Filling Children’s Teeth (Part VIII)

When a cavity has extended into the nerve of a baby tooth and the nerve is still healthy, it is best to save the tooth. When a nerve is exposed in an adult tooth, normally a root canal would be performed. However, since a baby tooth will only be in a child’s mouth for a few years, there is no need to do an expensive treatment like a root canal. A procedure called a vital pulpotomy is recommended. In a pulpotomy, the top portion of the nerve is removed leaving only the remnants inside the roots behind. The remaining nerve stump is treated with a medication to stop the bleeding. The most commonly used medicament is formocresol, although ferric sulfate, calcium hydroxide, or mineral trioxide aggregate have also been tried with varying success. Formocresol will not only stop any bleeding, but also mummifies the tissue effectively sterilizing it and keeping the underlying nerve alive and vital. The area is then covered with a base such as zinc oxide and eugenol, calcium hydroxide, or glass ionomer.