The pulp is the soft tissue in the hollow inner core of the tooth, where the nerves, blood vessels, connective tissue, and reparative cells are located.  These work to channel vital nutrients and oxygen to the tooth.   There are several ways in which pulp can be damaged.  Most commonly in children, it is traumatic injury or tooth decay, and that can lead to painful pulp exposure and inflammation.

There are two types of pulp therapy:  vital and non-vital.  The goal of vital pulp therapy is to maintain health and function of the dental pulp, in order to preserve the primary tooth until the permanent tooth erupts.  In non-vital pulp therapy, the pulp is either dead or is so diseased or damaged that it cannot be saved, and the goal is to remove the diseased tissue and save the tooth (called a pulpectomy in children, a root canal treatment in adults).

Primary teeth

While there may not have been much change in the treatment of permanent teeth, there have been significant changes in the approach to vital and non-vital pulp therapy for the primary teeth. These can be divided into the following:

Vital pulp therapy
  • Indirect pulp therapy (IPT) or indirect pulp capping
  • Direct pulp capping
  • Vital pulpotomy.
Non-vital pulp therapy
  • Pulpectomy.

Indirect pulp therapy:  Decay is removed from the outer layers of enamel and detin, but a thin layer of discolored dentin is preserved at the base of the excavation to avoid exposing the pulp.  It is usually successful in primary teeth that are symptom free.

Direct pulp capping:  The pulp is exposed and the filling material is placed directly on the pulp.  It is only recommended during cavity preparation of a vital, non-inflamed pulp when a small traumatic or inadvertent exposure occurs.

Vital pulpotomy:  Irreversibly inflamed coronal pulp tissue is removed, allowing the remaining healthy or reversibly inflamed pulp tissue in the roots to recover.  The usual restoration on back molars is with a stainless-steel crown, to provide normal chewing function and to preserve the space until the permanent tooth can come in.  On the visible upper front teeth, either a regular stainless-steel crown or a more esthetic white stainless-steel crown (stainless-steel with white resin on outer face) can be placed. This is performed in one visit and causes no more discomfort than placing a routine filling.

Pulpectomy:  Root canals in primary teeth are complex, but when the pulp is dead or too diseased to heal, then it is removed in crown and roots in a root canal treatment, and filled with a resorbable material.  In permanent teeth, a non-resorbable material is used, and either a temporary stainless steel crown or an adult ceramic, porcelain, or gold permanent crown would by placed.  If X-rays show failure, then an extraction is usually recommended.

It’s important to save primary teeth, because even though they are eventually lost when permanent teeth erupt, they are still needed for speech production, effective chewing, and to guide the proper alignment and spacing of permanent teeth.  Some of the undesirable consequences of prematurely extracted/missing teeth are:

  • Arch length may shorten.
  • Permanent teeth may lack sufficient space to emerge.
  • Opposing teeth may grow in a protruding or undesirable way.
  • Premolars may become painfully impacted.
  • Remaining teeth may “drift” into the gap.
  • The tongue may posture abnormally.
  • Chewing ability may be compromised
  • Speech abnormality may happen

Likewise, in young permanent teeth, treatment is important because the roots are still developing, and it is important to maintain the vitality of the pulp to achieve a favorable crown/root ratio and fully developed dentin walls for the long-term retention of a permanent tooth.

When a tooth is infected or damaged, these are some of the signs to look for:

  • Constant unexplained or localized pain.
  • Nighttime pain.
  • Sensitivity to warm and cool food temperatures.
  • Swelling or redness around the affected tooth.
  • Unexpected looseness or mobility of the affected tooth.

The pediatric dentist knows that every situation is unique when making a decision whether to extract the tooth or to save it with pulp therapy.  Some of the things the dentist will consider are:

  • The age of the child
  • The medical and dental history of the child
  • The positioning of the tooth
  • The general health of the child
  • The amount and location of pulp damage
  • Uncooperative or non-compliant patient/parent

If you are interested in pulpal therapy in Costa Rica, fill out the “Find a Dentist” form on this page.  One of our patient advocates will reply to your needs.