What determines pulpotomy versus extraction in a primary tooth with irreversible pulpitis?

Study for the Pediatric Dentistry II Exam. Utilize flashcards and multiple choice questions with hints and explanations. Prepare thoroughly for your exam!

Decisions between pulpotomy and extraction hinge on the status of the pulp and what is expected to happen after treatment. If the coronal pulp is inflamed but the radicular pulp remains vital and the tooth has a favorable prognosis (no signs of necrosis, no uncontrolled infection, and the tooth is restorable with a reasonable chance of healing and maintaining arch length), a pulpotomy can save the tooth by removing only the coronal portion and treating the remaining vital tissue. This preserves the tooth structure and guides proper eruption of the permanent successor.

If, however, the pulp is non-vital or the prognosis is poor (evidence of necrosis, periradicular pathology, extensive infection, or compromised structure that cannot be restored), extraction is the more predictable option. The other factors listed—color of the tooth, location, or parental preference—do not determine the clinical choice as directly as the vitality of the pulp and the likely outcome after treatment.