Primary Tooth Pulpotomy — ORE Part 1 MCQ

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ModeratePaediatric DentistryPrimary Tooth PulpotomyORE Part 1

A 7-year-old child presents with a vital primary lower second molar that has a large carious exposure. Radiographic examination shows no evidence of radicular pathology or periapical radiolucency. Clinical examination reveals no signs of irreversible pulpitis. What is the most appropriate pulp therapy?

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Correct answer: D — Pulpotomy with ferric sulphate for haemostasis and MTA or zinc oxide–eugenol as pulp dressing

Explanation lettering: D = shown as A · E = shown as B · B = shown as C · A = shown as D · C = shown as E

The correct answer is A. For a vital primary molar with carious pulp exposure and no evidence of radicular pathology or irreversible pulpitis, pulpotomy is the gold-standard treatment according to UK SDCEP guidance. Ferric sulphate is used as a haemostatic agent to arrest bleeding from the radicular pulp, followed by placement of calcium silicate cement (MTA) or zinc oxide–eugenol as a biocompatible dressing. A preformed metal crown should be placed immediately to seal the restoration. B is incorrect: direct pulp capping with calcium hydroxide is limited to iatrogenic exposures in asymptomatic teeth expected to exfoliate soon; carious exposures require pulpotomy. C is incorrect: pulpectomy is reserved for primary teeth with signs of radicular infection (abscess, sinus, inter-radicular radiolucency); there is no indication here. D is incorrect: extraction is a last resort and should not be chosen for a salvageable vital tooth. E is incorrect: leaving an exposed vital pulp untreated leads to infection, pain, and potential systemic complications.

Reference: Scottish Dental Clinical Effectiveness Programme (SDCEP). Prevention and Management of Dental Caries in Children: Guidance update 2025. Section: Pulpotomy for primary teeth. https://www.childcaries.sdcep.org.uk/guidance/dental-techniques/pulpotomy-for-primary-teeth/