Saving Your Tooth With a Pulpotomy

The two procedures sound alike, and patients often ask how they differ. A pulpotomy removes only the pulp in the crown of the tooth and leaves the root pulp intact. A pulpectomy goes further and removes all of the pulp, including the tissue inside the canals, much like a full root canal does. A complete root canal cleans, shapes, and seals every canal from crown to root tip, while a pulpotomy stays in the chamber and protects the living tissue below it. Which approach fits your tooth depends on how deep the inflammation reaches, and your endodontist will explain that clearly after the evaluation.

A pulpotomy is a good option when decay or an injury has inflamed the top portion of the pulp but the root pulp is still healthy. It is very common in children’s primary teeth, where keeping a baby tooth in place helps guide the adult tooth that follows. It is also used in adult teeth in certain situations, including as an interim step that relieves pain before a full root canal can be completed. Signs that the pulp in the crown is inflamed include a lingering toothache, sharp sensitivity to hot or cold, or tenderness when you bite down. Your general dentist may also spot deep decay close to the pulp on a routine X-ray. Whatever brings you in, the sooner the tooth is evaluated, the more options we have to save it.

Your visit starts with a friendly endodontic evaluation. We review your dental history, talk through your symptoms, and take advanced 3D cone beam (CBCT) images of the tooth so we can see exactly how far the decay or inflammation reaches. With CBCT imaging and the use of endodontic microscopes, we can tell whether the root pulp is healthy enough for a pulpotomy or whether a tooth would be better served by a full root canal.

Once we know what is happening, we numb the area with modern local anesthetic and isolate the tooth with a dental dam to keep it clean and protected. We gently remove the decay, then remove the inflamed pulp from the crown of the tooth on a microscopic level with NASA-approved tools. After the chamber is clean, we place a medicated material that soothes and protects the healthy pulp left in the roots. We then seal the tooth and restore it so it can function and look like any other tooth. Most pulpotomies are completed in a single visit.

We know that a sudden toothache is stressful, and we are here to make the visit an easy one. Endodontists are experts in pain management, and a pulpotomy is a gentle procedure for most patients. We keep you relaxed with amenities such as blankets, in-ceiling TVs, headphones, and music. For patients who would like more help relaxing, we offer sedation options including nitrous oxide, known as laughing gas, oral sedation in pill form, or even IV sedation following a consultation. Once the inflamed tissue is gone, the tooth usually feels much better right away, and any tenderness afterward tends to settle within a day or two. Our team checks in after treatment and is available by phone after hours to answer any questions.

By treating only the inflamed chamber and protecting the healthy pulp below it, a pulpotomy keeps your natural tooth in place, which protects your bite and the bone around it. That is almost always preferable to removing a tooth and replacing it with an implant or a bridge. Some teeth do go on to need a full root canal later, especially if the inflammation turns out to be deeper than it first appeared, and we monitor the tooth at follow-up visits to make sure it is healing as expected. Our goal is to relieve your pain, save your tooth, and let you get back to the foods you love.