Pulp-capping procedures are a critical cornerstone of our philosophy of minimally invasive dentistry. Not every tooth that has symptoms of sensitivity, pain or deep lesions needs the root canal therapy that is often ordered by the dentist. Careful evaluation of tooth condition is necessary to determine whether root canal therapy can or cannot be avoided.
The primary goal of tooth preservation philosophy is preserving as much as possible of both the tooth structure and dental pulp. A tooth that already had root canal therapy is often more likely to fail and needs to be extracted. Prevention of root canal can be achieved through a very careful diagnosis and minimally invasive procedure performed by a dentist, called “pulp capping.” Pulp-capping is designed to preserve the vitality of dental pulp when dental decay is near pulp or tooth nerve.
It is important to treat tooth decay early so tooth structure can be preserved as much as possible. As decay advances close to tooth pulp, root canal therapy may be necessary. The decision is based on several factors: a radiologic evaluation, the amount of tooth damage by decay, and most importantly, on the patient’s symptoms. Not every sensitive tooth or deep cavity should be subjected to root canal treatment.
When the tooth is asymptomatic or has only minimal sensitivity to cold—but diminishes immediately after the trigger is removed—such a tooth makes the best candidate for the pulp-capping procedure. In those favorable circumstances, the best solution is having the infected part of the tooth or tooth decay carefully removed and placed close to the treated tooth nerve, along with a medicated dressing. Then the tooth is temporarily closed with a sealed restoration/filling. Very careful removal of infected dentin is absolutely crucial in this procedure. The medicated dressing is most often Calcium Hydroxide, which initiates reparative dentin to form within 30 days after treatment. The tooth can actually rebuild itself with this protective barrier, and maintain its vitality or healthy nerve.
If this step is not done and bacteria is allowed to cross into the tooth pulp or nerve, the nerve becomes infected and then the condition will progress into irreversible pulpitis causing pain, which can vary in intensity. This pulp infection cannot be reversed anymore, and needs to be treated with root canal treatment, or alternatively, a tooth extraction.
The only minimally invasive approach to avoiding root canal treatment or tooth extraction is with pulp-capping procedure. Depending on the proximity to the dental pulp or nerve, there are two pulp-capping procedure types: 1) direct pulp-capping – dressing is placed directly on the tooth pulp, and 2) indirect pulp-capping –dressing is placed on top of the dentin. The length of these procedures will vary based on the extent of tooth decay. The procedures could involve longer treatment time due to careful tooth decay removal that requires very high skills, precision and knowledge. Keep in mind that effective pulp-capping saves tooth vitality, prevents irreversible pulpitis and then root canal therapy, but most importantly is a cornerstone for tooth preservation but also overall oral health.