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Question:
My four-year-old son needed to have a pulpotomy done on his two lower rear molars. His teeth were subsequently capped and the next day he woke up with a swollen cheek.

He went to the dentist and was found to have an abcess on the rear tooth that was capped. He was placed on penicillin and the tooth now needs to be extracted.

My question is, is this a common occurence on a tooth that has had a pulpotomy, and would the abcess have been detectable before the cap was placed? I feel that my chld has gone through a number of procedures that at this point, since the tooth needs to be pulled, have been unneccesary, in both cost and the emotional toll on my son. ...Visitor from NJ

Answer:
This is indeed unfortunate, especially for such a young child.

The pulpotomy procedure is intended to clear up an abcess (the same as a root canal procedure on an adult tooth). I'm sure that the pulpotomy and crown would not have been completed if the dentist felt that the prognosis for successful healing was not good. Unfortunately if a pulpotomy is not successful then extraction of this primary (baby) tooth becomes necessary as well as a method of "space maintenance" to hold that space for the eruption of the permanent teeth.

As far as how this is dealt with financially, that is going to differ office to office. In my office patients don't pay additionally in the rare event of a treatment being unsuccessful after a reasonable amount of time. The amount paid toward the original treatment is credited toward additional treatment with a few exceptions.

The most important thing is that hopefully all this treatment at a young age is not traumatizing your son. I hope he's either very comfortable with his dentist and accepting of the treatment, or sedated so it's easier for him.. I'd hate to see a modern dentist developing a future phobic dental patient.

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