A pulpotomy is a dental procedure that removes damaged or infected tissue from the upper portion of a tooth while leaving the healthy root tissue intact. It’s one of the most common treatments in pediatric dentistry, typically performed on baby teeth with deep cavities, though it’s increasingly used on permanent teeth as well. Think of it as a partial root canal: instead of clearing out the entire tooth’s nerve and blood supply, the dentist removes only the portion affected by decay and seals the rest to heal on its own.
How a Pulpotomy Works
Every tooth has a soft core called the pulp, which contains nerves, blood vessels, and connective tissue. When a cavity grows deep enough to reach this pulp, bacteria can cause inflammation or infection. A pulpotomy targets only the pulp inside the crown (the visible part of the tooth), leaving the pulp in the roots undisturbed.
During the procedure, the dentist numbs the area, places a rubber sheet called a dental dam over the tooth to keep it dry, and drills a small opening to access the pulp. The inflamed or infected pulp in the crown is scooped out, and the dentist checks that the remaining root pulp looks healthy and that any bleeding stops within a few minutes. A medicated filling material is placed over the exposed root stumps to promote healing and prevent future infection. The tooth is then sealed with dental cement, and a crown is placed on top to protect it.
The whole visit is typically quick, and most children (or adults) don’t need time off from school or work afterward.
When a Pulpotomy Is Recommended
A pulpotomy is appropriate when decay has reached the pulp but the damage is limited to the crown of the tooth. The key factor is how the tooth responds to stimulation. If pain is triggered by something specific, like cold food or biting down, and goes away once the trigger is removed, the inflammation is considered reversible and the tooth is a good candidate.
Signs that point toward a pulpotomy rather than a more involved procedure include:
- Pain that’s provoked, not spontaneous. The tooth hurts when something touches it or when you eat something cold, but it doesn’t throb on its own.
- No signs of infection on X-rays. The roots look normal with no dark spots around the tips or between them, and no evidence of the root dissolving.
- Healthy root tissue. Once the dentist opens the tooth and removes the crown pulp, the remaining tissue should look pink and vital, without pus or tissue death.
If bleeding from the root stumps can’t be controlled within a few minutes, or if the root tissue appears dead or infected, the dentist will typically move to a pulpectomy (a full root canal) instead.
Pulpotomy vs. Pulpectomy
The difference comes down to how far the damage extends. A pulpotomy removes pulp from the crown only. A pulpectomy removes all the pulp, crown and roots included, essentially a full root canal. A tooth with spontaneous, unprovoked pain, swelling in the gums, a visible pimple-like bump near the tooth, unusual looseness, or X-ray evidence of infection at the root tips needs a pulpectomy. A pulpotomy won’t be enough because the infection has already spread beyond the crown.
Why It’s Common in Children
Baby teeth serve as placeholders for permanent teeth, so pulling a decayed baby tooth early can cause spacing problems and affect how adult teeth come in. A pulpotomy saves the tooth structure while removing the source of pain and infection, letting the baby tooth stay in place until it falls out naturally.
The procedure is also used on young permanent teeth that haven’t finished developing. In children and teenagers, permanent molars can take several years after eruption for their roots to fully form. A pulpotomy allows root development to continue, which strengthens the tooth long-term. In these cases, the procedure may serve as an interim step before more definitive treatment once the root matures.
Pulpotomy in Adult Permanent Teeth
Pulpotomies were traditionally reserved for baby teeth, but recent evidence supports their use in fully mature permanent teeth as well. The procedure works for adult teeth when inflammation is confined to the crown pulp. Even in cases once classified as irreversible pulpitis, where pain is strong and lingers for minutes after cold exposure, a full pulpotomy can succeed if bleeding from the root stumps can be controlled during the procedure. When bleeding can’t be stopped, it signals that inflammation has spread deeper into the roots, and a conventional root canal becomes necessary.
What Materials Are Used
The material placed over the exposed root tissue matters significantly for long-term success. Older techniques relied on a chemical called formocresol to essentially preserve the remaining pulp tissue in place. Newer biocompatible materials, particularly mineral trioxide aggregate (MTA) and a calcium silicate material called biodentine, work differently. Instead of fixing tissue chemically, they encourage the tooth to form a protective barrier of new hard tissue over the pulp.
The difference in outcomes is notable. At two years, MTA-based pulpotomies show a 95% clinical success rate compared to 80% for formocresol. Complication rates tell a similar story: formocresol-treated teeth developed internal root resorption (where the tooth begins dissolving from the inside) four times more often than MTA-treated teeth. Most pediatric dentists now prefer these newer materials.
Success Rates and What Can Go Wrong
Pulpotomies on baby teeth have strong outcomes. A recent meta-analysis of randomized trials found clinical success rates of about 98% at three months, 96.5% at one year, and 93% at two years. These numbers reflect the reality that some treated teeth will eventually develop problems, particularly as the years go on.
The most common complications include internal root resorption, where inflammation in the remaining pulp causes the root to slowly break down from within. This is painless and typically caught on follow-up X-rays. Other possible issues include infection developing around the root tips or between the roots. When a pulpotomy fails, the tooth usually needs either a pulpectomy or extraction.
Because these complications can develop without symptoms, follow-up X-rays at regular dental visits are important for monitoring treated teeth.
Recovery After the Procedure
Recovery is straightforward. The numbness from local anesthesia wears off within a few hours. Some mild soreness around the tooth is normal for a day or two. Children can generally return to eating once the numbness fades, though softer foods are easier on the tooth initially. The crown placed over the tooth protects it from further damage and restores normal chewing function.
Cost varies depending on location and whether the tooth is a baby tooth or permanent tooth, but a pulpotomy on a primary tooth typically runs between $80 and $300 before any crown placement. Dental insurance frequently covers the procedure for children, as it falls under preventive care aimed at preserving tooth structure.