A pulpotomy is a dental procedure that removes the infected or inflamed portion of a tooth’s pulp (the soft tissue inside the tooth) while preserving the healthy pulp in the roots. It’s most commonly performed on baby teeth in children, though it can occasionally be done on permanent teeth. Think of it as a partial root canal: instead of clearing out all the living tissue inside a tooth, the dentist removes only the damaged top portion and places a protective material over what remains.
Why Baby Teeth Need Saving
If your child has a deep cavity in a baby tooth, you might wonder why the dentist doesn’t just pull it out since a permanent tooth will eventually replace it. The answer is that baby teeth serve as placeholders. They guide the permanent teeth into the correct position and help your child chew and speak normally during critical years of development. Losing a baby tooth too early can cause neighboring teeth to drift, leading to crowding or alignment problems when adult teeth come in.
A pulpotomy preserves that placeholder function. It’s less invasive, less time-consuming, and less costly than a full pulpectomy (which removes all the pulp, including in the roots). Because the procedure is shorter, it also tends to be easier on young children who may struggle to sit still in the dental chair.
When a Pulpotomy Is Recommended
The American Academy of Pediatric Dentistry recommends pulpotomy for primary teeth with a normal pulp or mild, reversible inflammation. The classic scenario is a baby molar with a large cavity that has reached or nearly reached the pulp chamber. Your child might complain of a toothache that comes and goes, especially with hot, cold, or sweet foods, but the pain doesn’t linger for long periods on its own.
A key factor is that the remaining root pulp must still be healthy. During the procedure, the dentist checks for signs of vitality: if the tissue bleeds normally and the bleeding can be controlled, that’s a good indicator the root pulp is salvageable. Recent research has also shown promising results using pulpotomy on primary molars with more severe symptoms, expanding the range of teeth that may benefit from this approach rather than requiring full pulp removal or extraction.
X-rays taken beforehand help the dentist look for warning signs like bone loss around the roots or abnormal root resorption that might indicate the infection has spread too far for a pulpotomy to work.
What Happens During the Procedure
The tooth is numbed with local anesthetic, just like a filling. For very young or anxious children, sedation or general anesthesia may be used. Once the area is numb, the dentist removes the decayed tooth structure and opens the pulp chamber to expose the damaged pulp tissue inside the crown of the tooth.
Using a specialized instrument, the dentist scoops out the inflamed coronal pulp, leaving the healthy root pulp intact. Small cotton pellets are then placed over the exposed pulp stumps to stop the bleeding. Achieving this bleeding control is a critical step, because it confirms the remaining tissue is healthy enough to heal.
Once bleeding stops, the dentist places a medicated material directly over the pulp stumps. This material acts as a barrier, encouraging the tissue underneath to heal and form a protective bridge. The tooth is then built back up with a filling material and, in most cases on primary molars, capped with a stainless steel crown to protect it until the permanent tooth is ready to come in. The entire visit typically takes one appointment.
Materials Used to Cap the Pulp
The material placed over the exposed pulp stumps matters quite a bit for long-term success. A biocompatible cement called mineral trioxide aggregate (MTA) has become the gold standard. In a comparative study tracking outcomes over two years, MTA achieved a 94% overall success rate at 24 months. Laser-assisted pulpotomy came in at 89%, while an older chemical agent called formocresol trailed at 75%.
Complication rates told a similar story. In the same study, formocresol was associated with 10 cases of infection around the root tips, 8 cases of internal root breakdown, and 6 cases of bone changes near the roots out of 60 teeth. MTA had just 3, 2, and 2 cases respectively. Because of these differences, many pediatric dentists have moved away from formocresol in favor of MTA or similar bioactive materials.
Recovery and What to Expect After
Recovery from a pulpotomy is straightforward. Most children feel back to normal within a few hours once the numbness wears off. Some mild soreness or sensitivity around the treated tooth is common for a day or two, and over-the-counter children’s pain relief is usually enough to manage it. Your child can eat and drink normally once the anesthetic has fully worn off, though sticking to softer foods for the rest of that day is a good idea.
There’s generally no need to miss school or activities beyond the appointment itself. If the tooth was capped with a stainless steel crown, your child might notice the new feel of the crown against their tongue or cheek for a few days, but they’ll adapt quickly.
Signs of Failure to Watch For
Pulpotomy success rates are high, but no procedure works 100% of the time. Keep an eye out for these warning signs in the weeks and months that follow:
- Persistent or returning pain that doesn’t improve with time
- Swelling in the gums near the treated tooth
- A small bump or boil on the gum (called a sinus tract), which can indicate an abscess
- Pus discharge around the tooth
- Tooth discoloration, particularly darkening
- Sensitivity to pressure or temperature that wasn’t there before
If any of these appear, contact your child’s dentist. A failed pulpotomy usually means the infection has spread into the root pulp, and the tooth may need a full pulpectomy or extraction at that point. Your dentist will take X-rays to check for internal root resorption or infection around the root tips before deciding on next steps.
Pulpotomy vs. Pulpectomy
The difference comes down to how much pulp is removed. A pulpotomy takes out only the pulp in the crown of the tooth, leaving the root pulp alive. A pulpectomy removes all the pulp, crown and roots, similar to a root canal on an adult tooth. The empty root canals are then filled with a resorbable paste so they don’t interfere with the permanent tooth growing underneath.
Dentists choose a pulpotomy when the root pulp is still healthy. They escalate to a pulpectomy when the infection has spread deeper, or when the tooth shows signs of irreversible damage like spontaneous pain that lingers, swelling, or X-ray evidence of bone loss around the roots. A pulpotomy is quicker, simpler, and preserves more of the tooth’s natural structure, which is why it’s the first-line option when the diagnosis supports it.
Cost
A pulpotomy is one of the more affordable restorative dental procedures. Costs typically range from about $80 to $300 or more depending on the tooth, your location, and whether sedation is needed. Most dental insurance plans that cover pediatric care include pulpotomies, though your out-of-pocket share will depend on your specific plan. If a stainless steel crown is placed afterward, that’s usually billed separately. Ask your dentist’s office for a predetermination from your insurance before the appointment so you know what to expect.