Pedodonti

Pulpotomy

Name: Pulpotomy
Creator: Dore Medical Editorial Board
Published: 2026-05-11

A treatment that aims to preserve baby teeth when decay has reached the nerve tissue, instead of extracting them. The affected tissue in the crown portion is cleaned while healthy tissue in the roots is preserved.

Medically reviewed. Last updated: May 18, 2026.

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What Is a Pulpotomy?

A pulpotomy is a dental procedure performed on children's primary teeth where the nerve tissue in the crown portion of the tooth is removed, but the nerve in the root canals is left alive. It is also known by its medical term "pulpotomy." The goal is to save a decayed baby tooth and allow it to remain in the mouth until its natural time to fall out. It is performed when deep decay in children reaches the nerve. The difference from a full primary tooth root canal treatment is that only the upper part of the nerve is removed, not all of it—the living nerve in the root portion is preserved.

A pulpotomy is most commonly performed when tooth decay in children reaches an advanced stage and extends to the nerve. Because the enamel of baby teeth is thin, decay progresses quickly and usually reaches the nerve in a short time. Your child may come in complaining of severe toothache, sensitivity to hot and cold, or nighttime pain. If the infection has not yet spread to the root area, a pulpotomy is the preferred treatment. If the infection has reached the root area, a full root canal treatment or primary tooth extraction may be necessary.

Before treatment, the pediatric dentist reassures your child and takes an X-ray to evaluate the extent of the decay and any infection in the root area. Local anesthesia is administered, the decayed tissue is cleaned, and the nerve tissue in the crown portion of the tooth is accessed. This nerve tissue is removed and a special medication is placed in the area. This medication helps the remaining nerve stay healthy and prevents infection in the root area. The top is sealed with a special filling. In the vast majority of cases, the tooth is then protected with a stainless steel crown, because after a pulpotomy the tooth becomes more prone to fracture.

The procedure is typically completed in a single session and takes 30 to 45 minutes. Parents should be careful to ensure the child does not bite their cheek until the anesthesia wears off. When a pulpotomy is successful, the tooth remains in the mouth until its normal time to fall out and continues to function. This preserves space for the permanent tooth coming in below and prevents space loss. Otherwise, neighboring teeth shift into the gap and a space maintainer becomes necessary. For all pediatric dentistry procedures, you can visit our pediatric dentistry page. For cost information, see our pulpotomy cost page.

Treatment Process

Alternative Treatments

Risks and Complications

Pulpotomy treatment is a well-established procedure widely performed in pediatric dentistry. With correct indication, appropriate material selection, and careful application, the vast majority of cases are completed successfully. However, like any medical procedure, there are certain risks and potential outcomes you should be aware of.

🦠 Infection Development or Persistence

The most significant risk of pulpotomy is that infection may have already spread to the root canals and persist despite treatment. Even if the crown pulp is cleaned, the root pulp may remain infected and treatment may fail. In this case, an abscess may form around the tooth or the existing infection may not be controlled. Pretreatment radiological evaluation reduces this risk, but in some cases the true extent of infection becomes apparent only during treatment.

😣 Temporary Pain and Sensitivity

Mild pain or sensitivity for a few days after treatment is normal. This is typically managed with pediatric-dose pain reliever (acetaminophen) and resolves within a few days. Increasing or prolonged pain may require reassessment of the treatment.

🔄 Treatment Failure and Need for Extraction

Pulpotomy may not be successful in every case. The infection status of the root pulp may progress differently than expected during or after treatment. If treatment fails, the tooth may continue to cause pain, an abscess may develop around it, or radiological findings may worsen. In this case, primary tooth extraction is necessary and a space maintainer is applied if needed.

🦷 Effect on Permanent Tooth Bud (Very Rare)

If ongoing infection at the root of the baby tooth is left untreated, it can negatively affect the underlying permanent tooth bud. Enamel defects or developmental disturbances in the permanent tooth are rarely seen. The goal of pulpotomy is precisely to prevent this: to stop the spread of infection and protect the permanent tooth.

👑 Crown-Related Issues

After pulpotomy, a stainless steel crown (SSC) is usually placed on the tooth. SSC can lead to issues such as dislodgement over time, plaque accumulation around the gums, or rarely the child's difficulty adapting. If the SSC comes off, it can usually be re-cemented.

😰 Child Anxiety and Procedure Duration

Pulpotomy is a longer and more involved procedure than a simple filling. The child spending more time in the dental chair can make cooperation challenging. At Doredent, we apply the tell-show-do technique and age-appropriate behavior management with pediatric patients. Gaining your child's trust and providing a positive experience is our priority.

Risk-Reducing Factors

Correct indication: Pulpotomy is not performed for every deep cavity. Whether infection has spread to the roots is determined by radiological and clinical evaluation. Extraction is planned for unsuitable cases.
Radiological evaluation: Before treatment, an X-ray checks the root condition, surrounding tissue health, and position of the permanent tooth bud.
Appropriate material: The medication placed in the cleaned pulp chamber and the crown applied over it directly affect the long-term success of treatment.
SSC placement: Covering the tooth with a stainless steel crown after pulpotomy protects it from fracture and increases treatment success.
Regular follow-up: After treatment, regular checkups monitor the tooth's status, signs of infection, and the eruption process of the permanent tooth.
Child-friendly approach: Topical anesthetic minimizes needle sensation. The tell-show-do technique gains your child's trust.

When Is It Necessary?

Pulpotomy is performed on primary teeth where decay has reached the nerve tissue but infection has not yet spread to the roots. The primary goal of treatment is to preserve the tooth in the mouth without extraction and maintain the primary tooth's space-holding, chewing, and speech functions.

🦷 Deep Decay (Pulp Exposure)

If decay in a primary tooth has progressed through the enamel and dentin to reach the nerve tissue (pulp), a standard filling is no longer sufficient. If the pulp is exposed but the root pulp is still healthy, the tooth can be saved with pulpotomy.

When nerve tissue is reached during decay removal.
When pulp exposure has occurred but the root remains healthy.
In cases of deep decay that cannot be resolved with filling alone.
When radiographic examination shows no pathology around the root.

⚡ Reversible Pulpitis (Nerve Inflammation)

If inflammation has begun in the nerve tissue due to decay but infection has not yet spread to the roots, pulpotomy removes the infected tissue in the crown while preserving the root pulp. This condition is called "reversible pulpitis."

If sensitivity to cold and heat is present but spontaneous pain is absent.
If pain subsides when the stimulus is removed.
If no radiographic findings are present around the root.
The tooth is still in a salvageable condition.

💥 Pulp Exposure Following Trauma

If a fall or impact has caused a fracture in a primary tooth and exposed the nerve tissue, pulpotomy can clean the tissue and attempt to save the tooth. Early intervention after trauma increases treatment success.

If nerve tissue is exposed in a fractured tooth.
Rapid intervention after trauma is important.
Root condition and surrounding tissue health are evaluated.
If there is no root fracture, pulpotomy can be attempted.

📏 To Prevent Early Extraction

Maintaining the primary tooth in the mouth until the permanent tooth erupts is critically important for space maintenance. Preserving the tooth with pulpotomy can eliminate the need for early extraction and subsequent space maintainers.

When there is still considerable time until the permanent tooth erupts.
When early extraction would lead to risk of space loss.
When the tooth can be saved with pulpotomy.
The goal is to maintain the tooth in the mouth as a natural space maintainer.

🍼 Advanced Baby Bottle Tooth Decay Cases

Baby bottle tooth decay (early childhood caries) can progress rapidly to reach the nerve tissue. Especially in primary molar cases where decay has reached the pulp but root health is maintained, the tooth can be saved with pulpotomy.

Baby bottle tooth decay progresses rapidly; early detection is critical.
Multiple teeth may require treatment.
Pulpotomy + stainless steel crown combination preserves the tooth long-term.
Feeding habits should be corrected after treatment.

🔬 Pulp Exposure During Decay Removal

Sometimes during treatment that was planned as a filling, the decay turns out deeper than expected and the nerve tissue is reached. In this case, treatment shifts from filling to pulpotomy.

The treatment plan may change during the procedure.
Parents are informed during treatment.
Pulp exposure is an indication for pulpotomy.
With proper intervention, the tooth can be saved.

What Happens When Pulpotomy Is Not Suitable?

Not every case of deep decay can be treated with pulpotomy. In the following situations, pulpotomy is not appropriate and extraction is planned:

If infection has spread to the root canals (irreversible pulpitis).
If radiolucency (sign of infection) is present around the root on X-ray.
If root resorption is advanced (excessive root erosion).
If the tooth structure is too damaged to support any restoration.
If there is mobility (looseness) in the tooth and clinical retention is inadequate.
If very little time remains before the permanent tooth erupts (the tooth is close to its natural shedding time).

At Doredent, the decision for pulpotomy is always made after clinical examination and radiographic evaluation. In unsuitable cases, extraction is honestly recommended and a space maintainer is planned if needed.

After Treatment

Pulpotomy treatment is typically completed in a single session. After treatment, a stainless steel crown (SSC) is placed on the tooth. Below you'll find all the details parents need to know following pulpotomy treatment.

First 2 Hours: Anesthesia Period

No eating: It's very important that your child does not eat until the local anesthesia wears off (usually 1-2 hours). The most common complication is accidentally biting the numb lip or cheek.
Lip and cheek biting warning: Explain to your child in age-appropriate terms that they should not bite their lip, cheek, or tongue. Careful parental supervision is critical with younger children.
Fluid intake: Until the anesthesia wears off, only room temperature or cool water may be consumed.

First 24 Hours

Eating: After the anesthesia wears off, soft and lukewarm foods are preferred. Avoid hard, crunchy, and spicy foods. We recommend avoiding chewing on the treated side.
Sensitivity: Mild pain or sensitivity for a few days after treatment is normal. This can be managed with children's pain reliever (paracetamol). Aspirin-containing medications should not be used in children.
SSC adaptation: The stainless steel crown placed on the tooth may feel different to your child for the first few days. A slight difference in bite is normal, and children typically adjust within a few days.

SSC Care

Brushing: Thorough brushing around the SSC and especially at the gum line is important. Plaque buildup around the crown can lead to gum inflammation.
Sticky foods: Sticky candies and gum increase the risk of the SSC coming loose and should be avoided.
If the SSC comes loose: If the crown comes loose, make sure there is no risk of swallowing and contact the clinic. The crown can usually be re-cemented.
Natural shedding: When the baby tooth under the SSC is ready to naturally shed, it will fall out together with the crown; this is completely normal.

Long-Term Follow-Up

First check-up: A follow-up appointment is recommended 1-2 weeks after treatment. The tooth's condition, the SSC's fit, and your child's comfort will be evaluated.
Regular check-ups: Every 6 months during pediatric dentistry check-ups, the treated tooth's condition is monitored. If necessary, X-rays will evaluate the root area and permanent tooth development.
Warning signs to watch for: Contact the clinic if you notice increased pain in the treated tooth, swelling, a fistula (abscess opening) on the gum, or mobility (looseness). These signs may require re-evaluation of the treatment.
If treatment fails: If the pulpotomy fails and infection cannot be controlled, extraction is planned. After extraction, a space maintainer may be applied if necessary to preserve space for the permanent tooth to erupt.

Expected Healing

Pain resolution: Pain caused by decay before treatment typically resolves completely within a few days after treatment.
Return of chewing function: The tooth protected by the SSC maintains normal chewing function.
Space maintenance: As long as the tooth remains in the mouth, it serves as a natural space maintainer, preparing the way for the permanent tooth beneath to erupt healthily.
Infection control: By removing the infected pulp tissue, the source of infection is eliminated and the permanent tooth bud is protected.

An Important Message for Parents

Pulpotomy treatment is a valuable treatment performed to avoid extracting a baby tooth and preserve your child's oral health. However, regular follow-up after treatment is essential. Even if the treated tooth shows no symptoms, its condition should be monitored with check-ups every 6 months. The most effective way to prevent decay from reaching this level is regular dental check-ups, daily oral hygiene habits, and limiting sugary foods. When decay is detected early, it can be resolved with simple filling; the need for pulpotomy or extraction is greatly reduced.

Frequently Asked Questions

What is pulpotomy?

Pulpotomy is a treatment used in primary teeth when decay reaches the nerve tissue (pulp) but the infection has not yet spread to the roots. The infected pulp tissue in the crown portion of the tooth is removed, the healthy tissue in the roots is preserved, and a special medication is placed in the cleaned area. Afterward, a stainless steel crown (SSC) is typically placed over the tooth. The main goal of pulpotomy is to preserve the primary tooth in the mouth without extraction. As long as the primary tooth remains, it continues to serve its chewing, speech, and aesthetic functions. More importantly, it acts as a natural space maintainer for the permanent tooth developing underneath. Early loss of the tooth can lead to crowding and the need for orthodontic treatment later. Pulpotomy is different from root canal treatment. In root canal treatment, all pulp tissue (both crown and root) is completely removed, whereas in pulpotomy only the crown pulp is removed and the root pulp is preserved.

Is pulpotomy painful?

At Doredent, pulpotomy is performed with your child's comfort as the top priority. Before the procedure, a numbing gel (topical anesthetic) is applied to the gum so your child feels minimal discomfort from the injection. Then local anesthesia is given to completely numb the treatment area, and no pain is felt during the procedure. Pulpotomy takes longer than a simple filling, so your child will need to spend more time in the dental chair. Using the tell-show-do technique, each step is explained to your child in an age-appropriate way beforehand. The goal is to build trust and turn the procedure into as positive an experience as possible. Some mild sensitivity for a few days after treatment is normal and can be managed with children's pain reliever (paracetamol).

Why is a crown (SSC) needed after pulpotomy?

During pulpotomy, a significant amount of tissue is removed from the inner structure of the tooth. This weakens the remaining tooth structure, which may not withstand normal chewing forces. A stainless steel crown (SSC) covers the entire tooth, preserves its structural integrity, prevents fractures, and helps the tooth remain healthy in the mouth until the primary tooth naturally falls out. The SSC also isolates the treated tooth's inner structure from the oral environment, reducing the risk of new bacterial entry and infection. Pulpotomy treatments performed without an SSC have significantly higher failure rates. When it's time for the primary tooth under the SSC to naturally fall out, it comes out together with the crown. This is completely normal and requires no additional intervention.

What happens if pulpotomy fails?

Pulpotomy is successful in most cases, but expecting the same outcome in every case is not realistic. If treatment fails, pain in the tooth may continue, an abscess may develop around it, or signs of infection around the root may appear on X-rays. In this case, the tooth is extracted. If there is still a long time before the permanent tooth erupts, a space maintainer is placed to prevent neighboring teeth from shifting into the gap. Attempting pulpotomy and having it fail does not create a disadvantage compared to extracting the tooth immediately. During the treatment process, the tooth continues to serve as a space maintainer for as long as it remains in the mouth. Regular follow-up after treatment allows early detection of possible failure. For this reason, regular 6-month checkups are recommended at Doredent after pulpotomy treatment.

Can pulpotomy be performed on every primary tooth with deep decay?

No. Pulpotomy can only be performed in cases where certain conditions are met. The main requirement is that the infection is limited to the crown pulp and the root pulp is still healthy. Situations where pulpotomy is not appropriate include: if the infection has spread to the root canals, if there are signs of infection around the root on X-rays, if root resorption (erosion) is advanced, if the tooth structure is too damaged to support any restoration, if there is significant mobility in the tooth, or if very little time remains before the permanent tooth erupts. In these situations, extraction is honestly recommended and a space maintainer is planned if necessary. At Doredent, the decision for pulpotomy is always made after clinical examination and radiological evaluation.

Should I choose pulpotomy or extraction?

In appropriate cases, pulpotomy is generally more advantageous than extraction. Keeping the primary tooth in the mouth is critically important for chewing, speech, aesthetics, and most importantly, as a natural space maintainer for the permanent tooth developing underneath. When a primary tooth is extracted early, neighboring teeth shift into the gap and there is not enough space left for the permanent tooth to erupt. This can lead to the need for orthodontic treatment later. A tooth preserved through pulpotomy eliminates this risk because the tooth continues to stay in place naturally. However, pulpotomy is not suitable for every case. If the infection has spread to the roots, if the tooth structure is severely weakened, or if very little time remains before the permanent tooth erupts, extraction is the better choice. Both decisions are made by evaluating the child's age, the condition of the tooth, root health, and the development of the permanent tooth together. At Doredent, unnecessary extractions are not performed. All options are evaluated to preserve the tooth.

Treatment Pricing

Pricing

Pulpotomy Pricing

At Doredent, we offer transparent pricing for our international patients. As every case is different, the final treatment cost depends on your individual evaluation.

The cost of Pulpotomy varies based on factors such as the number of teeth treated, scope of the case, and the restoration applied afterward. For an accurate quote, a personalized assessment is recommended.

For pricing details, reach out via WhatsApp or book your initial consultation.

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