Pulpotomy vs. Pulpectomy: What’s the Difference and Why Would Your Child Need One?

Root canal treatment might sound like something only adults need, but they’re fairly common in kids, too. Dentists often recommend one of two kinds of root canals — a pulpotomy or pulpectomy — to save badly damaged or decayed baby teeth and protect a child’s future smile.

So, what’s the difference between these two procedures? And what good do they do?

We talked with pediatric dentist Daniel Gindi, DMD, to get to the root of it.

Pulpotomy and pulpectomy

To understand pulpotomies and pulpectomies, let’s start with a look at what’s inside your teeth. Beneath the hard outer layers of enamel and dentin is a soft core called the pulp. It contains nerves, blood vessels and connective tissue. The pulp is what keeps your teeth alive.

“Baby teeth have bigger pulp spaces than adult teeth,” Dr. Gindi explains. “Their enamel is thinner, too, so cavities don’t have far to go to hit the nerve. That’s why tooth decay can progress quickly in kids.”

When a cavity or trauma reaches the pulp, it can cause pain, inflammation or even infection. That’s when dentists consider treatments like pulpotomy or pulpectomy. They’re procedures to help save baby teeth.

What is a pulpotomy?

A pulpotomy is a treatment that removes damaged or decayed pulp from the crown of the tooth (the part you can see above the gumline). The healthy pulp tissue in the root is left intact.

This approach works well when the problem area hasn’t spread beyond the crown. And it’s used mostly in baby molars, which have more pulp than other teeth.

The procedure can relieve your child’s tooth pain, and it keeps their baby tooth in place until it’s ready to fall out.

“Think of it like a partial root canal,” Dr. Gindi says. “They’re less invasive, and kids usually bounce back fast. Sometimes, they’re back in school the next day.”

What is a pulpectomy?

A pulpectomy goes a step further. In this procedure, all of the pulp is removed — including the pulp in the roots of the tooth (below the gumline). Pulpectomy is an option when the tissue is too damaged or too infected to be saved. Pulpectomies can be done in any infected tooth as long as there is enough bone around the tooth to support it.

After the pulp is removed, the empty roots are cleaned, disinfected and filled with a special material that your child’s body will absorb over time. That way, the baby tooth can still fall out naturally when it’s time for the adult tooth to come in.

“A pulpectomy is basically a full root canal for a baby tooth,” Dr. Gindi explains. “The big difference is we use different filling material in kids than we do for adults. It’s softer, so it doesn’t interfere with the permanent tooth growing in.”

As with a pulpotomy, recovery from a pulpectomy is quick. Kids are typically back to their usual selves the next day.

Deciding which procedure to use

The decision of whether your child may need a pulpotomy or pulpectomy depends on what their dentist sees during an exam and on X-rays.

“We’re looking for signs of infection in the bone, especially between the roots,” Dr. Gindi says. “If the bone looks like it’s starting to break down or there’s pus on the gums, those are good indications for a pulpectomy. It’s what’s needed to clear the infection.”

Why not just pull the tooth?

We know what you’re thinking: Baby teeth are going to fall out anyway. Why go through the trouble?

“I get that question all the time,” Dr. Gindi acknowledges. “Baby teeth matter more than people realize. Sometimes, this is the best way to keep a child out of pain and avoid bigger problems later.”

Baby teeth may not last long, but they play an important role in your child’s health and development.

“If you take baby teeth out too early, the other teeth can start shifting,” Dr. Gindi points out. “Then, when the adult tooth tries to come in, there’s no room for it.” Losing teeth too soon can also affect speech, chewing and jaw development.

And just letting a bad tooth stay in place isn’t always a healthy option either. Untreated tooth infections can lead to pain, swelling, trouble eating and even hospital visits. A pulpotomy or pulpectomy helps avoid all that.

Can these procedures be avoided?

Good oral hygiene and regular dental visits go a long way in preventing decay that leads to pulp treatments. So, encourage your kiddo to keep up with healthy habits, like:

• Brushing their teeth twice a day with fluoride toothpaste
• Flossing daily
• Limiting sugary snacks and drinks
• Visiting a dentist every six months

“The earlier we catch cavities, the better the outcome,” Dr. Gindi advises. “Sometimes, we can treat them with just a filling or silver diamine fluoride. But once the nerve is involved, we don’t have that option anymore.”

The bottom line

Pulpotomies and pulpectomies can save a baby tooth (and help your child avoid future dental troubles down the road). If your child’s dentist recommends one, know that it’s a common procedure — and kids tend to handle it better than adults might expect.

“It’s all about setting kids up for long-term success,” Dr. Gindi reassures. “If we can avoid pulling teeth, avoid pain and keep their mouth healthy, that’s a win for everyone.”