appendix info

Question 1

describe silvers mechanism of action in SDF?

Answer 1

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)

Question 2

indications for use of SDF?

Answer 2

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

Question 3

contraindications for use of SDF?

Answer 3

silver allergy
pain - irreversible pulpitis/ periapical periodontitis
infection
pt refusing treatment
unable to isolate tooth and maintain control over oral environment

Question 4

what are signs of irreversible pulpitis/ periapical periodontitis?

Answer 4

spontaneous, severe, constant pain or wakening child at night

Question 5

what are signs of infection?

Answer 5

swelling of soft tissues
abscess/ fistula

Question 6

what are signs and symptoms of reversible pulpitis?

Answer 6

• 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

Question 7

what are signs and symptoms of irreversible pulpitis?

Answer 7

• 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

Question 8

what are the signs and symptoms of periradicular periodontitis?

Answer 8

• clinical signs of caries
• increased mobility
• TTP
• signs of infection
• often acute symptoms gone
• dull throbbing pain
• can be asymptomatic

Question 9

what is the pathology of pulpitis?

Answer 9

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

Question 10

what do you do if there are symptoms of irreversible pulpitis?

Answer 10

pulp therapy
vital - pulpotomy
non vital - pulpectomy

Question 11

when is pulp therapy contraindicated?

Answer 11

Immunocompromised pt
risk of endocarditis

Question 12

when do you not do a pulpotomy?

Answer 12

precooperative child
multiple pulp therapies needed
close to exfoliation
extensive root resorption
tooth unrestorable
signs of infection
radiographic sign of infection
medically contraindicated

Question 13

how many roots do lower primary molars have?

Answer 13

2
mesial and distal

Question 14

how many roots do upper primary molars have?

Answer 14

3
mesiobuccal
distobuccal
palatal

Question 15

what percentage ferric sulphate is used to gain haemostasis in pulpotomy?

Answer 15

15.5%

Question 16

how does ferric sulphate 15.5% achieve haemostasis?

Answer 16

forms ferric ion protein complex when interact with blood

Question 17

features of MTA?

Answer 17

biocompatible and produced little inflammation
induces hard tissue formation
good success rate
expensive

Question 18

why is occlusal reduction performed in a pulpotomy?

Answer 18

so tooth isnt high in occlusion
minimise discomfort
avoid additional irritation

Question 19

how do you carry out a pulpectomy?

Answer 19

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

Question 20

why is calcium hydroxide used in pulpectomy?

Answer 20

disinfectant properties and restorable
bactericidal

Question 21

what do you never use for a pulpectomy in primary teeth?

Answer 21

gutta percha

Question 22

what are potential complications of pulpectomy?

Answer 22

early resorption leading to early exfoliation
over preparation
infection and caries
extrusion of files beyond apices and through furcation area

Question 23

what are the signs of success of primary molar therapy?

Answer 23

no symptoms
no infection
no mobility tenderness
retention of tooth
natural exfoliation

no bone loss in furcation region
no evidence of internal resorption

Question 24

what are signs of failure of primary molar pulp therapy?

Answer 24

pain
TTP in non exfoliating tooth
alveolar tenderness, sinus, swelling
non physiological mobility

interradicular radiolucency/ furcation bone loss
external/ internal resorption

Question 25

how often should you review primary molar pulp therapy treatment?

Answer 25

clinically - 6 months
radiographically - 12-18 monthly