What is a pulpotomy on a baby tooth?
A pulpotomy is nerve treatment for a baby tooth, often called a 'baby root canal'. When decay reaches the pulp, the inflamed pulp in the crown of the tooth is removed, the healthy pulp in the roots is kept, and the tooth is sealed and restored, usually with a crown on back teeth. At Creative Arts in Dubai, the dentists who see children explain whether pulp treatment or extraction suits each tooth.
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What is a 'baby root canal', and why is it different?
Inside every tooth is the pulp: soft tissue with nerves and blood vessels that runs from a chamber in the crown down through the roots. Baby teeth have thinner enamel and relatively large pulp chambers, so decay can reach the pulp quickly, sometimes before a child complains of pain.
There are two main kinds of nerve treatment for baby teeth:
- Pulpotomy removes only the pulp in the crown of the tooth. It is used when decay has exposed the pulp but the pulp in the roots is still healthy. A medicated material is placed over the root pulp and the tooth is sealed. The American Academy of Pediatric Dentistry describes it as the treatment for a baby tooth where removing decay exposes the pulp and the remaining root pulp is judged to be vital.
- Pulpectomy removes the pulp from the crown and the roots, when it is irreversibly inflamed or has died. It is the closest thing to an adult root canal, but the canals are filled with a material that dissolves, because the roots of a baby tooth must be able to resorb as the adult tooth comes through.
Both aim to keep the baby tooth comfortable and working until it falls out naturally. Adult teeth with fully formed roots are treated differently; our root canal treatment guide covers that.
Pulpotomy, pulpectomy or extraction: which fits?
The choice depends on how healthy the pulp is, how much tooth is left, the roots, and how soon the tooth would fall out anyway. Only an examination with an X-ray can decide.
| Pulpotomy | Pulpectomy | Extraction | |
|---|---|---|---|
| Usually fits when | Decay reaches the pulp, the root pulp is still healthy and there are no signs of infection in the bone | The pulp is irreversibly inflamed or has died, but the tooth and roots can still be kept | Too little tooth is left, the roots are badly resorbed, infection cannot be controlled, or the tooth is close to falling out |
| What is removed | Pulp in the crown only | All of the pulp, crown and roots | The whole tooth |
| What goes inside | A medicated material over the root pulp | A resorbable filling in the canals | Nothing; the gum heals over |
| Afterwards | The tooth is restored, preferably with a crown on back teeth | The tooth is restored, usually with a crown on back teeth | The dentist checks whether space for the adult tooth needs to be kept |
| Main advantage | Keeps the tooth with the least treatment | Can keep a tooth that would otherwise be lost | Removes the problem in one step |
Your child's dentist explains which option they recommend for the specific tooth, and why, before anything is done. Treatment is set out in a written plan with the cost and alternatives.
Why not just take the baby tooth out?
Because many baby teeth stay in the mouth for years. A lower second baby molar, for example, is usually there until ten to twelve years of age; our baby teeth chart shows the typical timing for each tooth. Losing it early can mean:
- Lost space. Neighbouring teeth can drift into the gap, leaving less room for the adult tooth and making crowding more likely.
- Harder chewing on that side for a long time.
- An extraction for a young child, which is not always an easier experience than keeping the tooth.
But keeping a tooth is not always right. If the tooth is close to falling out, if the roots are already largely resorbed, if there is not enough tooth left to restore, or if infection in the bone cannot be controlled, extraction is often the more sensible choice. The AAPD guidance notes that extraction should be considered when there is excessive root resorption. A good recommendation weighs all of this rather than defaulting to either option.
Signs a child's tooth may need pulp treatment
Toothache that comes on by itself or wakes your child at night; pain that lingers after cold or sweet food; a large dark cavity; a small spot or 'pimple' on the gum near a tooth; or a tooth that has darkened after a knock. Facial swelling, fever or a child who is unwell with tooth pain needs prompt care the same day; see our page on toothache in children.
What happens during a pulpotomy?
A typical sequence. Many pulpotomies are done in one visit, together with the restoration.
Examination and X-ray
The dentist checks the tooth, asks about the pain and takes an X-ray to see the depth of decay, the roots and the bone around them.
AssessmentNumbing
Local anaesthetic numbs the tooth. For an anxious child, laughing gas may be discussed if it suits them.
StartRemoving decay and the crown pulp
Decay is cleaned away and the pulp in the crown is removed. The dentist checks how the remaining pulp looks; if it does not appear healthy, a pulpectomy or extraction may be the better option.
TreatmentMedicating and sealing
A medicated material is placed over the root pulp and the tooth is sealed so bacteria cannot leak back in.
TreatmentRestoring the tooth
Back teeth are usually restored with a crown, which seals and protects the tooth best; the dentist explains the restoration they recommend.
Same visit or soon afterReview
The tooth is checked at routine visits, sometimes with an X-ray, until it falls out naturally.
Follow-up
Told your child may need nerve treatment on a baby tooth? Children's dentistry at Creative Arts in Dubai explains the options, pulp treatment or extraction, in a written plan first.
See children's dentistryWhat is normal after a pulpotomy, and when should you call?
For a few hours the lip, cheek and tongue may stay numb. Children often bite or suck a numb lip without noticing, so keep an eye on them and offer soft food only once the feeling has returned; our guide to how long dental numbness lasts has more detail. The gum around a new crown can be a little tender for a day or two. If your child needs pain relief, ask a pharmacist or your doctor which one suits their age and weight, give it only as directed on the label, and never give aspirin to children under 16.
Call the clinic during opening hours, 10:00 to 20:00 daily, if pain gets worse rather than better after a couple of days, the gum swells, a small spot appears on the gum near the tooth, or the crown or filling comes loose. Facial swelling with fever, or swelling spreading towards the eye, or difficulty swallowing or breathing needs a hospital emergency department straight away.
Preventing the next cavity matters as much as treating this one. See our guides to cavities in baby teeth and brushing and toothpaste by age.