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Pediatric Dentistry/Pulpotomy or Extraction?

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bottomrightmolars
bottomrightmolars  
Hi Dr.Saxe,
My 7 yr old daughter had some cavities and her doctor suggested fillings. We did the filling, but a few days ago (nearly 2 months after the fillings are done) there was a boil/bubble on her gum. I went back to the doctor and he took X-rays and told us that the filling was too close to the nerve and it did not like it and got infected. The tooth is not savable and extraction with space maintainer is the only option.
I took a second opinion  with the same X-ray and was told that since the tooth is very strong, Pulpotomy would work. Extraction would be very drastic in this case.
I called back my original doctor to find why he chose extraction and he said that the tooth was too damaged for it and Pulpectomy would be option not pulpotomy and the success rate is 50% and he did not want to subject her for such a probability. The fact that she has a permanent molar there would help with the space maintainer.
Can you please suggest what I should choose in this case?
The tooth is the second baby molar on the bottom right. The permanent molar next to it has already in place.

I can scan the X-ray if you need.

Any advise on this will be very much appreciated as I am very confused.


Best Regards,
Radhika

Answer
A Pulpotomy is only used on a vital tooth (alive), if it had a bump next to it, the tooth is no longer alive and a Pulpotomy is contraindicated.  A Pulpectomy or extraction is the treatment needed. All pulp treatments have a large fail rate, and may have to be extracted in the long run.  If the roots are in perfect condition then a pulpectomy would have a fair prognosis.  The extraction with a needed spacer is 100%, to protect the developing tooth underneath.  Your second opinion is wrong on the treatment recommendation.  

Pediatric Dentistry

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Michael D. Saxe D.M.D.

Expertise

All questions related to Pediatric Dentistry, Dental Growth, Dental Trauma, First Dental visit, Baby Bottle tooth Decay, Dental Sedation, Etc...

Experience

20 years private practice as a Pediatric Dentist, Staff at University Of Nevada School of Dental Medicine, Advanced Education Program in Pediatric Dentistry.

Organizations
ADA, AAPD, Nevada dental society, Clark County Dental Society, Cal. AAPD, Western society of Pediatric Dentistry, Southern Nevada CFA Team core member.

Publications
ASDC Journal

Education/Credentials
Washington University in Saint Louis, Dental School University of Texas Health Science Center San Antonio, residency

Awards and Honors
Top pediatric Dental office 6 years in a row.

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