Why is direct pulp capping generally not recommended in primary teeth, and what alternative would you consider?

• A. Indirect pulp therapy or pulpotomy depending on exposure and vitality.
• B. No treatment needed.
• C. Direct pulp capping is recommended.
• D. Extraction.

Answer: (A)

In primary teeth, direct pulp capping is avoided because the pulp–dentin complex in young teeth responds unpredictably, and the outcomes are less reliable. The pulp in a primary tooth is closer to the surface and the dentin layer can be thinner, so inflammation from decay or exposure tends to spread more readily to the radicular pulp, increasing the risk of pulpitis, necrosis, and premature exfoliation. There is also concern about interference with the normal physiologic root resorption that allows the primary tooth to loosen naturally to make way for the permanent successor.

The preferred approaches depend on how the disease presents. If the decay is deep but there is no exposure, indirect pulp therapy is used to remove most of the decayed dentin while leaving a small layer to avoid exposure, then a protective base and final restoration are placed to encourage reparative dentin formation. If there is an exposure but the pulp tissue is still vital and the inflammation is minimal, a pulpotomy is considered to remove the inflamed coronal pulp while preserving the healthy radicular pulp, followed by sealing with a medicament such as MTA or calcium hydroxide and a definitive restoration.

Extraction is reserved for teeth that are non-restorable or when treatment cannot preserve function, but it is not the first-line choice when the tooth can be saved.