Pulpotomy (Baby Root Canal) Consent Form



  • A tooth with extensive caries (decay) that approaches or enters the nerve of the tooth may require a nerve treatment called a pulpotomy. A portion of the nerve inside the tooth is removed, and a medicated dental material is placedinside the pulp chamber. A full-coverage restoration called a stainless steel crown is typically placed after pulpotomy treatment.

    Potential benefits of a pulpotomy:
    1. Helps to maintain current occlusion and prevents loss of teeth prior to normal exfoliation.
    2. Prevents pain and/or infection.
    Risks include but are not limited to the following:
    1. Need for further treatments in the future, such as extractions and/or space maintainers.
    2. Damage to adjacent teeth and/or tissues.
    I understand that a pulpotomy does not guarantee that the tooth will be retained until normal exfoliation. The prognosis for the tooth following a pulpotomy procedure may range from as little as a few months to as much as a few years.

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