In deciding between indirect pulp therapy and pulpotomy in a primary tooth, what is the key determinant?

• A. Pulp exposure and vitality
• B. Age of patient
• C. Extent of caries
• D. Tooth color

Answer: (C)

The amount of decay reaching toward the pulp—the extent of caries—drives the choice between indirect pulp therapy and pulpotomy. If the caries is deep but hasn’t exposed the pulp, you can preserve vitality with indirect pulp therapy by removing the affected dentin from beneath and sealing it, allowing the pulp to heal. If the decay is so extensive that it has exposed the coronal pulp or caused inflammation of the pulp chamber, a pulpotomy is needed to remove the inflamed coronal tissue while keeping the radicular pulp healthy. In practice, the extent of caries helps determine whether there is exposure or a high risk of exposure, which in turn guides the chosen approach. Age and tooth color aren’t the key determinants for this decision.