Hi Dr Hall
I had a direct pulp capping performed on my upper molar last month as a small area of pulp was exposed during caries removal. There was minimal bleeding and was easily controlled with a cotton pallet. The caries on the rest of the cavity were not completely removed as it was quite close to the pulp. The area of exposure was lined with “Life” – Calcium hydoxide, and glass ionomer placed on top and lined the rest of the cavity. A permanent filling – amalgam was placed immediately. There was no symptoms prior to treatment or after treatment so far. The question I have is that 1) when do I know for sure that the treatment is successful and I won’t be needing a root canal? 2) what kind of symptom will I be starting to get concerned? ie what signs will indicate that treatment is failing? is it going to severe pain? I mean, I don’t have pain in the tooth, but I feel it just feels different, or is it that I am constantly thinking about it that I may be starting to imagining symptoms? Looking forward to hear from you Thank you for your help
– Lee from Tasmania
A direct pulp cap can work just fine and if there is any problem with it, it will usually show up immediately, but in your situation it is complicated by the way it was done. Let me explain the correct procedure for a direct pulp cap, and the principles involved. If done this way, there is a high rate of success in healing of the tooth, and you will avoid needing a root canal treatment.
First, it’s important that all the decay be removed. Decay is loaded with bacteria, and when bacteria get into the pulp of the tooth, that’s what causes a tooth to become infected. Any decay left, especially if it is left under an amalgam, will be likely to continue to grow slowly and could eventually infect the tooth.
Second, when there is a pulp exposure, the pulp should be inspected to see if it is healthy. What your dentist did was the correct procedure – try to control the bleeding with a cotton pellet. If it is controlled easily, the pulp is healthy and the dentist can proceed with the pulp cap. Calcium hydroxide is a good material to put directly on the pulp but isn’t the only one that can be used. The glass ionomer cement that was put over the calcium hydroxide is also a good material for a base. It is strong and biocompatible and releases a small amount of fluoride to inhibit recurrent decay. For filling the rest of the tooth, the best material would be a composite filling that is bonded to the tooth, as the bonding seals the tooth the best and prevents any micronutrients or additional bacteria from getting in around the filling. Unfortunately, this wasn’t done in your case.
What I would advise for you at this point is to let your tooth alone for now. Give it a year or two and then have the dentist take an x-ray of the root to see if it is healthy. If it is, then have them go back into the tooth and remove all of the remaining decay and place a new filling, or, if the amount of tooth missing is large, place a crown. By then, if the tooth responds well, it should have built up a protective layer of dentin under the filling.
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About David A. Hall
Dr. David A. Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does advanced internet marketing for dentists.
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