What is a pulpotomy?

The pulp inside a tooth consists of the pulp chamber in the crown and the canals inside the roots. When deep decay reaches the pulp, inflammation usually starts in the crown portion first. In a pulpotomy, this inflamed crown pulp is carefully removed; a biocompatible material that supports healing is placed over the living pulp remaining at the canal openings, and the tooth is restored with a tight seal. In Turkey, both patients and clinicians often call this procedure “amputation” (amputasyon). The difference from a full root canal treatment is that the root pulp is not removed – in other words, the tooth’s vitality is preserved.

The baby tooth will fall out anyway – why treat it?

• In most children, baby molars stay in the mouth until the age of 10–12 and are needed for chewing.
• They act as a space maintainer for the permanent tooth coming in underneath; losing them early can lead to crowding and a lack of space.
• An untreated infected baby tooth can adversely affect the enamel of the permanent tooth developing below it.
• Pain and infection disrupt a child’s sleep, eating and school life.

Why are baby teeth affected more quickly?

Dental textbooks compare the structural differences between baby teeth and permanent teeth in detail. In baby teeth, the enamel and dentin are thinner, the pulp chamber is larger relative to the size of the tooth, and the pulp horns lie closer to the outer surface. As a result, decay can reach the pulp in a shorter time than in permanent teeth. The same source notes that direct pulp capping (covering an exposed pulp directly) is less successful in baby teeth than in permanent teeth, which is why pulpotomy is more often preferred for baby teeth with an exposed pulp.

Who is it suitable for?

A pulpotomy is suitable for teeth where the pulp inflammation is thought to be limited to the crown. Typically:

• Pain triggered by sweets, cold or eating that stops once the stimulus is removed
• The pulp is exposed while the decay is being removed, but the bleeding can be controlled quickly
• No sign of inflammation around the roots or between them (furcation) on the X-ray
• The tooth is restorable and not about to fall out

When it may not be suitable: spontaneous pain that wakes the child at night, swelling or a fistula, a loose tooth, bone loss on the X-ray or excessive root resorption. In these situations, a pulpectomy (root canal treatment of a baby tooth) or extraction, with a space maintainer if needed, is considered.

How is it done?

1. The tooth is anaesthetised locally and, where possible, isolated with a rubber dam.
2. The decay is completely removed and the roof of the pulp chamber is opened.
3. The pulp in the crown is removed and the bleeding at the canal openings is allowed to stop. Bleeding that stops within a reasonable time is an important sign that the remaining pulp is healthy.
4. A biocompatible material is placed over the remaining pulp. Today, MTA and similar calcium silicate-based materials are widely used; fixative agents used in the past, such as formocresol, have increasingly been replaced by these materials.
5. The tooth is sealed with a well-sealing filling or, in baby molars, often with a preformed stainless steel crown.

Pulpotomy in permanent teeth with incomplete root development

The roots of permanent teeth keep developing for about 2–3 more years after the tooth erupts. During this period the roots are short, their walls thin and the root tip wide open. For example, if the pulp is exposed in the first permanent molar that erupts at 6–7 years of age, or in front teeth broken in a fall, keeping the pulp alive is very valuable for continued root development. This approach, which preserves the living pulp so the root can lengthen and its walls thicken, is called apexogenesis; partial or full pulpotomy are its main methods.

Because the root tip is open, such permanent-tooth cases require technically careful planning. At our clinic, pulp treatments in permanent teeth with incomplete roots are assessed by the endodontic specialist in our team.

What should you watch out for at home after treatment?

• Until the anaesthetic wears off (usually a few hours), supervision is important so that the child does not eat or bite their lip.
• There may be mild tenderness on the first day; do not give any medicine other than the age-appropriate painkiller recommended by the dentist.
• Do not neglect cleaning the tooth with the stainless steel crown or filling; keep brushing with a parent’s help.
• Sticky sweets and frequent snacking put both the treated tooth and the other teeth at risk.
• Use fluoride toothpaste in the amount appropriate for your child’s age.

Risks and follow-up

Inflammation in the treated pulp can progress over time; in that case pain, swelling or changes around the root on the X-ray may be seen. Rarely, baby teeth can develop internal resorption, where the tooth dissolves from the inside. That is why regular clinical check-ups after treatment and X-ray follow-up at the intervals your dentist considers appropriate are recommended. In permanent teeth whose roots are still developing, follow-up X-rays are particularly important to show that the root is lengthening and thickening. The factors that most affect success are correct case selection, bacterial control during the procedure and a tight seal from the restoration on top.

One more point to remember: deep decay in baby teeth is often closely linked to eating habits and brushing routine. Since the teeth next to a tooth treated with a pulpotomy may also have early decay, preventive measures (fluoride varnish, fissure sealants) and regular check-ups should be planned with your dentist after treatment.

Frequently asked questions

Related pages

Medically reviewed by: Dr. Dt. Mehmet Fuat BozabaSpecialist in periodontology · September 2026

Does your child have deep decay or toothache? To book an examination at our clinic in Istanbul, message us on WhatsApp or call us on 0544 289 66 33.

Sources: Rai B, Kaur J. Fundamentals of Operative Dentistry. 1st ed. Jaypee Brothers Medical Publishers, 2010. Trope M, Debelian G. Diş Hekiminin Endodonti El Kitabı (Endodontics Manual for the General Dentist, Turkish translation). Quintessence. American Academy of Pediatric Dentistry. Pulp Therapy for Primary and Immature Permanent Teeth. The Reference Manual of Pediatric Dentistry. Duncan HF et al. European Society of Endodontology position statement: Management of deep caries and the exposed pulp. International Endodontic Journal, 2019.

This article is for information only; diagnosis and treatment planning can only be carried out by a dentist after an examination.