Pulpectomy - Types, Indications, Contraindications, and Prevention

Before we understand what pulpectomy is, let us know more about the parts and layers of a tooth. The parts of a tooth are:

1. Crown - The part of the tooth that is visible inside the mouth is called the crown. The crown’s shape varies depending on the tooth’s function. For example, the anterior teeth are chisel-shaped for cutting, while the molars are flat for grinding the food.

2. Root - The two-thirds of the tooth that is embedded in the jaw bone is called the root. It holds the tooth in place.

3. Neck - The area where the crown and root meet is called the neck.

The layers of the tooth are:

1. Enamel - It is the outermost tooth layer, which is the hardest tissue in the body.

2. Dentin - It is the middle layer of the tooth. Dentin has millions of tiny tubules where the nerve endings from the innermost layer are present.

3. Pulp - It is the center and soft core of the tooth. This is where nerves and blood vessels are present.

4. Cementum - The hard layer that covers the tooth root is called cementum.

What Does Pulpectomy Mean?

Dental caries or tooth decay, caused by the acid produced in the mouth by bacteria, can affect the enamel, dentin, and reach the pulp. When the pulp of a primary or milk tooth gets infected, pulpectomy is the best treatment option to save the teeth. In adults, if the pulp is infected, the tooth is either extracted or root canal treatment is done to save the tooth. In pulpectomy, the entire pulp is removed from the infected primary tooth to relieve pain and prevent extraction of the tooth. The root canal is then filled with a suitable resorbable material. As it is similar to a root canal treatment, it is also called “baby root canal.”

The dental pulp is the living part of the tooth. It contains nerve endings and blood vessels that keep your tooth alive or vital. Your teeth perceive hot and cold temperatures with the help of the pulp. It also circulates nutrient-rich blood to the entire tooth. The most important function of the pulp is to produce calcified tissue (dentin), which supports and strengthens the tooth.

What Are the Types of Pulpectomy?

The types are:

1. Partial Pulpectomy - When the infected crown portion of the pulp, along with some part of the root pulp, is removed. It is similar to the procedure called pulpotomy, where only the crown portion of the pulp is excavated.

2. Complete Pulpectomy - The entire pulp is removed.

What Are the Indications of Pulpectomy?

Pulpectomy is indicated whenever the pulp of a primary tooth gets infected (pulpitis). The following causes can result in pulp infection:

1. Tooth injury or trauma.

2. Cracked tooth.

3. Radiation injury.

4. Sudden temperature changes, for example, lead produced during dry cavity preparation.

5. Galvanic current that is produced by metallic dental fillings.

6. Use of acid etchant on exposed dentinal tubules.

7. Pulp necrosis.

Extraction might seem like an easier option considering that the permanent tooth will replace the lost milk tooth. But the premature loss of milk teeth can affect your child’s speech and his or her ability to chew food.

Why Is Pulpectomy Better Than Extraction?

The aim of pulpectomy is to retain all milk or primary teeth to help the child chew, speak, and swallow properly. Early loss of primary teeth can close the space required for the permanent teeth to erupt, resulting in misalignment of teeth. Preserving the infected tooth until it is time for the permanent tooth to erupt will maintain the space required for the erupting tooth. Similarly, premature loss of primary teeth can significantly reduce the arch length, again resulting in malalignment.

When it is time, the root’s of the milk tooth resorb and fall out, making way for the permanent tooth. As root resorption is important, the material used to fill the tooth root after a pulpectomy is biodegraded and gets absorbed by the body along the tooth root.

What Are the Contraindications of Pulpectomy?

Pulpectomy is not indicated when:

• The tooth is damaged beyond restoration.

• More than 2/3rd of the root is resorbed.

• The tooth is severely mobile.

Pulpectomy is also contraindicated for:

• Uncontrollable patient.

• Children with a known heart problem.

• Immunocompromised children.

What Are the Steps Involved in Pulpectomy?

1) One-Visit Pulpectomy Steps:

• A local anesthetic agent is injected to numb the tooth.

• The dentist will then access the root canal by drilling through the enamel and dentin.

• The infected or the entire dental pulp is then removed.

• Dental files are used to shape and clean the root canal.

• Sodium hypochlorite is used to irrigate the canal to remove all debris.

• The canal is then dried and filled with a resorbable obturating material, for example, Zinc Oxide Eugenol or Iodoform.

2) Multi-Visit Pulpectomy:

Here, instead of filling the canal with the obturating material in the first sitting, the dentist will fill the root with Calcium Hydroxide and place a temporary filling after cleaning, shaping, and irrigating the canal.

After a week, the dentist will check if the tooth is showing any symptoms of infection during the follow-up appointment. If the tooth is asymptomatic, the temporary filling is removed, and Calcium Hydroxide is rinsed out. The canal is filled with a resorbable obturating material.

How Can Pulp Infection (Pulpitis) Be Prevented?

Once the pulp gets infected, the tooth has to be extracted, or pulpectomy has to be done. Preventing tooth decay and injury to the pulp can prevent pulpitis. The following oral hygiene practice can help:

1. Brush your kids’ teeth at least twice a day.

2. Ask them to rinse their mouth with warm water after every meal.

3. Make sure they drink sufficient water to prevent mouth dryness.

4. Avoid frequent snacking between meals.

5. Restrict sugary food and drinks.

6. Take your child for regular dental check-ups to catch decay early.

7. Tooth injury can be reduced by wearing a mouthguard while playing sports.

For more information about pulpectomy, consult a dentist online now.