A complete guide on pulpectomy

Pulpectomy

Cavities are common in baby teeth and progress rapidly due to their small size, thin enamel and dentin, and large pulp chambers. Your dentist may recommend a pulpectomy procedure as a treatment for the cavity. In this article, I will provide you with all the information you need to know about pulpectomy. 

What is a pulpectomy?

A pulpectomy is a root canal treatment done on baby teeth. It involves the removal of infected pulp and cleaning and placing a resorbable filling in the root canal to save the tooth until the permanent tooth erupts.

The pulp is the tooth’s innermost layer, rich in blood vessels, nerves, and reparative cells. 

The treatment may require two or more appointments with six-month follow-up visits. 

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When does your dental professional suggest a pulpectomy?

Irreversible pulp damage, knowns as irreversible pulpitis, and injured baby teeth require pulpectomy. Also, dead and necrosed teeth are saved with pulpectomy. 

The pulpectomy aims to keep baby teeth fully functional to allow chewing and swallowing of food and speech. Baby teeth also save space for future permanent teeth. Their early exfoliation allows adjacent teeth to drift in the space leading to crowding in the teeth. 

Another important reason to perform a pulpectomy in baby teeth is to prevent the infection from spreading to the permanent teeth that develop beneath the roots of the baby teeth. 

In deep cavities, when bacteria invade the pulp, the pulp tissue shows irreversible changes in response to damage caused by bacterial toxins. 

At this stage, the infected pulp needs removal to stop the infection from spreading. An untreated baby tooth infection spreads in the bone, risking the health of the developing permanent teeth. 

Can you get a pulpectomy in permanent teeth (pulpectomy vs. root canal)? 

A procedure similar to a pulpectomy is done in the permanent teeth, known as a root canal treatment. However, the root canals of permanent teeth are filled with a permanent non-degradable filling to seal the tooth. 

The baby teeth’ roots undergo resorption, so a root canal filling is required whose resorption rate matches the tooth. The baby root canals are filled with an iodoform paste that contains calcium hydroxide that not only has anti-bacterial properties but is also easily resorbed by permanent tooth.  

What is the pulpectomy procedure?

It involves the following steps:

  • An x-ray of the problematic tooth is taken, and a diagnosis is made.
  • A Nitrous oxide inhalation is given to sedate the patient, followed by a local anesthetic injection.
  • The decay is removed with a dental drill, and access is made to the pulp. 
  • Long needle-like instruments, known as files, remove the infected pulp tissue. 
  • The root canals are continuously washed with a disinfectant solution to eliminate the dead and infectious pulp. 
  • Your dentist may fill the canal with an anti-bacterial medicament and send you home or place the final filling at the same appointment. 
  • The pulp chamber is filled with zinc oxide eugenol filling. 
  • The lost dentin and enamel are replaced with composite or amalgam fillings. 
  • If there is subtantial loss of tooth structure due to decay, your dentist recommends covering it with a silver cap to avoid fracture. 

Click on the link for full article, Why do kids get silver caps on baby teeth?

Is pulpectomy painful?

Inhalation and local anesthesia are given before the procedure to make the process painless.  However, in acute pulpitis (severe pain), the child may feel pain while the canals are disinfected. An intrapulpal or intraligamentary injection is given to curb this pain. 

What is the minimum number of appointments needed for pulpectomy?

In case of acute infection or swelling, you may need an initial course of antibiotics. The pulpectomy treatment will begin after the antibiotic therapy. 

Pulpectomy may be completed in one appointment. However, if there is an infection or pus in the bone, the dentist may place an anti-bacterial medicament in the root canal and close the tooth with a temporary filling and send you home. The root filling paste is placed in the next appointment. 

Can you get an abscess or swelling after a pulpectomy?

Yes, you can get an abscess or a swelling after pulpectomy. Pulpectomy aims to eliminate root canal infection. However, if the canal is not cleaned correctly or you have an unusual root canal anatomy where infected pulp is left behind, you can get an abscess.

It is important to know that the baby teeth’s root canals show wide variations in number and shape.

The residual infectious tissue and the resulting pus will find no path to escape causing swelling around the tooth after the pulpectomy. 

When do dentists consider baby tooth removal (pulpectomy vs. extraction)

The extraction of baby teeth is considered if;

Conclusion

A pulpectomy is a root canal treatment performed on baby teeth to keep them functional until the permanent tooth erupts. It is carried out to treat deep cavities and involves the following steps:

  • The removal of infected pulp tissues 
  • Cleaning and disinfecting the canals with files and disinfectant solution. 
  • Filling the canals with a resorbable material that allows unimpeded exfoliation of the tooth. 

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