Mastering Pediatric Dentistry: Pulpotomy and Crown Techniques – PDP274

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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 — “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 of This Episode

• 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

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 👉  @babytoothdentist on Instagram

Want more?

If you enjoyed this episode, check out: Zirconia vs Metal Hall Crowns vs Conventional with Dr Tim Keys – PDP227

#PDPMainEpisodes #EndoRestorative

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This episode is eligible for 1.0 CE credit via the quiz on Protrusive Guidance.

This episode meets GDC Outcomes C 

AGD Subject Code: 430 Pediatric Dentistry.

Aim & Learning Outcomes

Aim: To give dental practitioners a clear, decision-led approach to restorative paediatric dentistry — how to choose between filling, crowning, pulpotomy and extraction, how to manage caries conservatively, and how to carry out a pulpotomy and stainless steel crown safely.

Learning Outcomes — by the end of this episode, dentists will be able to:

• Differentiate the presentations that indicate a direct restoration, a stainless steel crown, a vital pulpotomy, or an extraction in the primary dentition, using clinical and radiographic findings.
• Describe minimally invasive and behaviour-management options in children — silver diamine fluoride, fluoride varnish, resin infiltration, local anaesthesia, sedation and isolation — and select them appropriately for the individual child.
• Apply a step-by-step technique for a vital pulpotomy and stainless steel crown in a primary molar, including the current choice of medicament and cementation.