Pediatric Dentistry · patient case question
Which agent is used to achieve haemostasis of the radicular pulp stumps during a vital pulpotomy?
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: C. Sodium hypochlorite or ferric sulfate on a cotton pellet
- A. Silver diamine fluoride arrests caries; it has no role in achieving haemostasis in an exposed pulp.
- B. Calcium hydroxide is a pulp-capping and medicament material but is NOT used to achieve haemostasis, and it performs poorly as a primary molar pulpotomy agent — it is associated with a high rate of internal resorption in primary teeth.
- C. CORRECT. Haemostasis is achieved with a moistened cotton pellet applied under gentle pressure — most commonly with dilute SODIUM HYPOCHLORITE (1.5–3%) or FERRIC SULFATE (15.5%). Ferric sulfate forms a ferric ion-protein complex that mechanically seals the cut vessels. Achieving haemostasis within about 5 minutes is the clinical test that the radicular pulp is healthy; persistent bleeding means the inflammation extends further and a pulpectomy is required instead.
- D. Saline is used to rinse and to moisten the pellet, but saline alone does not reliably arrest pulpal bleeding.
Note: ⚑ FLAG. The recall keyed calcium hydroxide. The recognised haemostatic agents are ferric sulfate and dilute sodium hypochlorite; the recognised MEDICAMENTS placed afterwards are MTA (best outcomes), Biodentine, ferric sulfate and formocresol (now largely abandoned over formaldehyde concerns). Calcium hydroxide is the WRONG answer on both counts for a primary molar.
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