Pulpal Therapy

Pulpal Therapy in Vero Beach, FL - Also Called a Baby Root Canal

When decay or trauma reaches the pulp - the inner part of a tooth that contains nerves and blood vessels - leaving the tooth alone isn’t an option. The pulp becomes inflamed or infected, the tooth begins to hurt, and an untreated infection can spread. Pulpal therapy (also called a *baby root canal*, *pulpotomy*, or *nerve treatment*) is what we do to clean out the affected pulp, save the tooth, and let your child keep that tooth where it belongs until it’s naturally ready to come out.

At Nickel Pediatric Dentistry, Dr. Andrew Nickel - a board-certified pediatric dentist (ABPD Diplomate) - performs pulpal therapy on baby teeth and, less commonly, on younger permanent teeth where preserving the natural tooth matters for a child’s long-term outcome.

Why Save a Baby Tooth?

It’s a fair question - baby teeth fall out anyway. Why go through the trouble?

Because a baby tooth lost too early often causes problems that show up years later. Baby teeth hold space for the permanent teeth coming in behind them. They guide jaw development, help with chewing, and shape clear speech. When a baby tooth is removed before its time, the surrounding teeth often drift into the empty space, leaving the permanent tooth without enough room when it tries to come in. The result, years later, can be crowding and orthodontic treatment that wouldn’t have been necessary otherwise.

Whenever we can save a baby tooth - through pulpal therapy, a crown, or another treatment - we will.

What Is Pulpal Therapy?

Inside every tooth is a small chamber containing the pulp - soft tissue made up of nerves, blood vessels, and connective tissue. In a healthy tooth, the pulp keeps the tooth alive and responsive. When decay reaches the pulp, or when trauma exposes it, the tissue can become inflamed or infected. Without treatment, the infection can cause:

• Persistent toothache, especially at night
• Sensitivity to hot or cold that lingers
• Swelling of the gum or face
• Pain when chewing
• Sometimes a noticeable change in tooth color (darkening)

Pulpal therapy is the procedure that removes the affected pulp, treats the area with a medicated material, and seals the tooth - usually with a stainless steel or tooth-colored crown - so it can keep functioning until it’s ready to fall out naturally.

Two Types - Pulpotomy and Pulpectomy

The right approach depends on how far the infection has spread.

Pulpotomy (“Partial” Baby Root Canal)

A pulpotomy removes only the affected pulp in the upper part (crown) of the tooth, leaving the healthy pulp in the roots intact. We then treat the area with a medicated material to keep the remaining pulp healthy, and place a crown over the tooth to protect it.

This is the most common form of pulpal therapy in baby teeth. Clinical research shows pulpotomy success rates above 90% for appropriately selected cases, meaning the tooth typically survives until natural exfoliation.

When it fits: decay or trauma that has reached the pulp but where the pulp in the roots is still healthy.

Pulpectomy (“Full” Baby Root Canal)

A pulpectomy removes all of the pulp, including from the root canals, when the infection has spread further into the tooth. The canals are cleaned, filled with a resorbable material that breaks down naturally as the tooth’s roots dissolve before exfoliation, and the tooth is restored with a crown.

When it fits: more advanced infection that has affected the pulp in the roots, not just the crown.

In both cases, the goal is the same - save the tooth, eliminate the infection, restore comfort.

What the Visit Is Like

Most pulpal therapy is completed in a single appointment.

• Local anesthetic numbs the area completely. Your child will feel pressure but not pain.
• Nitrous oxide (“laughing gas”) is available for children who would benefit from extra calm. For children with significant anxiety, special healthcare needs, or extensive treatment, we may discuss deeper sedation.
• Dr. Nickel walks your child through every step, telling them what they’ll feel before they feel it. Most kids are genuinely surprised by how quickly it’s over.

A pulpotomy typically takes about 30-45 minutes; a pulpectomy can take longer. After the procedure, the tooth is restored with a crown - usually at the same visit.

After the Procedure

• The first day - your child may have mild soreness as the anesthetic wears off. Children’s acetaminophen typically manages it.
• Eating - soft foods for the first 24 hours, no chewing on the treated side until the crown feels comfortable.
• Brushing and flossing as usual, gently around the treated tooth.
• Activity - normal activity is fine. Most children return to school and play the next day.

The crown protects the tooth long-term - it stays on until the baby tooth is naturally ready to come out, at which point it falls out along with the tooth in the usual way.

When Pulpal Therapy Isn’t the Answer

Pulpal therapy works when the tooth still has enough healthy structure to support a crown and when the infection hasn’t progressed too far. When neither is true - when the tooth is too damaged to restore, or the infection has spread beyond what therapy can address - extraction is the better option, often paired with a space maintainer to hold the position for the permanent tooth.

We’ll always tell you honestly what we’re seeing and what the realistic options are.