Pulpotomy – A Conservative Solution for Tooth Pain

When we hear the words root canal treatment, we often only think of ‘pulpectomy’ which is a treatment that removes infection inside the damaged nerves of our teeth by removing the tooth nerve. But did you know that depending on how much of the nerve is damaged, there is an easier, effective and cheaper solution? Introducing… the ‘pulpotomy’. A pulpotomy is a conservative and less complex procedure to relieve pain and save your tooth. While pulpotomies are more commonly performed in the paediatric dental setting, they are done for adult teeth as well.

This guide will help you understand what a pulpotomy is, how it works, and what to expect during the procedure.

What is a Pulpotomy or Vital Pulp Therapy?

A pulpotomy is a dental procedure to remove damaged or inflamed nerve tissue (pulp) from the crown of a tooth—the top part of the tooth that you can see above the gumline—while keeping the healthy pulp in the roots intact. Like any dental treatment, it will help to prolong the life of your tooth. Think of it as a “partial root canal” or a more conservative alternative to a full root canal (or pulpectomy). Not all teeth can have a pulpotomy, as it depends how much of the nerve is damaged. If the damage has extended into the roots of the teeth, a full root canal (pulpectomy) is the only option to save the tooth. Pulpotomies are only performed on teeth that are ‘alive’ or vital, not on teeth that are ‘dead’ or fully infected, hence the name vital pulp therapy.

The nerve or pulp is the soft inner core of the tooth that contains nerves and blood vessels. When a deep cavity or trauma lets bacteria invade this area, it can cause inflammation and pain. Instead of removing the entire nerve, a pulpotomy treats the problem by removing the unhealthy part of the pulp at the top and placing medication over the healthy nerve to help it heal.

Research on the success rates of pulpotomies is very promising although ongoing as the technique is relatively new compared to traditional root canals. In baby teeth with deep cavities, the success rate is between 90-94% at 24 months. (1) Adult teeth have similar success rates between 91-97% at 24 months (2), then at 5 years it has a comparable success rate to full root canal treatment at 78% (3).

Why Would I Need a Pulpotomy?

A pulpotomy can help to relieve pain or sensitivity in damaged teeth when the damage has affected only the top part of the tooth. This includes teeth with deep cavities, cracked teeth, and dental trauma. They are particularly beneficial in trauma in a developing/growing tooth where the root hasn’t completed formation at the tip (apex). This is because a pulpotomy allows normal formation and growth of the tooth root.

Pulpotomy vs. Pulpectomy: What’s the Difference?

It’s easy to confuse these two terms. Here’s a simple way to remember the difference:

– Pulpotomy: Removes unhealthy pulp only from the crown (top of the tooth). It’s a partial treatment that saves the healthy pulp in the roots.

– Pulpectomy: Removes all the pulp from both the crown and the root canals. A full root canal is performed when the infection is more severe into the roots.

Your dentist will recommend the appropriate treatment based on the extent of the infection as determined by your symptoms, clinical testing results and x-rays. During the procedure, the dentist will let you know if the damage has extended into the roots and support you on your next decision to either have the full root canal treatment (pulpectomy) or to have the tooth removed.

You might wonder, “Why save a baby tooth? Aren’t they going to fall out?”

This is the most common question parents ask—and it’s a great one. While baby teeth are eventually replaced by adult teeth, they have a crucial role in your child’s long-term health:

Saving Space for Permanent Teeth: Baby teeth act as natural placeholders. When a baby tooth is lost too early, the neighboring teeth drift into the empty space. This can block the permanent tooth from coming in correctly, leading to crowding and alignment issues that might require braces later.
Supporting Speech and Chewing: Healthy baby teeth are essential for proper chewing, nutrition, and clear speech development.
Preventing Pain: An infected nerve can be painful. A pulpotomy can quickly relieve your child’s discomfort. Pain can disturb a child’s normal routine including eating, school and sleep.

What Happens During the Procedure?

At Dental on Blackwood, we prioritize you or your child’s comfort and make the process as smooth and anxiety-free as possible. Before any dental treatment, our dentists will conduct a thorough examination and help explain to you the condition of your teeth. Then after discussing possible treatment options in detail and the cost, the dentist will help support you on whatever decision you make. Here’s a step-by-step look at what to expect during a typical pulpotomy appointment:

Numbing the Area: To make the visit as comfortable as possible, we start with applying a topical numbing gel, we will administer a local anesthetic to gently numb the tooth and surrounding gum.
Isolating the Tooth: A small rubber sheet, known as a rubber dam, is placed over the tooth. This keeps the area dry, clean, and free from saliva during the treatment.
Cleaning Out Decay: The dentist will use a dental handpiece and bur to carefully remove any tooth decay and the infected nerve (pulp) from the top part of the tooth.
Applying Medication: A special, medicated material (commonly Mineral Trioxide Aggregate) is placed over the remaining healthy pulp in the root. It is a highly nerve-friendly and biocompatible material which will help soothe the nerve, prevent infection, and encourages healing.
Sealing and Restoring: The tooth is then sealed with our usual white filling materials. Your dentist may suggest strengthening the tooth with a crown/cap. For adults, it may be recommended to have a porcelain or metal crown placed on the tooth to prevent fracture, depending on how much of the tooth was already damaged. For children, a stainless steel crown is placed over the tooth to protect it. Since children’s teeth are weaker due to their small size, this crown provides a strong, durable shield until the tooth naturally falls out.

The entire procedure takes about 30 to 90 minutes depending on its complexity and type of filling required.

Recovery and Aftercare

Recovery from a pulpotomy is usually quick. Initial discomfort on the day and few days after can be managed with simple Panadol and/or Neurofen. You can normally return to your regular routine on the same or next day.

A Pulpotomy in Summary

A pulpotomy is a safe, effective, and common procedure that can save your tooth from further pain and infection, allowing you to keep your tooth for longer. We know that coming to the dentist can be stressful but our team is dedicated to making every visit a positive experience.

Dr Trisha Harijatna has completed further training to be able to complete pulpotomy procedures in both children and adults. She loves to be able to provide more simple, accessible and conservative treatment options for her patients.

If you or your child has a toothache or you suspect a deep cavity, don’t wait. The sooner we can treat the problem, the better the outcome. Book an appointment online today or call us on 07 3355 2222.

References

Coll JA, Dhar V, Chen CY, Crystal YO, Guelmann M, Marghalani AA, AlShamali S, Xu Z, Glickman GN, Wedeward R. Use of Vital Pulp Therapies in Primary Teeth 2024. Pediatr Dent. 2024 Jan 15;46(1):13-26. PMID: 38449041.
Coll JA, Dhar V, Guelmann M, Crystal YO, Chen CY, Marghalani AA, AlShamali S, Xu Z, Glickman G, Ather A, Sabeti M, Wedeward R. Vital Pulp Therapy in Permanent Teeth: A Systematic Review and Meta-Analyses. Pediatr Dent. 2025 May 15;47(3):137-150. PMID: 40533920.
Asgary, S., Eghbal, M.J., Fazlyab, M. et al. Five-year results of vital pulp therapy in permanent molars with irreversible pulpitis: a non-inferiority multicenter randomized clinical trial. Clin Oral Invest 19, 335–341 (2015). https://doi.org/10.1007/s00784-014-1244-z