Pediatric Dentistry · patient case question
What is the most appropriate treatment for teeth #S and #T?
Patient case: A Seven-Year-Old with Two Painful Primary Molars
Patient: 7-year-old female
Chief Complaint: “Both bottom back baby teeth on the left hurt when she eats.”
Background: First dental visit. No medical history. Cooperative but apprehensive — she will sit and open, but keeps asking what will happen next and needs frequent reassurance.
Medications: None
Vital Signs: BP 100/64 mmHg · HR 90 bpm · RR 20 · T 98.4°F
Findings: Deep occlusal caries in teeth #S and #T with pain on eating that stops when the food is removed. Both teeth are RESTORABLE with substantial remaining structure. No swelling, no sinus tract, no mobility. Radiographs show no furcation or periapical radiolucency and no pathological root resorption.
Show answer and explanation
Correct answer: B. Pulpotomy followed by stainless steel crowns
- A. Extraction discards restorable teeth. Both are second primary molars, which are the critical space maintainers for the arch; losing them at age 7 causes mesial drift of the first permanent molar and arch-length loss.
- B. CORRECT. Deep caries with symptoms of REVERSIBLE pulpitis (pain on stimulus that resolves when the stimulus is removed), no radiographic signs of furcal or periapical pathology, and restorable teeth is the textbook indication for PULPOTOMY. The inflamed coronal pulp is removed, the radicular pulp — judged healthy — is preserved and medicated, and a STAINLESS STEEL CROWN restores the tooth. SSCs are used because a multi-surface restoration on a pulpotomised primary molar has a far higher failure rate than full coverage.
- C. Indirect pulp capping applies when caries is deep but NOT into the pulp and the tooth is asymptomatic or minimally symptomatic. And amalgam alone would not adequately restore these teeth.
- D. A direct pulp cap in a PRIMARY tooth with a CARIOUS exposure has a poor prognosis and is generally contraindicated — the primary pulp responds to carious exposure with internal resorption rather than repair. Direct capping is reserved for small mechanical exposures in an asymptomatic tooth.
Note: Primary molar pulp therapy decision tree: reversible pulpitis, no exposure → indirect pulp cap. Reversible pulpitis with exposure, healthy radicular pulp → pulpotomy + SSC. Irreversible pulpitis or necrosis with a restorable tooth and no root resorption → pulpectomy + SSC. Non-restorable, or furcal pathology with resorption → extraction with space maintenance.
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