- A pulpotomy removes the affected nerve tissue from the top of a baby tooth so the tooth can be saved.
- It is usually followed by a crown, and the tooth still falls out on its normal schedule.
- Children needing several treatments can have them done in one visit under general anesthesia.
If your child's dentist has recommended a pulpotomy, you may be hearing the word for the first time. It is often called a "baby root canal," and it is one of the most common ways pediatric dentists save a baby tooth with a deep cavity. Here is what it involves and why it matters.
What is a pulpotomy?
Every tooth has soft tissue inside called the pulp, which contains the tooth's nerve and blood vessels. When a cavity grows deep enough to reach the pulp, bacteria can irritate or infect it.
In a pulpotomy, the dentist removes the affected pulp from the crown (the top part) of the tooth, leaves the healthy pulp in the roots, and places a medicated material to protect what remains. The tooth is then sealed and, in most cases, covered with a crown.
Why would a baby tooth need one?
Baby teeth have thinner enamel and relatively large pulps, so decay can reach the nerve faster than in adult teeth. A pulpotomy may be recommended when:
the decay reaches, or comes very close to, the pulp.
a broken tooth has left the pulp exposed.
the pulp in the roots still looks healthy on exam and X-rays.
Your dentist decides based on the exam, X-rays, and your child's symptoms. If infection has spread into the roots, a different treatment may be needed (see below).
Pulpotomy vs. root canal vs. pulpectomy
removes only the pulp in the crown of the tooth. The root pulp stays. This is the most common nerve treatment for baby teeth.
removes the pulp from both the crown and the roots, then fills the canals with a material that dissolves naturally as the baby tooth gets ready to fall out. It is used when the root pulp is also affected.
also removes all of the pulp, but the canals are filled with a permanent material, because an adult tooth needs to last a lifetime.
You can read more on our pulpotomy and pulpectomy page.
Why save a baby tooth instead of pulling it?
Baby teeth help children chew, speak clearly, and hold space for the adult teeth underneath. Some baby molars stay in place until around age 10 to 12. Losing one early can let nearby teeth drift into the gap, which may affect how adult teeth come in. When a tooth can be saved, keeping it is usually the better option. When it can't, the dentist may recommend an extraction and, in some cases, a space maintainer.
What happens during a pulpotomy?
the tooth is numbed so your child does not feel pain. Depending on your child's age, needs, and how much treatment is planned, sedation or general anesthesia may be used.
the dentist cleans out the cavity and the affected pulp in the crown of the tooth.
a medicated material is placed over the remaining pulp, and the tooth is sealed.
a crown is placed to hold the tooth together. On back teeth, this is often a stainless steel crown; tooth-colored zirconia crowns are another option for some teeth.
A pulpotomy is often needed alongside other treatment, because a child with one deep cavity frequently has others. For young children or kids who need several teeth treated, many families choose to have everything completed in one visit under general anesthesia. At littleGRINS, this care takes place in a hospital or surgical-center operating room, with a board-certified medical anesthesiologist caring for your child throughout.
Is a pulpotomy painful?
The procedure itself should not hurt, because the tooth is numb. Afterward, some children have mild soreness of the tooth or gums for a day or two. This is usually managed with the over-the-counter pain reliever your dentist or pediatrician recommends, at the dose right for your child's age and weight.
Caring for your child afterward
while the numbness wears off, which can take a few hours.
and avoid very sticky or hard foods on the crowned tooth.
including gently around the crown, with a fluoride toothpaste.
so the dentist can monitor the tooth on X-rays over time.
If your child had treatment under general anesthesia, see our guide to what to expect before and after surgery.
Will the tooth still fall out normally?
Yes. A baby tooth that has had a pulpotomy and a crown is expected to loosen and fall out on its normal schedule as the adult tooth comes in underneath.
When to call a pediatric dentist
Call your child's dentist if you notice swelling of the face or gums, a pimple-like bump on the gum near the tooth, a fever, pain that gets worse instead of better, or a crown that comes loose. If your child's dentist has recommended pulpotomies or other extensive treatment, request a free consultation with littleGRINS. We'll review the treatment plan and explain how care under sedation works at a location near you.
This article is general information and does not replace an exam by your child's dentist or pediatrician.
Published by the littleGRINS pediatric dental team. This article is general information and does not replace an exam by your child's dentist.