Dentistry/Pulpotomy vs Root Canal
Hi Dr. Backlund,
I'm 27. I had my first dental check up in a number of years a couple of months ago (I accept that this is terrible and I am working to improve on the situation with regular checkups from now on in), we took x-rays and the dentist indicated I would need two root canals at some point in the near future (had been experiencing some tenderness but no constant pain) and some fillings. They said I would need an endotontist for the more complicated of the two teeth, but they could do one in their surgery. They said the root canals could maybe wait a couple of months but they were 'time bombs' and without a root canal I'd be begging for an extraction.
I dutifully booked in what I thought was a root canal as soon as I could afford to do so, which was about a month. After the gas was starting to kick in the dentist was numbing both sides of my mouth. When I inquired about this he said we wouldn't be doing a root canal today, we would be doing two pulpotomies, which he explained meant opening up the tooth, clearing away damaged pulp, medicating and re-sealing. He indicated if successful, this may mean that the root canal becomes unnecessary. During the procedure he noted that the nerves were bleeding and still alive.
Everything I've read about pulpotomies since seems to indicate that they are only a temporary fix and that I likely have extractions or a root canals in my future - obviously though I'm thoroughly out of my depth with the scientific literature. Are there things I can do to give the treatment a better chance at success? When is it better to give a patient a pulpotomy instead of doing a root canal procedure?
First, congratulations on your decision to make your dental exam more regular. That's a good decision for your oral health as well as your bank account. Dental neglect can be very expensive.
Now to answer your question. When decay is very deep, but the tooth is not abscessed, the first step is to remove all the decay. If, during that process, there is an exposure of the pulp(nerve) of the tooth, then the dentist needs to make a decision based on the size of the exposure. If it is very small, like the size of a BB, then medication can be placed over that exposure and a filling placed. Often that will solve the problem and no root canal would be necessary. In technical terms, this is called a pulp cap. If the exposure is large, then the entire pulp is removed and medication is placed to cover the entrance of the nerve into the roots. This is a pulpotomy. Pulpotomies are really designed to buy time before a root canal is done. They are not intended to be final treatment. It's hard for me to really know whether your dentist did a pulp cap or a pulpotomy even though you were told it was a pulpotomy since it sounds like you were told this was the final treatment.
My suggestion would be that you call your dentist's office and ask for clarification. Just tell them you did an Internet search and are confused about the next step. At least you will then know what the plan is and what you should be looking for if any problems develop.
I hope this helps. If you have other questions or need clarification, please write back.
Gary Backlund DMD, MSD