Pulpotomy: Indicated for vital primary teeth with exposed pulp (nerve chamber). Best performed when:
- There is spontaneous pain
- Swelling around the gingiva
- Tenderness to percussion
- Abnormal mobility
- Presence of fistula (infection)
- Presence of sulcular drainage (infection)
- Presence of internal resorption
- Pulp calcification
- Pathologic external root resorption
- Periapical radiolucency on radiograph
- Radiolucency around the root on radiograph
- Excessive pulpal bleeding or decaying odor
The procedure involves caries removal if needed and accessing or unroofing the pulp chamber with a sterile bur. A sterile large spoon excavator is used to incise and remove all pulpal tissue with the coronal chamber being careful not to pull out the root tissue. Bleeding is controlled with cotton pellet pressure. A zinc oxide and eugenol base mixture is inserted with a final restoration.
Pulpectomy: This is the complete removal of the pulp of the tooth which implies a root canal therapy but utilizing a physiologically tolerable and resorbable material. The treatment is indicated if the degenerative pulpal changes have involved the toot tissue. Often the dentist may use this approach even under extreme circumstances when the potential for success is low or not ideal, for example in the case when the second primary molar has severe caries but the first permanent molar has not erupted. If there is no ability to place a space maintainer, the option is to try to do the pulpectomy on the second primary molar to extend it existence till the first permanent molar erupt. The natural primary tooth is the best space maintainer although a distal shoe spacer may or may not be an option.