The Cosmetic Dentistry Blog

May 28, 2010

Do vital pulp caps work?

Filed under: Root canals — iowasmiles @ 1:49 pm

My dentist touched the pulp of tooth # 19 and now the tooth is infected. The tooth is cosmetically perfect and feels as strong and healthy as my other molars. He prescribed a week of amoxicillin and told me my only option is a root canal. What can be done to ensure that the crown does not leak or become infected? Is there a way to tell from an xray if a tooth will need a post? I have done my best to take good care of my teeth, and feel as if the only option the dentists I have seen offer is root canal followed by a crown, but I don’t understand why something less extreme like topical antibiotic and refilling the tooth isn’t possible? This filling last 12 years before this infection, and a crown would last about that long as well? Essentially, what is your opinion of pulp-capping? And is there a point of infection after which root canal is no longer an option?
- Roger from Alabama

Roger,
It used to be thought that anytime there was a pulp exposure on a tooth, the tooth needed a root canal treatment.

However, if there is a “clean” exposure of the pulp, it is very possible to preserve the vitality of the tooth and avoid root canal treatment. I did this vital pulp cap treatment many times, including to a fractured front tooth where the fracture had exposed the pulp.

The important issue is whether or not the pulp is healthy. If the bleeding is minimal and stops within a couple of minutes, that’s a good indication that the pulp is healthy. If the bleeding is hard to control, then the pulp isn’t healthy and the tooth will need a root canal treatment.

When I did these vital pulp caps, I would put a cavity cleanser containing chlorhexidine gluconate on the exposure, then some type of base such as calcium hydroxide, and a resin ionomer over that. Then you wait a few weeks to see if it heals. If the tooth becomes very sensitive, or if their is tooth pain, then the pulp cap didn’t work. But my experience was that usually the tooth would heal without incident.

You said your tooth #19 is infected. Just because the tooth has a pulp exposure doesn’t mean that it’s infected. If it doesn’t hurt, then it very well could be not infected. And the antibiotics won’t help. Penicillin won’t help an infection that is inside a tooth. I’ve never known penicillin to be any help in a situation like this.

I hope this is helpful. I don’t understand the other things you’re saying and asking about the filling and a post and everything else, but hopefully this information will be useful for you.
Dr. Hall

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