It is a dental procedure that consists of extracting all the pulp tissue from the crown to the root of the tooth to treat the infection and prevent the loss of teeth.
This usually involves the primary teeth of pediatric patients and is considered part of the endodontic treatment. Some dentists refer to this procedure as partial root canal therapy.
The pulp, located in the center of the tooth, is formed by odontoblasts (cells that produce dentin and connective tissue) and a network of nerves and blood vessels.
In addition to being the source of dentin, the pulp is also responsible for supplying nutrients to the surrounding parts. It is a source of pain perception in trauma, disease, or pressure in dentin. When the pulp becomes infected or injured, it can cause the patient much pain and trauma.
Pulpectomy should not be confused with a pulpotomy, which involves the removal of part of the pulp to stop the spread of dental caries. A pulpectomy is performed when the pulp tissue has irreversibly damaged or has suffered necrosis (tissue death) due to tooth decay or extreme dental trauma.
Who should submit, and what are the expected results?
A pulpectomy is typically performed in children diagnosed with pulpitis with tissue necrosis or death. Pulpitis is a medical term that refers to the inflammation of the pulp due to a bacterial infection secondary to dental caries.
This condition is characterized by throbbing pain and extreme sensitivity to cold or hot temperatures. The procedure is particularly indicated for those with the formation of periapical abscesses or when pus is already present.
The damage to the pulp can be due to several factors, including large dental fillings that can not provide sufficient protection against bacteria and injuries to the face that damage the pulp.
Pulpectomy in deciduous teeth has a high success rate in preventing the spread of bacterial infection and necrosis in nearby teeth. Avoidance of tooth loss is achieved, and immediate pain relief is provided.
It is a standard practice for patients to take some analgesics after the procedure to decrease their discomfort. After the initial design, patients have scheduled several follow-up appointments to fill the channels and encourage the normal development of the teeth.
Dentists follow strict protocols to ensure enough room for permanent teeth when they erupt later.
How is the procedure performed?
Several days before the pulpectomy is performed, antibiotic medications are prescribed to the patient to treat the bacterial infection, especially in cases where the abscess has already occurred.
The procedure begins with applying topical anesthesia to reduce the patient’s discomfort. Next, the dentist makes a hole in the tooth to access and extract the infected pulp using snaps, a spiked dental instrument. The nerve inside the pulp is also pierced.
The dentist would typically use tools of different sizes to ensure that all wastes, as well as all infected tissues, are removed before irrigating the conduit with a solution of sodium hypochlorite or a mixture of sodium hypochlorite with surface modifiers.
After irrigation, the root canal and the pulp chamber are filled with an inert and non-absorbable material. The tooth is covered with a crown, which can be temporarily attached to the underlying structure with dental cement.
Possible risks and complications
A pulpectomy is a straightforward procedure with a low risk of serious complications. However, some cases result in the following:
Adverse reactions to applied anesthesia: local anesthetics can numb the lips, tongue, and other nearby tissues, but this usually resolves on its own a few hours after the procedure.
However, there are exceptional cases where the patient develops adverse reactions to applied anesthesia. Therefore, parents are usually asked if their child is allergic to any substance before performing the procedure.
The affected tooth can suffer a fracture and break during the procedure, causing further damage that can lead to tooth loss.
Excessive bleeding: this is a possibility, especially for patients with pre-existing medical conditions.
Treatment site infection can also occur and cause inflammation and more pain for the patient.
Some irrigation solutions may inadvertently affect the surrounding tissue, causing pain and edema.
Pain: if the dentist does not manage to eliminate all the necrotic tissue, there is a possibility of recurrence of the pain and the spread of the infection to nearby parts.