Which would you rather have: a root canal or a pulpotomy? Even if you’re not familiar with a pulpotomy, you might be inclined to learn more.
That is what a new national center has started to explore, funded with nearly $2 million from the National Institutes of Health, and co-led by principal investigator Rahma Mungia, BDS, MSc, DDPHRCS, associate professor in the School of Dentistry at The University of Texas at San Antonio.
While a root canal often is performed for a tooth that is deeply decayed and painful, drilling into its top to remove inflamed pulp tissue inside and sealing with a crown, the procedure usually must be referred by your general dentist to an endodontic specialist.
With that can come a second appointment, a new office, time away from work and another bill. In places where endodontists are scarce, the wait can be long, and some patients never complete the referral.
But research suggests that a pulpotomy – sometimes called vital pulp therapy, in which inflamed tissue is removed from inside the crown of the tooth while preserving healthy pulp tissue in the roots, relieving pain while saving the tooth – could be done more often in a general dental practice for select patients.
It might not be appropriate for every patient, as sometimes a root canal is unavoidable. But for appropriately selected patients, it might provide a tooth-preserving treatment without the need for immediate root-canal therapy.
As an endodontist, I know how much it means to a patient to stop the pain and keep their natural tooth. This alternative approach may help general dentists and endodontists offer it safely to the right patients.”
Kenneth M. Hargreaves, DDS, PhD, Dean of the UT San Antonio School of Dentistry
Closing the gap between what research supports and what happens in everyday clinical practice is the focus of the new NIH award establishing the National Dental Practice Training Center (NDP-TC), a collaboration of the UT San Antonio Health Science Center with the University of Alabama at Birmingham and the University of Rochester, together with the National Dental Practice-Based Research Network and the Project ECHO Superhub based at UT San Antonio’s health science center.
The National Dental Practice-Based Research Network is a U.S. consortium in which dental clinics and researchers work together on real-world patient care studies. Project ECHO (Extension for Community Healthcare Outcomes) is a virtual training and mentoring framework that helps local health providers treat complex medical conditions in their own communities.
Joining Mungia as co-leader and principal investigator of the new center is Joana Cunha-Cruz, DDS, PhD, professor at the UAB School of Dentistry. Together, they will lead the development, implementation and rigorous evaluation of the national training platform, beginning with pulpotomy. Mungia also leads the Southwest Regional Node of the National Dental Practice-Based Research Network and directs the South Texas Oral Health Network.
Translating evidence to clinical practice
The project began Sept. 1 and runs through Aug. 31, 2028. It marks the opening phase of an NIH UG3/UH3 award funded through the National Center for Advancing Translational Sciences (NCATS) and the National Institute of Dental and Craniofacial Research (NIDCR). If the team meets its predefined milestones, the project will move into a funded three-year multicenter trial of the training program.
The center’s first course focuses on pulpotomy treatment, using this procedure as an initial model for accelerating the translation of evidence into clinical practice. In its first year, the research team will survey dentists about what stands in the way of using it: clinical knowledge, confidence, technical training, office workflow or access to expert support. The answers will shape the course.
Dentists then will work through patient cases and X-rays, discuss difficult decisions with colleagues and mentors and practice on 3D-printed tooth models. The training aims to do more than teach a sequence of clinical steps. It will help dentists decide which patients may benefit, which patients need another approach and how to carry out the procedure safely.
“A treatment decision takes place in the context of a patient’s symptoms, clinical and radiographic findings, and the practice environment,” Mungia said. “Case-based learning gives dentists a way to practice that judgment. Hands-on simulation lets them develop the procedural skills before they use them with a patient. Our broader goal is to understand how we can move evidence into everyday practice more efficiently and then apply that model to other areas of care.”
Many dentists were trained at a time when the pulpotomy procedure was not routinely taught as a definitive option for permanent teeth, before strong evidence for its effectiveness emerged. Cunha-Cruz says the goal is to understand what makes it challenging for dentists to adopt the procedure and build training that supports real change in practice.
“Patients in pain may face a delay, travel and extra expense simply because the treatment they need is not available in the office they already trust,” Cunha-Cruz said. “For appropriately selected patients, pulpotomy may provide another option.
“When we understand the real barriers to putting research into practice, we can build training that actually works,” she said. “I’m grateful to NIH for supporting this vision, and I’m confident it will help patients get evidence-based care sooner.”
The center is designed as a scalable, reusable national translational platform that can be adapted to other evidence-based dental practices beyond pulpotomy, helping shorten the time between scientific discovery and routine patient care.
Mungia is a nationally recognized leader in translational oral health research, implementation science and practice-based research networks. Her professional journey began in India, where she earned her Dental Degree from the KLE Institute and practiced as a general dentist.
Witnessing firsthand the profound impact of social and structural determinants on oral health inspired her to pursue advanced training in public health and population-based research. She earned a Master of Science in dental public health from University College London and a Diploma in Dental Public Health from the Royal College of Surgeons (DDPHRCS) of England, followed by completion of a dental public health residency at the then-University of Texas Health Science Center at San Antonio in 2005.
Today, the South Texas Oral Health Network she directs is a community-engaged practice-based research network supported by UT San Antonio Health Science Center’s Clinical and Translational Science Award (CTSA) program, creating a direct bridge between community dental practices, the National Dental PBRN and the university’s translational science infrastructure.
