When decay in a baby tooth reaches close to the nerve, a pulpotomy is often the treatment that saves it. Sometimes called a baby root canal, a pulpotomy removes only the top, affected part of the nerve inside the crown while keeping the healthy nerve in the roots. The single idea that decides whether a pulpotomy is the right choice is the state of the deeper nerve: if the roots are still healthy and there is no abscess, the tooth can usually be saved and kept until it falls out naturally.
Key takeaways
- A pulpotomy removes the affected top part of a baby tooth's nerve and keeps the healthy root part.
- It is used when decay nears the nerve but the deeper nerve is still healthy and there is no abscess.
- The tooth is usually capped with a small crown to protect it for the rest of its life in the mouth.
- Success rates are high, with modern materials reporting clinical success around 97 percent.
- Saving the baby tooth holds the space for the adult tooth and keeps normal chewing and speech.
Why save a baby tooth at all?
It is a fair question, since baby teeth fall out anyway. The answer is timing. A baby molar may not be replaced until around age ten to twelve, so a tooth lost at five leaves years of missing space. Baby teeth hold the gap for the adult tooth, guide it into place, and let a child chew and speak normally. Losing one early can let neighbouring teeth drift and crowd the space, which can mean orthodontic problems later. A pulpotomy keeps the tooth doing its job until it is ready to go.
When a pulpotomy is the right choice
A pulpotomy suits a tooth where decay has reached or is very close to the nerve in the crown, but the nerve in the roots is still healthy. The tooth should not have an abscess, should not be very loose, and should be restorable. If the deeper nerve is already infected, if there is swelling or an abscess, or if the tooth is near falling out anyway, removal may be the better option. Our guide to dental abscess in children explains the signs that point away from a simple pulpotomy.
How it is done
The tooth is numbed with local anaesthetic, the decay is removed, and the affected top part of the nerve is taken away. A medicated material is then placed over the healthy nerve in the roots to calm and seal it. Materials such as mineral trioxide aggregate and other calcium-silicate cements are now widely used and perform very well. The tooth is then usually protected with a small crown, often a preformed metal crown, which we describe in our article on kids crowns. The whole procedure is typically completed in a single visit.
How well does it work?
Pulpotomy is one of the most reliable procedures in children's dentistry. Reviews of modern materials report clinical success around 97 percent and radiographic success in the mid-90s over the following years. A crown over the treated tooth improves the long-term result by sealing it well. As with any treatment, success depends on choosing the right tooth, so an accurate assessment beforehand matters.
Helping your child through it
Most children manage a pulpotomy well, especially with a calm, friendly approach. For anxious children, options such as laughing gas can help, as covered in our guide to nitrous oxide for children. When a child is very young or has several teeth to treat, care can sometimes be done under one general anaesthetic. The right approach depends on the child.
General cost and what to expect
The cost of a pulpotomy and crown varies with the tooth and the child. Lumi Dental does not list its own prices here. You can view current options on our deals and pricing page or ask for a written quote at a general check-up.
Frequently asked questions
Is a pulpotomy the same as a root canal?
Not quite. A pulpotomy treats only the top part of the nerve in a baby tooth, while a root canal removes the whole nerve. A pulpotomy is simpler and suits primary teeth.
Does it hurt?
The tooth is numbed first, so the procedure itself should not hurt. There may be mild tenderness afterwards that settles quickly.
Why does the tooth need a crown?
A decayed, treated baby tooth is weaker. A small crown seals and protects it, which gives the best chance of it lasting until it falls out naturally.
How long will the tooth last?
The aim is for it to last until it is naturally replaced. With a good result and a crown, most treated teeth do exactly that.
What if a pulpotomy is not suitable?
If the deeper nerve is infected or there is an abscess, removal may be needed, sometimes with a space maintainer to hold the gap. Your dentist will advise.
When to see a dentist
If your child has a sore or heavily decayed tooth, an early visit gives the best chance of saving it with a simple treatment like a pulpotomy. The team at Lumi Dental can assess the tooth and explain the options gently. Book 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.
