Pulpotomy vs Pulpectomy: Root Canal Treatment for Baby Teeth, Explained

Why baby teeth sometimes need this at all

Baby (primary) teeth have thinner enamel and dentin than permanent teeth, so a cavity that's been left untreated can reach the nerve (pulp) faster than parents expect. When that happens, the options are usually limited to two: treat the pulp to save the tooth, or extract it. Since baby teeth hold space for the permanent tooth developing underneath and matter for chewing and speech, dentists generally try to save them when the tooth can still be restored.

Pulpotomy: treating just the top part

A pulpotomy removes only the inflamed or infected pulp inside the crown — the visible part of the tooth above the gumline — while leaving the healthy pulp inside the roots untouched. It's essentially a partial procedure, often described as similar to a partial root canal, and is used when the damage hasn't spread down into the root canals yet. Baby molars, which have relatively large pulp chambers, are the most common candidates.

Pulpectomy: treating the whole tooth

A pulpectomy removes pulp tissue from the crown and all the way down each root canal, similar to a full root canal in an adult tooth. The empty root canals are cleaned, disinfected, and filled with a material designed to be safely resorbed as the baby tooth's roots naturally dissolve later on. This is needed when infection has already reached the roots — signs a dentist looks for include bone changes visible on an X-ray or pus near the gumline.

How a dentist decides which one your child needs

	Pulpotomy	Pulpectomy
Extent of pulp affected	Crown only	Crown and roots
Used when	Deep cavity reaches pulp, no root infection yet	Infection has spread into root canals or surrounding bone
Comparable to	Partial root canal	Full root canal (with resorbable filling)
Follow-up restoration	Usually a crown to protect the weakened tooth	Usually a crown to protect the weakened tooth

The decision is made after an X-ray and clinical exam, not just by how much a child says it hurts — some infected teeth are surprisingly comfortable right up until an abscess forms.

What actually happens during the appointment

Both procedures are done under local anaesthesia, and many pediatric dentists also offer nitrous oxide (laughing gas) for anxious children. After the pulp is removed and the canal (for a pulpectomy) is cleaned and filled, the tooth is almost always finished with a crown — usually a stainless steel crown for a back tooth — since a tooth that's had this much structure removed is too weak to rely on a filling alone for years of chewing.

Recovery: what to expect afterward

Recovery for both procedures tends to be quick. Most children have only mild, short-lived discomfort and are back to normal eating and activity, often the very next day. Some tenderness while chewing on that side for a day or two is normal; persistent swelling, fever, or pain that gets worse rather than better after two to three days is not, and is worth an unscheduled call to the dentist.

Why saving the tooth matters, even though it's "just" a baby tooth

Baby molars in particular can stay in the mouth until age 10-12, holding space for the premolar developing beneath them. Losing one early without a space maintainer can let neighbouring teeth drift into that gap, contributing to crowding when the permanent tooth is ready to come in.