appendix info Flashcards
describe silvers mechanism of action in SDF?
interacts with bacterial cell membranes and bacterial enzymes that can inhibit bacterial growth
silver ions degrade cell walls, disrupt bacterial DNA synthesis and disrupt intracellular metabolic processes leading to cell death
strong inhibitory effect on cathepsins and matrix metalloproteinases (enzymes for collagen degradation)
indications for use of SDF?
high risk of caries
pre-cooperative children
treatment challenged with behavioural/ medical conditions
several carious lesions that cant be treated in 1 visit
patients without access to dental care
contraindications for use of SDF?
silver allergy
pain - irreversible pulpitis/ periapical periodontitis
infection
pt refusing treatment
unable to isolate tooth and maintain control over oral environment
what are signs of irreversible pulpitis/ periapical periodontitis?
spontaneous, severe, constant pain or wakening child at night
what are signs of infection?
swelling of soft tissues
abscess/ fistula
what are signs and symptoms of reversible pulpitis?
- clinical signs of caries
- not TTP
- no abnormal mobility
- no sign of infection
- short lived pain
- pain doesnt linger
- pain in direct response to stimuli
what are signs and symptoms of irreversible pulpitis?
- clinical signs of caries
- not TTP
- no abnormal mobility
- no signs of infection
- spontaneous pain
- prolonged
- pain lingers on removal of stimulus
- pt wakes from sleep
what are the signs and symptoms of periradicular periodontitis?
- clinical signs of caries
- increased mobility
- TTP
- signs of infection
- often acute symptoms gone
- dull throbbing pain
- can be asymptomatic
what is the pathology of pulpitis?
progression of occlusal caries to pulpal involvement similar in primary and permanent dentition
odontoblasts adjacent to lesion demonstrate inflammatory response
reactionary dentine is deposited
inflammed radicular tissue
what do you do if there are symptoms of irreversible pulpitis?
pulp therapy
vital - pulpotomy
non vital - pulpectomy
when is pulp therapy contraindicated?
Immunocompromised pt
risk of endocarditis
when do you not do a pulpotomy?
precooperative child
multiple pulp therapies needed
close to exfoliation
extensive root resorption
tooth unrestorable
signs of infection
radiographic sign of infection
medically contraindicated
how many roots do lower primary molars have?
2
mesial and distal
how many roots do upper primary molars have?
3
mesiobuccal
distobuccal
palatal
what percentage ferric sulphate is used to gain haemostasis in pulpotomy?
15.5%
how does ferric sulphate 15.5% achieve haemostasis?
forms ferric ion protein complex when interact with blood
features of MTA?
biocompatible and produced little inflammation
induces hard tissue formation
good success rate
expensive
why is occlusal reduction performed in a pulpotomy?
so tooth isnt high in occlusion
minimise discomfort
avoid additional irritation
how do you carry out a pulpectomy?
gently debride canals with endodontic files
irrigate with sodium hypochlorite
dry canals
fill with calcium hydroxide
restore pulp chamber with GI core
restore tooth with crown
take radiograph
why is calcium hydroxide used in pulpectomy?
disinfectant properties and restorable
bactericidal
what do you never use for a pulpectomy in primary teeth?
gutta percha
what are potential complications of pulpectomy?
early resorption leading to early exfoliation
over preparation
infection and caries
extrusion of files beyond apices and through furcation area
what are the signs of success of primary molar therapy?
no symptoms
no infection
no mobility tenderness
retention of tooth
natural exfoliation
no bone loss in furcation region
no evidence of internal resorption
what are signs of failure of primary molar pulp therapy?
pain
TTP in non exfoliating tooth
alveolar tenderness, sinus, swelling
non physiological mobility
interradicular radiolucency/ furcation bone loss
external/ internal resorption
