Pulpotomy & Pulpectomy

The most important functions of the primary dentition are maintenance of the integrity of the dental arch and ensuring normal facial growth and development. To that end, the goal of vital primary tooth pulp therapy is keeping primary teeth with deep caries until normal exfoliation to maintain the integrity of the dental arch. A knowledgeable approach to pulp therapy and successful management of the cariously involved primary tooth in which the carious lesion approximates the pulp begins with an accurate diagnosis of the status of the pulp. Because initial efforts are aimed at determining the histologic status of the pulp, preliminary data gathering and interpretation must focus on determining if the primary tooth pulp is normal, reversibly inflamed, irreversibly inflamed, or necrotic. If the pulp is determined to be vital or reversibly inflamed, the vital pulp therapy techniques of pulpotomy or indirect pulp treatment (IPT) are indicated. When the pulp is determined to be irreversibly inflamed or necrotic, pulpectomy or extraction is appropriate. This article discusses the vital pulp therapy procedures of pulpotomy and IPT for primary teeth. When the nerve or pulp tissue of a primary or permanent tooth is infected, it needs to be treated to prevent a dental abscess and loss of the tooth. The two methods of treating infected dental nerve tissue are the pulpotomy and pulpectomy. The ultimate objective of these procedures is to save the tooth, so that it will maintain the integrity and function of the dental arch.

When assessing pulp vitality in young children, it is vital to obtain a patient history that indicates the presence or absence, cause, and duration of pain. Because young children are not reliable historians, dentists must ask both the child and his or her caretaker about the child’s pain history. Determining the type and duration of pain are important components of the history. A history of spontaneous non provoked pain (such as pain that awakens the child in the middle of the night) may indicate an irreversible pulpitis and/or a partially necrotic tooth. Such teeth are not indicated for vital pulp therapy. Interpreting a history of elicited or provoked pain is more complicated. Pain on chewing may be the result of food compressing into the occlusal aspect of a large carious lesion or food impaction in a proximal carious lesion rather than the result of percussive pain, which is a more ominous sign. To rule out percussive pain, place a tongue blade on an uninvolved cusp of the tooth in question and have the child bite down, watching for signs of discomfort that would be consistent with percussive pain. If percussive pain is identified, the tooth is contraindicated for vital pulp therapy. Elicited pain of short duration from sweets or hot or cold foods and drinks does not contraindicate vital pulp therapy but should be recorded in the data collection sheet.1 Interproximal lesions with food wedged subgingivally usually demonstrate gingival swelling but not mucous swelling and thus are not contraindicated for vital pulp therapy.