What Is a Pulpectomy?
A pulpectomy removes the infected nerve from inside a baby tooth. Your dentist then fills the space and seals the tooth.
It is the treatment that saves a badly decayed baby tooth instead of pulling it. The tooth stays in place until it is ready to fall out on its own.
The pulp is the soft tissue in the middle of a tooth. It holds the nerve and the blood supply. Once decay reaches it, the tissue becomes infected and will not heal by itself.
Why a Baby Tooth Is Worth Saving
Parents often ask why we treat a tooth that is going to fall out anyway. It is a fair question, and the answer is about the teeth that come next.
- A baby tooth holds the space for the adult tooth forming underneath it
- Lose it early and the neighbouring teeth drift into the gap
- The adult tooth then has nowhere to come through straight
- Back teeth are needed for chewing until roughly age eleven or twelve
- Front teeth matter for speech sounds while your child is still learning them
Saving the tooth now is usually cheaper than straightening the result later.
Signs Your Child May Need One
- Toothache that wakes them at night or does not settle
- Pain that lingers well after something hot or cold
- A tooth that has darkened compared with the ones beside it
- A small pimple or swelling on the gum near the tooth
- Chewing on one side only, or refusing food they normally enjoy
Facial swelling needs a same-day appointment. Phone us rather than waiting to see whether it settles.
Pulpectomy or Pulpotomy?
Both treatments deal with infected pulp. The difference is how far the infection has spread.
Pulpotomy
Only the pulp in the crown of the tooth is removed. The tissue in the roots is still healthy and stays where it is. This is the smaller treatment.
Pulpectomy
The infection has reached the roots, so all the pulp comes out. The root canals are cleaned and filled with a material that dissolves as the tooth loosens naturally.
That last point matters. A baby tooth needs to shed on time, so we do not use the permanent filling material that goes into an adult root canal.
What the Appointment Involves
- Your dentist examines the tooth and takes a small x-ray.
- The area is numbed, so your child feels pressure rather than pain.
- The decay and the infected pulp are removed.
- The canals are cleaned and filled.
- A crown is fitted over the tooth to hold it together.
Most pulpectomies are done in one visit. A stainless steel crown is usually placed at the end, because a tooth this decayed has too little structure left to hold an ordinary filling.
After the Treatment
- Soft food for the rest of the day, and nothing hot while the numbness lasts
- Watch that your child does not bite the numb lip or cheek
- Mild tenderness for a day or two is normal
- Brush the tooth as usual from the next day
- Come back if pain returns or the gum swells
A treated tooth should then behave like any other baby tooth and fall out at the normal time.
Stopping It Happening to the Next Tooth
Decay deep enough to need a pulpectomy rarely arrives in one tooth alone. The same habits usually affect the teeth beside it.
- Brush twice a day with a fluoride toothpaste, and help until about age seven
- Cut down on how often sugar is eaten, more than on how much
- Avoid sweetened drinks in a bottle, especially at bedtime
- Ask about sealants for the back teeth once they come through
If the Tooth Cannot Be Saved
Sometimes there is too little tooth left to rebuild, or the infection has damaged the bone around it. In that case removing the tooth is the safer choice.
Where a back tooth comes out early, your dentist can fit a space maintainer. It is a small appliance that holds the gap open so the adult tooth has room to arrive.
Book an appointment if your child has toothache, a dark tooth, or a lump on the gum. Decay that has reached the nerve does not settle on its own, and treating it early keeps the options open.
Related Reading
- Root Canal Treatment – the adult equivalent, and why it differs
- Tooth Decay – how decay reaches the nerve in the first place
- Pit and Fissure Sealants – sealing back teeth before decay starts
- Dental Extraction – when a tooth cannot be saved
- Dental Crowns – how a crown holds a weakened tooth together