What are the other Names for the Procedure?
- Dental Pulpectomy
- Pediatric Pulpectomy
- Pulp Therapy (Pulpectomy)
What is the Pulpectomy Procedure?
- The pulp is the soft and sensitive part of teeth found on the inside (central portion of tooth) that has nerves and blood vessels. The outer layers are hard and consist of enamel and dentin
- Sometimes, the pulp tissue may get damaged or infected, when the outer part of tooth is injured or affected. In order to save and restore the tooth, dentists may recommend the surgical removal of all of the diseased or necrotic pulp. This is known as Pulpectomy. The procedure is mainly performed in children with primary teeth (milk teeth)
- Saving a primary tooth helps in enabling normal eating, chewing, and speaking, and in maintaining “permanent teeth” profile (dental arch) by preserving space that may be otherwise occupied by adjacent growing teeth, which can lead to overcrowding
Typically, in Pulpectomy, the diseased material is removed from the root canal and pulp chamber or crown of the tooth. However, if pulp is partially removed, only from the pulp chamber/crown of the tooth, it is known as pulpotomy.
What part of the Body does the Procedure involve?
Pulpectomy involves the affected region of the tooth and gums.
Why is the Pulpectomy procedure Performed?
Pulpectomy procedure may be performed for the following reasons:
- Severe trauma to tooth causing pulp damage
- Inflammation of the pulp causing pulpitis due to cavities, when the pulp cannot be restored
- Abscess formation in the primary molar teeth
- When X-rays show loss of bone in the infected milk teeth
- In some cases, to maintain the profile of teeth (arch)
A Pulpectomy is mainly performed in children with milk teeth, since the roots are not deep into the teeth (which help when milk teeth are replaced by permanent teeth). Removing damaged milk teeth prematurely (without thought to saving it), may cause misalignment and other dental issues, when permanent teeth take their place. So, a Dental Pulpectomy may be preferable to tooth extraction (in children), where necessary. However, if the tooth is severely damaged and cannot be restored, it is extracted/removed.
What are some Alternative Choices for the Procedure?
Pulpectomy is a preferred treatment to avoid loss of tooth in the affected individual. However, if the tooth cannot be salvaged it may have to be extracted. Also, when the child cannot sit through long dental procedures, a tooth extraction may be the only option.
The alternatives may include measures to avoid damage to teeth through:
- Educating child on oral care
- Regular brushing and practice good eating habits
What are the Recent Advances in the Procedure?
There are no recent advances in the Pulpectomy procedure.
What is the Cost of performing the Pulpectomy Procedure?
The cost of Pulpectomy procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.
In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.
When do you need a Second Opinion, prior to the Procedure?
- It is normal for a patient to feel uncomfortable and confused by the information regarding a Pulpectomy procedure and on what needs to be done
- If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required
- Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently
What are some Helpful Resources?
Complete Guide to Symptoms, Illness & Surgery; Written by H Winter Griffith, M.D.; Revised and updated by Stephen Moore, M.D. and Kenneth Yoder, M.D.; The Berkley Publishing Group, 5th Edition, New York, 2006
http://www.drjosherickson.com/faqs/what-is-a-pulpotomy-or-a-pulpectomy/ (accessed on 01/03/2018)
http://www.moscattinidental.com/procedures/pediatric-dentistry/pulp-therapy-pulpotomy/pulpectomy/ (accessed on 01/03/2018)
https://www.dentalfind.com/glossary/pulpectomy (accessed on 01/03/2018)
Prior to Pulpectomy Procedure:
How is the Pulpectomy procedure Performed?
The Pulpectomy is performed in the following manner:
- The dental professional undertakes an accurate assessment of the pulp and tooth. A visual identification of infection, abscess formation, or tooth damage is made
- The tooth in concern is isolated using a rubber dam (or a suitable technique) and local anesthesia administered
- Special instruments are then used to explore the root canal; a hole is drilled, and the diseased pulp removed
- Any broken tooth pieces are removed and the cavity filled with suitable inert (resorbable) material
- If the primary tooth is badly damaged, then a stainless steel crown may be used to cap the tooth
- Antibiotics are given to prevent any infection
- The procedure may take several sessions to complete
A follow-up is recommended every 3-6 months, for individuals less than 20 years old.
A Pediatric Pulpectomy process is a conservative approach that can be stated to form a part of root canal treatment, with the key difference that the tooth is not removed. Instead, once the pulp is removed, a synthetic ‘resorbable’ material (for primary teeth) takes the place of the pulp in the canal area. This material is placed, once the insides of the tooth are cleaned, and disinfected/medicated. Hence, this therapy is also known as a “baby root canal” therapy.
Where is the Procedure Performed?
A Pulpectomy is usually performed in an out-patient surgery center facility, a dentist’s or endodontist clinic/office, or a hospital.
Who Performs the Procedure?
A dental professional expert or an endodontist performs a Pulpectomy.
How long will the Procedure take?
The time for procedure depends on the underlying reason for Pulpectomy. However, it may take anywhere between 1-2 hours, over several sessions.
What do you need to tell your Physician before the Procedure?
It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the Pulpectomy and helps avoid unnecessary complications.
- Provide a complete list of medications you are currently taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
- If you are allergic to any specific medication or food items
- If you are taking blood thinners such as aspirin, warfarin, herbal supplements, or any other such medications
- If you or your family members have a history of bleeding disorders, or if there is a tendency to bleed more than normal
- If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
- If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
- If you have a history of frequent bone fractures (this may affect bone-healing if bones are involved as part of your procedure)
- A list of all previous surgical procedures you have undergone, for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.
What Preparations are needed, prior to the Procedure?
- The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are currently being taken
- Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time before the procedure is performed
- Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
- Inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
- Avoid application of any cosmetics, deodorant, or topical medicines on the area prior to the procedure
- It is advisable to quit smoking and the use of any nicotine based products for a while before the surgery
- Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
- The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
- For individuals suffering from diabetes, it is important that the blood sugar stays within the normal range; if not, their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines
What is the Consent Process before the Procedure?
A physician will request your consent for Pulpectomy using an Informed Consent Form.
Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.
You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.
What Tests are needed, before the Pulpectomy Procedure?
Before a Pulpectomy, the patient has to undergo certain tests such as:
- Examination of the affected tooth
- Routine blood and urine analysis
- X-rays of the mouth
What are some Questions for your Physician?
Some of the basic questions that you might ask your physician are as follows:
- What is a Pulpectomy?
- Why is this procedure necessary? How will it help?
- How soon should I get it done? Is it an emergency?
- Who are the medical personnel involved in this procedure?
- Where is the procedure performed?
- What are the risks while performing the procedure?
- What are the complications that might take place during recovery?
- How long will it take to recover? When can I resume normal work?
- How many such procedures have you (the physician) performed?
- Are there any follow-up tests, periodic visits to the healthcare facility required after the procedure?
- What are the costs involved?
During the Pulpectomy Procedure:
What kind of Anesthesia is given, during the Procedure?
Local anesthesia by injection is administered prior to the Pulpectomy procedure.
How much Blood will you lose, during the Procedure?
The blood loss during a Pulpectomy is usually minimal.
What are the possible Risks and Complications during the Pulpectomy procedure?
There are general factors that increase the risk of getting complications during surgery and they include:
- Obesity: Generally, the greater the degree of obesity, the greater the surgical risk
- Smoking: The longer the smoking history (in pack years smoked), the greater the surgical risk
- Advancing age
- Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
- Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
- Poorly functioning liver, as evidenced by increased blood liver function tests
- Hypertension (increased blood pressure), especially if it is poorly controlled
- Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
- Poor lung function, as evidenced by abnormal lung function tests
- History of bleeding disorders
- Longstanding illness, such as autoimmune disorders and chronic infections
- Poor immune system due to a variety of causes
The possible risks or complications that may arise during the Pulpectomy are:
- Excessive bleeding
- Infection of the surgical wound
- Anesthetic complications
- Damage to tooth during the procedure, leading to its loss
- Overfilling may occur if the cleaned pulp cavity extends deep into the roots
What Post-Operative Care is needed at the Healthcare Facility after the Pulpectomy procedure?
At the healthcare facility, usually there is no requirement for any post-procedure care, unless any complications arise.
After the Pulpectomy Procedure:
What are the possible Risks and Complications after the Pulpectomy procedure?
The possible risks and complications that may arise after Pulpectomy are:
- Excessive bleeding
- Severe facial swelling
- Infection in the surgical wound
- Cold or heat (tooth) sensitivity
- Dislodgement of tooth
What is the Prognosis after the Surgery?
The prognosis of Pulpectomy is usually good and no serious complications are observed, in most cases.
When do you need to call your Physician?
Do contact your physician if you notice any of the following symptoms:
- Worsening pain and swelling of the surgical wound
- Bleeding or fluid drainage from surgical wound
- The occurrence of any symptom that causes uneasiness such as nausea or vomiting
- Numbness or cold sensation of the gums
- Signs of an infection
- Fever, feeling sick
- Complications associated with prescription medications used in treatment
What Post-Operative Care is needed at Home after the Pulpectomy procedure?
At home, the following post-operative care may be recommended after a Pulpectomy:
- Use ice packs to relieve pain; if necessary, pain-relief medication may be prescribed
- Apply ice packs to reduce facial swelling, if necessary
- Complete the course of prescribed medication/antibiotics as advised by the physician
- Individuals are advised to have soft foods after surgery for a few days
- Keep mouth clean/clean teeth using suitable toothbrush and toothpaste
How long does it normally take to fully recover, from the Procedure?
A full recovery from the Pulpectomy procedure may take a few days, after the sessions are completed.
What happens to tissue (if any), taken out during the Procedure?
- If any tissue is removed, it is taken for further examination and later disposed as per the standard medical procedure
- Majority of the times, the tissue that is removed is not sent for examination. But if the dental professional determines it should be, then it is sent
When should you expect results from the pathologist regarding tissue taken out, during the Procedure?
If a specimen (tissue) is submitted for exam, then the following steps are involved:
- The tissue removed is processed in the laboratory under a pathologist's supervision
- Slide(s) are prepared once the tissue is processed and is examined by a pathologist and a pathology report issued
- Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time
Who will you receive a Bill from, after the Pulpectomy Procedure?
It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.
Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:
- The outpatient facility, dentist’s or periodontist clinic/office, or a hospital
- An anesthesiologist (if anesthesia was administered)
- A dental professional or a periodontist
- A pathologist (if the tissue was sent for analysis)
The patient is advised to inquire and confirm the type of billing, before the Pulpectomy is performed.
Thanks and Gratitude:
We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.
Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA