I am so upset right now I am shaking. I had my daughter in for a checkup and he told me there is a cavity on a back tooth and he’ll need to do a pulpotomy. I had some questions. First, what is a pulpotomy? Second, why can’t we just do a filling? Third, if it is a baby tooth, why can’t we just extract it and let the adult one come in? Rather than answer ANY of my questions he said, “Do you ever get tired of questioning experts all the time? Maybe you should trust I am the dentist and know what I’m doing.” I don’t think my questions were unreasonable. AND this is MY child. Not his. Would you mind answering the questions for me so I can decide what to do?

Jennifer

Dear Jennifer,

Four Smiling Children

I am sorry that you were treated this way. I will be happy to answer your questions. Before I do, I am going to suggest you find another dentist for your daughter. You need someone who is on your side and willing to answer every single question and concern you have. It does not have to be a pediatric dentist. There are family dentists who treat both adults and children. Now for your questions.

A pulpotomy is a child’s version of a root canal treatment. They are less involved than the adult versions. It is typically reserved for back teeth and is a last resort at saving the tooth that is infected. This leads to your second question.

If it is a matter of a simple cavity, then a filling will be all she needs. I recommend mercury-free composite fillings as the safest option. Once the cavity spreads to about 30% of the tooth, then a filling will not be enough and you would have to get her a dental crown.

Only if the tooth is infected would you do a pulpotomy. You did not mention that your daughter had an infection in the tooth, just a cavity, so that makes me wonder. It may be in her best interest to get a second opinion.

Your final question was a good one as well. In some cases, it is fine to just extract a baby tooth and wait for the adult tooth to make its appearance. Back molars are different. They have to last until your child is around twelve years of age. Otherwise, that space is left open for too long waiting on the adult molars. The adjacent teeth drift or tip into the spot. When the adult teeth finally do arrive, there is not enough room for them, which leads to crowding and the need for orthodontics.

If a back tooth does have to be extracted, her dentist would need to put a space maintainer there in order to keep the rest of the teeth in place until her adult tooth arises.

I hope this helps.
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