The Pulpotomy Procedure
A dentist may or may not know from the x-rays that a baby tooth is infected. Often it is in the process of removing the decay that the infection is confirmed. At the point when it is discovered that the baby tooth is infected, the bulk of the pulp of the tooth, down to where the roots begin, is removed with a handpiece. If the living tissue remaining in the tooth is healthy enough, the dentist will be able to stop the bleeding of that tissue with a cotton pellet and waiting about five or ten minutes. If he or she can't get the bleeding to stop that way, it's an indication that the tissue is not healthy enough for a pulpotomy and the baby tooth will have to be removed. If the bleeding does stop, then the dentist will daub a disinfectant, often formocresol, on the tissue and then seal the tooth with a filling material.
A baby tooth with a cavity large enough to be infected is probably weak enough that it needs the protection of a crown. Again, because this is a tooth that will fall out before very many years, the crown procedure is simplified by using a prefabricated crown, such as a stainless steel crown or a polycarbonate crown.
A successful pulopotomy treatment will last without any complications or need for maintenance until the baby tooth falls out, which could be as long as nine years.
Some parents may wonder why even bother, if the tooth will fall out anyway. But it's not that simple. Yes, if the baby tooth is a front tooth, it can fall out without any complication. But if it's a baby molar, which is the case with almost all pulpotomy cases, and the tooth is lost prematurely, the permanent dentition will become a jumbled mess. With no teeth present to hold their position, the permanent six year molars will drift forward. Then, at age 10 to 12, when it's time for the permanent premolars to come in, there won't be space for them and they may be forced out sideways.