Background Information:

What are the other Names for the Procedure?

• Dental Pulpotomy
• Pediatric Pulpotomy
• Pulp Therapy (Pulpotomy)

What is Pulpotomy 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 a part of the diseased pulp
• When the infected pulp is removed only from the pulp chamber or crown of tooth (called the coronal pulp) and not from the root canal, it is known as Pulpotomy. The procedure is mainly performed in children with primary teeth (milk teeth)

However, if the entire diseased pulp is removed from both the root canal and pulp chamber or crown of the tooth, it is known as pulpectomy.

What part of the Body does the Procedure involve?

Pulpotomy involves the affected region of the tooth and adjacent gums.

Why is the Pulpotomy procedure Performed?

Pulpotomy procedure may be performed for the following reasons:

• Minor trauma to tooth causing pulp damage
• Inflammation of the pulp causing pulpitis due to cavities
• Dental caries that may be severe, but not affecting the root
• When tooth extraction is not indicated, and no abscess formation is noted
• Also, when the tooth is considered vital/important (as determined by a dentist) in the child
• In some cases, to maintain the profile of growing teeth (arch)

When a tooth pulp is infected, the following symptoms may warrant a Pulpotomy:

• Severe pain, pain in the night
• Increased sensitivity of tooth
• Swelling of the gums
• The tooth is shaking or movable
• Biting causes severe pain

A Pulpotomy is mainly performed in children with milk teeth. The procedure may constitute the initial stage of a root canal treatment process. It is useful for treating milk teeth problems and “growing permanent” teeth problems.

What are some Alternative Choices for the Procedure?

Pulpotomy is a preferred treatment to avoid loss of tooth in the affected individual. 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 Pulpotomy procedure.

What is the Cost of performing the Pulpotomy Procedure?

The cost of Pulpotomy 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 Pulpotomy 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, 5^th 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 Pulpotomy Procedure:

How is the Pulpotomy procedure Performed?

The Pulpotomy is performed in the following manner:

• The dental professional undertakes an accurate assessment of the pulp and tooth. A visual identification of infection and/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 crown region and remove the pulp lesion; the remaining pulp is left to be functionally active (pulp vitality is retained)
• The cavity is cleaned, disinfected and a suitable medication (therapeutic material) is placed in the empty space/chamber
• If the primary tooth is severely injured/damaged, then a stainless steel crown is used to cap the affected tooth
• Antibiotics are given to prevent any infection

A follow-up is recommended by the dental professional.

Where is the Procedure Performed?

A Pulpotomy 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 or an endodontist performs a Pulpotomy.

How long will the Procedure take?

The time for procedure depends on the underlying reason for Pulpotomy. However, it may take a few hours.

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 Pulpotomy 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 Pulpotomy 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 Pulpotomy Procedure?

Before a Pulpotomy, 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 Pulpotomy?
• 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 Pulpotomy Procedure:

What kind of Anesthesia is given, during the Procedure?

Local anesthesia by injection is administered prior to the Pulpotomy procedure.

How much Blood will you lose, during the Procedure?

The blood loss during a Pulpotomy is usually minimal.

What are the possible Risks and Complications during the Pulpotomy 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 Pulpotomy are:

• Excessive bleeding
• Infection of the surgical wound
• Anesthetic complications
• Damage to tooth during the procedure, leading to its loss
• The root canals may be affected during the procedure

What Post-Operative Care is needed at the Healthcare Facility after the Pulpotomy procedure?

At the healthcare facility, usually there is no requirement for any post-procedure care, unless any complications arise.

After the Pulpotomy Procedure:

What are the possible Risks and Complications after the Pulpotomy procedure?

The possible risks and complications that may arise after Pulpotomy are:

• Excessive bleeding
• Severe facial swelling
• Infection in the surgical wound
• Cold or heat (tooth) sensitivity

What is the Prognosis after the Surgery?

The prognosis of Pulpotomy is usually excellent 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
• Headache
• Fever, feeling sick
• Dizziness
• Complications associated with prescription medications used in treatment

What Post-Operative Care is needed at Home after the Pulpotomy procedure?

At home, the following post-operative care may be recommended after a Pulpotomy:

• 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 Pulpotomy procedure may take a few days, after the sessions are completed.

Additional Information:

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 Pulpotomy 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 an endodontist
• A pathologist (if the tissue was sent for analysis)

The patient is advised to inquire and confirm the type of billing, before the Pulpotomy 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