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Dentistry/Abscessed Tooth

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Question
Hello,

My 3 year old daughter slipped on a tile pool deck in June and injured her top two front teeth. Just a little over a week ago, a bump appeared on her gum above one of the injured teeth. After taking her to two pediatric dentists, it has been determined that one tooth has abscessed and should be extracted. After not getting the discussion we expected from her dentist, we sought out another for a second opinion. I am so grateful we did, because I feel I understand things better now - but not completely. Is it possible to successfully do a pulpotomy on an abscessed top front tooth? I am wondering what a dentist looks for when determining whether or not a successful pulpotomy for an abscessed tooth is possible. If you could explain this to me a bit so I can be at peace with the appointment we have to extract my baby's top two baby teeth, I would be very grateful!

Answer
Hopefully, my response will not create further confusion for you.
First, understand that there is a very important distinction between "pulpotomy" and "pulpectomy".  
A pulpotomy is a partial root canal treatment of the affected tooth.  It is reserved for marginally infected primary (baby) teeth where the nerve in the root portion of the tooth is still healthy.  This is definitely not indicated for a tooth that has already abcessed.  In an abcessed tooth the entire pulp tissue including the entire root is infected along with some infection spreading to the bone and gum.
In the case of an abcessed primary tooth a pulpectomy is indicated.  This is more like a complete root canal procedure.  The procedure is a bit more complicated and takes somewhat longer than a pulpotomy but is still accomplished in the dental chair.  Sometimes it may take several visits but sometimes not.  Depending on the extent of the infection in the area of the bone the pulpectomy may not be entirely successful and the tooth may have to be extracted at some point.

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Dr. Randolph Myerson

Expertise

Please limit your inquiry to questions about orthodontics (braces) and children's dentistry. I am both an Orthodontist and a Pediatric Dentist, having been trained in both of these dental specialty fields. Orthodontics is the dental specialty that treats problems of tooth, bite and jaw alignment using braces and removable appliances. Pediatric Dentistry is the dental specialty also known as dentistry for children, which deals specifically with the dental problems of this special age group from infants to adolescents. I am also experienced in Forensic Dentistry, the application of dentistry to law enforcement and identification using dental records.

Experience

I have been in the private practice of orthodontics and pediatric dentistry for over 20 years. Prior to that I served for three years on the Cleft Palate and Cranio-facial Reconstruction team at Children''s Hospital of Philadelphia and was an Assistant Professor of Dentistry at University of Pennsylvania School of Dental Medicine. I also served as a dentist in the U.S.Air Force, stationed at Andrews AFB in Washington, DC.

Organizations
I am a Fellow in the American Academy of Pediatric Dentistry, and a member of the American Association of Orthodontics, as well as a member of the American Dental Association and the Dental Society of the State of New York.

Education/Credentials
I received my BA in Biology from Frankin & Marshall College in 1969, and my dental degree from University of Pennsylvania School of Dental Medicine in 1973. In 1978 I received both my Certificate in Orthodontics from University of Pennsylvania School of Dental Medicine, and my Certificate in Pediatric Dentistry from Children''s Hospital of Philadelphia after completing a three year Teaching Fellowship in Orthodontics and Pediatric Dentistry in 1978.

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