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An indirect pulp cap is one method of preserving a tooth that has decay, trauma, or other damage.

The crown of your tooth is the part of the tooth you can see in your mouth. It has three layers:

  • enamel
  • dentin
  • pulp, which includes nerves and blood vessels

Damaged or exposed pulp can cause a lot of pain and sensitivity and may become infected.

An indirect pulp cap is a procedure that protects a compromised tooth without exposed pulp. It may help you avoid more invasive procedures like tooth extraction or a root canal. It retains the tooth and allows its roots to continue developing.

You can receive a pulp cap in one or two appointments. Your dentist will recommend the best way to treat a tooth at risk for pulp exposure.

There are two indirect pulp cap procedures. Your dentist may recommend either based on their experience and your situation.

One-step indirect pulp cap procedure

Your dentist:

  1. treats cavities in the tooth (without exposing pulp) and places the protective liner over the dentin layer
  2. covers the dentin with a seal
  3. seals the tooth with a filling

Two-step indirect pulp cap procedure

On the first visit, your dentist:

  1. removes decayed dentin in the outermost areas of the tooth
  2. leaves decay that is near the pulp
  3. covers the tooth with a seal and possibly adds a temporary filling

This part of the procedure changes the tooth environment. It is meant to reduce the chances of bacteria entering the pulp, close off cavities from the biofilm of the tooth, and slow the development of cavities.

You will have your second procedure several months or up to a year after the first one.

On the second visit, your dentist:

  1. confirms if the indirect pulp cap was effective
  2. removes any cavities in the tooth
  3. completes any additional restoration needed (this may include a filling)

A pulp cap is effective if:

  • The pulp has stayed protected.
  • There’s no infection in the pulp.
  • You have no pain or tooth sensitivity.
  • The roots of the tooth are healthy and developing (in the case of children and youth).

Your dentist will examine the teeth directly and may take X-rays to decide if the pulp cap was successful.

If the indirect pulp cap was unsuccessful, you may need to have additional dental work. This may include getting your tooth removed or getting a root canal.

There are several materials your dentist may use for an indirect pulp cap. They include:

  • resin-modified glass ionomer
  • dentin-bonding agent
  • calcium hydroxide
  • mineral trioxide aggregate
  • glass ionomer

Your dentist may consult you on the type of materials used. You can always ask what they will be using before agreeing to the procedure.

There are several benefits of pulp capping versus other procedures that can repair a decayed tooth:

  • You can retain your tooth.
  • You can avoid more complex and invasive procedures like a root canal.
  • A pulp cap is generally less expensive than a root canal.

A pulp cap may not work, and bacteria or decay may penetrate the pulp after the procedure. This may cause pulpitis. You may feel pain and discomfort, which would need to be addressed first.

Your dentist may then recommend a root canal, or as a last resort, tooth removal to address pulpitis. Call your dentist right away if you think you may have an infection.

You will likely be a candidate for an indirect pulp cap if the compromised tooth only affects the enamel and dentin, not the pulp itself. The treatment goal for an indirect pulp cap is to protect the pulp so it can regenerate the damaged dentin in the tooth and remain in your mouth.

A pulp cap keeps bacteria and other harmful elements from entering the inner part of your tooth. It also can prevent cavities from getting bigger. Pulp caps are only viable when you have a healthy tooth and mouth. Your dentist may recommend a different procedure if you have a history of tooth pain or if your tooth pulp is in poor condition.

Dentists treating children and youth may be more likely to recommend an indirect pulp cap than another procedure.

Indirect pulp caps may help save your tooth and avoid further dental procedures.

The American Academy of Pediatric Dentistry looked at several studies and found that indirect pulp cap procedures have a higher success rate than direct pulp cap and pulpotomy procedures in children and youth. The organization recommends using the indirect procedure when the pulp is normal and has no exposure or if the affected tooth can be treated.

Whether you receive an indirect or direct pulp cap depends on the condition of your tooth and how your dentist chooses to treat it.

Direct pulp capping occurs when the tooth pulp becomes exposed. This could occur because of cavities, trauma to the tooth, or work done by your dentist.

Your dentist will need to cover the exposed pulp. This is in contrast to an indirect cap that treats unexposed pulp.

An indirect pulp cap can prevent infection and help you avoid tooth removal or a root canal.