What is a pulpectomy?

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Pulp is the soft mass of connective tissue that is located in the center of the tooth. Dental pulp also contains nerves and blood vessels to provide essential nutrients to keep the tooth healthy and working properly.

A pulpectomy is the removal of pulp tissue from all parts of a tooth that has become irreversibly infected or necrotic (dead due to a lack of blood and oxygen to the tissue). A pulpectomy is usually performed in children by using various materials and techniques to fill the canals of primary teeth.

Stages of a pulpectomy

In a pulpectomy, the root canals undergo debridement (removal of plaque), shaping, drying, and obturation (filling). Pulpectomy has a success rate of over 90% in primary teeth and can normally be completed in a single appointment.

Pulpectomy involves:

  1. Taking X-rays to detect signs of infection and determine the shape of the root canals
  2. Using a local anesthetic to numb the area
  3. Identifying and opening the cavity
  4. Removing all infected pulp using small dental instruments
  5. Cleaning and disinfecting the tooth for filling
  6. Filling the tooth with resorbable material

Obturation (filling)

The material used to fill the tooth is designed to be reabsorbed by the body when it begins to be replaced by the permanent tooth. The most common root filling materials for primary teeth are zinc oxide-eugenol (ZOE), iodoform-based pastes, and calcium hydroxide.1

However, none of these materials meet the ideal requirements of an obturating material. Endoflas is a combination of these three materials that has been growing in popularity for obturation. This is because the disadvantages of one material can be compensated with the advantages of another.2

In permanent teeth, pulpectomy is the initial part of the root canal procedure. The major difference between a pulpectomy and a root canal is that the tooth gets a permanent filling or crown in a root canal.

Recovery after a pulpectomy

People normally recover very quickly after a pulpectomy procedure so normal activity can be resumed right away. Regular oral care like brushing and flossing are also typically continued as normal.

However, eating should be avoided until the numbness from the anesthetic disappears. Pain killers are usually recommended if the area around the treated tooth feels swollen and sensitive. If the tooth is severely infected, antibiotics can sometimes be required.

Why is a pulpectomy needed?

Pulpectomy may seem like a complicated dental procedure to rescue baby teeth. A pulpectomy is also controversial for several reasons:3

  • Complex root canal structure
  • Complicated diagnosis due to the age of the patient
  • Choice of technique
  • Choice of root filling materials

However, it is an extremely helpful procedure as it is dangerous to maintain untreated infected primary teeth in the mouth. Since they are a source of infection, they should be treated or removed.

The normal replacement of baby teeth to permanent teeth during the growth and development of children is crucial for their chewing, pronunciation, jaw development, and appearance. Pulp disease of baby teeth can lead to premature loss, which can lead to more problems. These can include chewing difficulties, speech development issues, overcrowding of teeth, and altered alignment of permanent teeth. In severe cases, it can affect the physical and mental health of children.4

Can a pulpectomy be prevented?

Good oral care can help prevent decay:5

  • Brushing your teeth thoroughly at least twice a day with fluoride toothpaste
  • Flossing between the teeth daily to remove food, debris, and plaque
  • Rinsing with an antimicrobial mouthwash
  • Drinking water with meals to wash away sugar and acids
  • Replacing sugary drinks with water
  • Avoiding tobacco products
  • Limiting alcohol intake
  • Having regular dental check-ups

A pulpectomy is a valuable treatment option for oral health. However, it is important to call your dentist if you have any symptoms after a pulpectomy, such as increasing pain, signs of infection or inflammation around the tooth, or heightened sensitivity to heat and cold.

References:

1. Chen X, Liu X and Zhong J. (2017). Clinical and radiographic evaluation of pulpectomy in primary teeth: a 18-months clinical randomized controlled trial. Head & Face Medicine, 13(1), 1-10. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5658955/

2. Nagarathna C, et al. (2018). Primary molar pulpectomy using two different obturation techniques: a clinical study. Contemporary Clinical Dentistry, 9(2), 231-236. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/29875566/

3. Pramila R, et al. (2015). Pulpectomies in primary mandibular molars: a comparison of outcomes using three root filling materials. International Endodontic Journal, 49(5), 413-421. Retrieved from: https://onlinelibrary.wiley.com/doi/10.1111/iej.12478

4. Yu Y, Zhou X and Zheng L. (2020). Advanced research on root canal therapy for primary teeth. West China Journal of Stomatology, 38(2), 205-210. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7184287/

5. Yap A. (2017). Oral health equals total health: a brief review. Journal of Dentistry Indonesia, 24(2), 59-62. Retrieved from: https://www.researchgate.net/publication/319919543_Oral_Health_Equals_Total_Health_A_Brief_Review

Image by Memed_Nurrohmad from Pixabay 

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