Pulpotomy & Crowns in Children A Pediatric Dentistry Masterclass

Filling, stainless steel crown, pulpotomy or extraction — how do you actually decide on a deciduous tooth?

Why is the lower first primary molar the one that always seems to flare up?

When should you reach for silver diamine fluoride instead of the drill — and when is a child’s cooperation telling you to change the plan entirely?

And how do you actually do a pulpotomy, step by step, without it blowing up under the crown?

This is a paediatric dentistry masterclass with Dr Nidhi Kotak (https://www.instagram. com/babytoothdentist/) - “The Baby Tooth Dentist”. It’s built for the general dentist who treats children and wants clearer rules: when to fill versus crown, how to read the radiograph, silver diamine fluoride, local anaesthetic and behaviour guidance, isolation, and a full pulpotomy and stainless steel crown technique. The through-line is simple - in children you decide fast, protect the airway, and treat for predictability rather than heroics.

Protrusive Dental Pearl: Strategic Flexibility. You cannot be rigid when treating children. The mindset shift is to stop asking “what should be done for this child?” and start asking “what can be done for this child?”. With children you have to be fast and efficient, and curveballs are constant - sometimes the parent is harder to manage than the child. So the plan has to bend.

The worked example: you planned a conventional prepped stainless steel crown, but cooperation drops mid-appointment. Rather than abandon the visit, switch to a no-prep whole-crown approach and protect the tooth anyway. It stays in the child’s best interest - and it’s far kinder to your own mental health. It’s a mindset worth carrying into all of dentistry, not just children’s.

What You’ll Take From This Episode

- When to fill vs crown - the surface rule for baby molars, why crowns are so predictable in children, and where composites still work.

- The “D” devil tooth - why the lower first primary molar flares up, and why mesial caries on a D is an automatic crown.

- Pulpotomy indications - the signs that say vital pulpotomy, the ones that say extraction, and why a pulp exposure in a primary tooth is an automatic pulpotomy.

- SDF, sedation and isolation - arresting decay without drilling, matching sedation to the child, and protecting the airway.

- The pulpotomy technique - a full step-by-step from caries removal to cementing the stainless steel crown, including the modern medicament choice.

Highlights

00:00  Teaser

00:59  Pediatric Dentistry for GDPs: The Strategic Flexibility Mindset

07:24  Why GDPs Struggle Treating Children

08:19  When to Fill vs When to Crown a Baby Tooth

12:18  Class II vs Stainless Steel Crown: The Surface Rule

13:41  Reading Pediatric Radiographs & When to Take Bitewings

19:15  SDF vs Fluoride Varnish: When to Use Each

22:37  Resin Infiltration (Icon) for Children's Teeth

25:15  Pulpotomy in Primary Teeth: When It's Indicated

26:19  The "D" Devil Tooth: Why Mesial Caries Means a Crown

27:31  Hall Crowns and the Modified Whole Crown Technique

27:48  Midroll

38:39  Local Anaesthetic & Behaviour Guidance in Children

40:38  Sedation Options: Oral, Nitrous & Intranasal

46:22  Rubber Dam vs Isolite: Isolation for Kids

48:59  How to Do a Pulpotomy: Step-by-Step Technique

58:03  Outro

From the Guest Dr Nidhi Kotak is a dual US and Canadian board-certified paediatric dentist - a Diplomate of the American Board of Pediatric Dentistry and a Fellow of the Royal College of Dentists of Canada. 

Follow Dr. Nidhi for more paediatric dentistry tips.