Premature loss of primary teeth can lead to malocclusion and/or to esthetic, phonetic, or functional problems. Maintaining the integrity and health of the oral tissues is the primary objective of pulp treatment. It is important to attempt to preserve pulp vitality whenever possible; however, when this is not feasible, the pulp can be entirely eliminated without significantly compromising the function of the tooth. This article provides a concise review of the normal histological characteristics of the primary pulp and briefly describes the dentinogenesis process and the factors affecting the dentin–pulp complex response to stimuli. Finally, the biological basis and rationale for the various modalities of pulpal treatment for the primary dentition are discussed and data on the success rates for the different treatment is presented.