A baby molar with deep decay at age five may still have five or six years of chewing ahead of it before the premolar underneath is ready. When the decay has reached the nerve but the nerve is still alive, a pulpotomy lets the dentist remove the damaged part, seal the rest and keep that tooth working until it is due to come out.
Parents often hear it called a baby root canal. That nickname is a little misleading, because the nerve in the roots is left in place. What decides whether a pulpotomy will work is the health of that remaining root nerve, which the dentist judges from symptoms, an X-ray and how the tissue looks during treatment.
Three layers of a baby tooth, and where the problem is
Every tooth has a hard outer shell of enamel, a softer layer of dentine, and a central chamber holding the pulp, the nerve and blood vessels. In a baby molar the enamel and dentine are thinner than in an adult tooth and the pulp chamber is relatively large, so decay can reach the nerve quickly, sometimes before a child complains of anything.
The pulp runs from a chamber in the crown down narrow canals into each root. A pulpotomy removes the pulp from the crown chamber only. The tissue in the root canals stays, alive and functioning, under a protective dressing.
Teeth that suit a pulpotomy, and teeth that do not
A pulpotomy is usually considered when:
- decay has exposed or nearly exposed the nerve in a baby tooth
- any pain has been short-lived, such as a twinge with cold or sweet foods, rather than constant or waking the child at night
- there is no swelling, gum boil or abscess, and the tooth is not abnormally loose
- the X-ray shows no infection around the roots and the roots are not already largely dissolved
- enough tooth is left to be sealed and crowned
During treatment, the bleeding from the remaining nerve should stop within a few minutes. If it does not, the root nerve is probably inflamed too, and the plan changes.
Where the nerve is already dying or infected, the choices are usually a pulpectomy, which cleans out the root canals as well, or taking the tooth out. Our article on dental abscesses in children describes the signs that point that way. A tooth close to falling out on its own may simply be extracted.
Deep decay does not always mean nerve treatment. Some teeth where the nerve is not exposed can be sealed under a crown or filling without touching the pulp at all, an approach your dentist may discuss.
What happens at the appointment
The tooth is numbed with local anaesthetic, often after a numbing gel on the gum. A thin rubber sheet may be placed to keep the tooth dry and stop water and debris going down the throat. The dentist removes the decay, opens the pulp chamber and takes out the nerve tissue in the crown.
Once bleeding is controlled, a medicament is placed over the root nerve. Calcium silicate cements such as mineral trioxide aggregate (MTA) are now widely used, and other options exist. The tooth is then filled and, in most cases, covered with a preformed crown, usually a stainless steel one, because a treated baby molar is weak and a full-coverage crown seals it better than a filling. Our article on crowns for children's teeth explains these crowns in more detail.
In most cases everything is finished in one visit. Afterwards the gum around the crown may be a little sore for a few days, and children need watching so they do not chew their numb lip or cheek.
The evidence on how well it works
Pulpotomy in baby molars is one of the better-studied treatments in children's dentistry, and success rates in research are high when teeth are carefully selected. A Cochrane review by Smaïl-Faugeron and colleagues (2018) compared the materials used and found that MTA may be among the most effective, with other agents also performing well. Results depend heavily on choosing the right tooth and sealing it properly, which is why the crown matters.
Treated teeth are checked at regular visits, with X-rays from time to time, to make sure the roots stay healthy. A small proportion fail over time and need further treatment or removal.
Keeping a child comfortable
Many children manage a pulpotomy with local anaesthetic, a gentle pace and clear, calm explanations. For nervous children, laughing gas may help. A very young child, or one who needs several teeth treated, may be better served by having everything done in one session under general anaesthetic in hospital, which is arranged by referral when it is needed. You are welcome to ask us about sedation options.
Questions about pulpotomies
Is it worth treating a tooth that will fall out?
Usually, if it has years left. Baby molars hold space for the adult teeth and are needed for chewing. Losing one early can allow other teeth to drift and crowd the space.
Is the cost covered?
Fees vary with the tooth and the type of crown. Some of these services may be covered for eligible children under the Child Dental Benefits Schedule, depending on the items involved. We do not list our own prices here, but our current offers page and a general check-up are good starting points, and you can ask for a written treatment plan with fees.
Will the silver crown come off?
It is designed to stay on until the baby tooth falls out, and it usually comes out with it.
Booking a visit
Toothache, a dark spot or a hole in a back tooth are all reasons to have your child seen soon. The earlier deep decay is found, the more likely the tooth can be kept. You can reach us through our contact page.
This article is general information and is not a substitute for individual advice. The right treatment for a tooth is decided after an examination.
