Pulp Therapy in Baby Teeth: Pulpotomy and Pulpectomy

Inside every tooth lies the pulp, the living tissue of nerves and blood vessels. When deep decay reaches the pulp of a baby tooth, the tooth does not have to be pulled. Pulp therapy saves it: a pulpotomy removes only the infected pulp from the crown and keeps the healthy root pulp alive, while a pulpectomy removes all the pulp from crown and roots, like a miniature root canal.

This matters because baby teeth are space holders for permanent teeth. Losing a molar years early lets neighboring teeth drift into the gap, causing crowding that later needs braces. Saving the tooth with pulp therapy is usually cheaper, kinder, and better for development than extraction plus a space maintainer.

Key Concepts

• Pulp: the soft living tissue inside the tooth containing nerves, blood vessels, and connective tissue.
• Reversible pulpitis: mild pulp inflammation that settles once decay is removed; the pulp can be saved.
• Irreversible pulpitis: severe inflammation with spontaneous or night pain; the affected pulp must be removed.
• Pulpotomy: removal of coronal (crown) pulp only; the root pulp is medicated and kept vital. Medicaments include MTA, ferric sulfate, and formocresol.
• Pulpectomy: complete pulp removal and filling of the canals with a resorbable paste such as zinc oxide eugenol, which disappears as the root naturally resorbs.
• Hemostasis: stopping pulp bleeding with gentle pressure; bleeding that stops within about 5 minutes signals the remaining pulp is healthy.

How It Works

A pulpotomy proceeds step by step:

1. Local anesthesia is given and a rubber dam isolates the tooth from saliva.
2. All decay is removed and the pulp chamber is opened.
3. The infected coronal pulp is lifted out with a spoon excavator.
4. A moist cotton pellet presses on the root pulp stumps; bleeding should stop within about 5 minutes.
5. A medicament such as MTA is placed over the healthy root pulp to protect it.
6. The tooth is sealed and covered with a stainless steel crown, because pulp-treated teeth are brittle.

Worked Example

A lower baby molar needs a pulpectomy. The X-ray shows the root canal working length is 10 mm. The dentist subtracts a 1 mm safety margin to avoid injuring the developing permanent tooth sitting just below the root tip, so the filling length is 10 − 1 = 9 mm. The resorbable paste is packed to exactly 9 mm. Over the next 3 years the baby root naturally dissolves to make way for the permanent tooth, and the paste dissolves along with it instead of blocking eruption.

Common Misconceptions

• A root canal on a baby tooth is pointless. Wrong. It keeps the tooth working for its remaining years, often 3 to 6 years of chewing and space holding.
• Pulpotomy and pulpectomy are the same thing. Wrong. Pulpotomy keeps the root pulp alive, while pulpectomy removes all pulp tissue from the roots.
• The filling paste will block the permanent tooth. Wrong. Only resorbable pastes are used in baby teeth, and they vanish as the root resorbs.

Real-World Applications

• Pediatric dentists perform pulpotomies daily on 3- to 8-year-olds with deep cavities.
• Traumatized front teeth with pulp exposure are saved with partial pulpotomy instead of extraction.
• Saving teeth with pulp therapy often avoids hospital treatment under general anesthesia.

Pulp therapy proves that a deeply decayed baby tooth is not automatically a lost tooth. By removing only the diseased pulp and protecting what is healthy, dentists keep the tooth chewing, smiling, and holding space until the permanent tooth is ready to take its place.