Objective. There is a lack of knowledge regarding the health economic consequences of pulp capping and root canal treatment in order to treat children’s and adolescents’ permanent teeth with pulp exposures due to caries. Therefore, the aim of this study was to study the cost effectiveness of performing a pulp capping compared to a root canal treatment in children and adolescents with pulp exposures due to caries. Methods. The cost effectiveness was studied by the use of a Markov simulation model where a simulated 12-year-old patient with a pulp exposure in a permanent tooth was followed for 9 years. The probability of making a transition from one health state to another was calculated from data retrieved after literature searches of published clinical studies. The outcome was measured as avoided extractions until the subject was 21 years old. The time spent on the two treatments was studied by sending a survey to general dentists. Costs were discounted with 3% annually. Results. Based on the answers from the general dentists, the cost for a pulp capping as the initial treatment was 138 EUR and the cost for a root canal treatment as the initial treatment was 608 EUR during the 9 years. We found that less teeth were extracted after a pulp capping than after a root canal treatment in this age group. Pulp capping was found to be cost effective (dominant) compared to root canal treatment as the initial treatment.