29. Primary Molar Pulp Therapy Flashcards
Aim of all paeds dentistry
- maintain a disease-free primary tooth until exfoliation
Indications for pulp therapy in primary teeth
- to maintain an intact arch
- to avoid physiological and psychological trauma of extraction
- if extraction is medically contraindicated
- no permanent successor tooth
- space maintenance (mixed dent)
- cooperative child and carers
Contraindications of pulp therapy in kids
- uncooperative child or carers
- child at risk of infection/immunosuppressed
- neglected dentition (more than 3 pulpotomies needed)
- severe acute infection
- unrestorable crown
- root caries
- more than 2/3 root resorption (near to exfoliation)
What’s the ideal pulp therapy?
- harmless to pulp and surrounding structures
- no interferance with physiological root resorption
- promote healing of radicular pulp
Aetiology of pulp disease
- microbial infection like in perm teeth
- rapid progression
- cruder diagnosis of pulp status (marginal ridge collapse? pain?)
Types of vital pulp therapy
- indirect pulp therapy
- direct pulp cap
- single visit pulpotomy
- pulpectomy
Example of non-vital pulp therapy
pulpectomy
What is the line of amputation?
- the line through the point of the tooth where normal or reversible inflammation becomes irreversible inflammation towards the crown
Bleeding carious exposure can lead to 2 situations?
- coronal amputation
- sensitive exposure
What happens in a coronal amputation?
- if you can arrest the bleed, a ferric sulphate pulpotomy happens (one application)
- if there is copious blood, two applications of ferric sulphate or a pulpectomy
What happens in sensitive exposure?
- use a temp dressing with Ledermix
- ferric sulphate pulpotomy
Composition of Buckley’s formocresol
- 19% formaldehyde
- 35% tricresol
- 15% glycerin
- 31% water
What dilution is used in Buckley’s formocresol?
- 1:5 dilution used
- 3 parts glycerol to 1 part water
Properties of formaldehyde
- protein binding
- bacteriostatic
- can be bactericidal in the confines of the pulp system
One-visit formocresol pulpotomy is gold-standard?
Clinical success?
- was until recently
- studies of full strength and 1/5th dilution show 55-98% clinical success
- 84% clinical and radiological success after a year at Newcastle too
Issues with formaldehyde vapour in formocresol
- been classified as carcinogenic to humasn by IARC
- occupational/industrial studies
- nasopharyngeal/nasal/paranasal sinuses
- possible link to chronic myeloid leukaemia
One-visit formocresol pulptomies is no longer advocated for by most UK paeds dentists. Why?
- no formaldehyde containing preps should be used in dentistry
Alternatives to formacresol
- glutaraldehyde
- calcium hydroxide
- dentine chips
- modified collagen solutions
- electrocautery/lasers
- ferric sulphate
- bone morphogenic proteins (BMP)
- mineral trioxide aggregate (MTA)
Ferric sulphate was derived from …
It’s … in nature
- calcium hydroxide pulpotomy for haemorrhage control
- styptic
Ads and disads of ferric sulphate
- easily obtained
- expensive (80£ a bottle)
Ferric sulphate is used how in restorative dentistry?
as a haemostatic agent
Ferric sulphate is applied at …% for how long?
- 15.5
- 15 seconds
How is a ferric sulphate pulpotomy done?
- analgesia
- caries is close to the pulp horn
- cavity prep (pulp exposure, vital and bleeding)
- remove roof of pulp chamber with a non-end cutting bur
- amputate coronal pulp tissue with sterile instruments
- arrest bleeding with cotton wool pressure
- try not to perforate floor of pulp chamber
- place a cotton wool pledget moist with 15% ferric sulphate for 15 seconds
- remove cotton wool and look for haemostasis (2nd application if still bleeding)
- place a layer of zinc oxide-eugenol cement over pulp stumps
- restore the crown
- GIC/composite and a preformed crown
Why does ferric sulphate work as a pulpotomy material?
- ferric and sulphate ions cause agglutinations of blood proteins
- mechanically seals blood vessels
