If decay has progressed into the tooth pulp, which treatment is indicated?

• A. Root canal therapy or extraction
• B. Pulpotomy
• C. Coronal sealant
• D. Observation

Answer: (A)

When decay reaches the pulp, the infection is inside the tooth and cannot be resolved with a simple protective restoration. The goal becomes either to remove the infected tissue and seal the canal system or to remove the tooth if it cannot be saved. Root canal therapy accomplishes this by cleaning out the infected pulp, shaping and filling the root canals, and sealing the tooth to prevent reinfection, thereby preserving the natural tooth. Extraction is chosen when the tooth cannot be restored or adequately treated.

Pulpotomy is not appropriate here because it removes only the coronal pulp while leaving the radicular pulp, which is not reliable when the decay has invaded the pulp and infection may be present. Coronal sealant is a preventive measure for sound tooth surfaces and does not treat an actively infected pulp. Observation is inadequate because delays in treatment allow ongoing infection, pain, and potential complications.

So the indicated management for pulp involvement from decay is either root canal therapy or extraction, depending on restorable status.