Dr. Benitez answers, ‘Why save a baby tooth with a pulpotomy or an indirect pulp cap’?

Dr. Karen Benitez, founder & designer, board certified pediatric dentist at Chevy Chase Pediatric Dentistry writes a series of guest posts related to adolescent dentistry and questions for Beltway Bambinos based on questions and concerns she frequently receives from patients. If you have a topic you’d like to see her feature, leave it in the comments. Below is a list of previous topics Dr. Benitez has covered; an invaluable source of information for all parents.

I touched on the subject of cavities early on in my blog posts for Beltway Bambinos. The idea was to lightly introduce the various treatment approaches available to manage or treat cavities. In this post I speak on two very common procedures in pediatric dentistry, and in my opinion, very important procedures to be able to perform on a baby tooth: a pulpotomy or an indirect pulp cap. I hope this is insightful in your preparation for your child’s upcoming treatment.

Generally speaking, teeth that would potentially need these treatment options are affected with large cavities—more specifically, cavities encroaching on the neurovascular central mass of soft tissue, simply referred to as the nerve. It is the size of the cavity and the proximity to the nerve that warrants the question by all dentists of (1) vitality of the tooth– is it living? and (2) restorablilty–is there enough remaining sound tooth structure to build on?

At your exam visit, your dentist will share with you their need for x-rays to determine the depth of decay and if there is evidence of infection with the tooth in question. Sometimes, there is not yet evident infection, but there is too much tooth structure lost and no ability to restore the tooth. An extraction is warranted in either the situation of an infection or insufficient tooth structure remaining. Both a pulpotomy and an indirect pulp cap are procedures designated for teeth that are still considered alive (vital), but have decay encroaching upon or invading the nerve.

But why perform these procedures on teeth with large or deep decay? The truth is, that maintaining the baby tooth is hugely important for preserving space for the permanent tooth to follow. Baby teeth help the arches to grow in preparation for ideal facial development and speech. It is not a preferred practice to have to remove any number of baby teeth (unless otherwise better for skeletal growth accommodation). The procedure of a baby pulpotomy is mostly practiced on baby molars.

A pulpotomy is commonly referred to as a “baby root canal” because it is a cleaning out of the nerve tissue of the baby tooth. Unlike a permanent tooth, the baby teeth are only treated in the top part of the nerve within the crown. We leave behind the nerve tissue in the root lengths to allow for natural resorption during the transition of baby teeth to permanent teeth. A medicated putty is placed in the crevice that the coronal nerve occupied, followed by a full-coverage stainless steel crown or white-zirconia crown (if eligible). In cleaning out the infected coronal nerve tissue, you are preserving the remainder of the tooth to be able to carry out its job of holding space for the following permanent tooth. Remember there are circumstances of no permanent tooth, hence all the more reason to maintain the baby tooth!

An indirect pulp cap is practiced for cavities very close to the nerve, but not quite in it. It is not uncommon to leave a tiny amount of decay at the most inner, proximal part closest to the nerve entry. You place a fluoride-releasing glass ionomer material to protect that remaining bacterial cavity from growing into the nerve. Then a final filling of full-coverage stainless steel crown (1) or white-zirconia crown (2) is placed over the tooth.

Both a pulpotomy or indirect pulp cap are optimal ways to preserve the design of baby teeth in preparation for the permanent teeth ahead. It is my first line of restoration for teeth involved with large cavities. Both are vastly considered the standard of care in pediatric dentistry. I hope this is insightful in your preparation for your child’s upcoming treatment.

We at Chevy Chase Pediatric Dentistry welcome your child to come in and have a look. It would be our pleasure to have you! You can also find us as Bethesda Magazine’s Face of Pediatric Dentistry, view our Top Docs video and read our stellar reviews on Yelp, Google and ZocDoc. Follow us on Facebook to learn more about what Chevy Chase Pediatric Dentistry is all about focusing on your kids.