why do you place a metal crown on after?

In order to achieve an adequate seal around the tooth and prevent further infection by bacteria, a stainless-steel crown is placed over the prepared tooth. This achieve a very good seal around the tooth and helps to prevent the tooth from further breakdown. After a procedure there is less structure and the tooth can become weaker, so a crown will help to keep the tooth intact and remain in the mouth until it is ready to naturally fall out.

There is a possibility that the pulp inside the tooth is necrotic (dead) or is more inflamed and affected than expected. If bleeding cannot be controlled it is a sign that inflammation has extended further into the pulp. If there is no bleeding at all within the pulp area it is a sign of a dead tooth. The tooth would need extraction in these cases. If left it can cause an infection and abscess to form in time, resulting in gum swelling and pain.