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week 60 > Deep Caries & Pulp Therapy for primary dentition-Dr. Tucker > Flashcards

Deep Caries & Pulp Therapy for primary dentition-Dr. Tucker Flashcards

1
Q

Pulp Therapy Objectives

A
  • maintain:
    • integrity and health of the teeth and supporting tissues
    • vitality of the pulp affected by caries, traumatic injury, other causes
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2
Q

Pulp Preservation

A
  • Primary goal for tx of young permanent dentition
  • continues apexogenesis
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3
Q

Long term retention of a permanent tooth requires:

A
  • root w/a favorable crown/root ratio
  • thick dentin walls to withstand normal function
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4
Q

Pulp therapy Progression: Label each line

A
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5
Q

Things to consider before starting pulp therapy

A
  • Medical Hx
  • Dental Hx
  • Clinical eval
  • Radiograph exam
  • Value of involved teeth in relation to child’s overall dental developement
  • alternatives to pulp therapy
  • restorability of tooth
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6
Q

Medical Hx

A
  • Serious illness-contraindicated for endo
    • bc of risk of acute infection if pulp therapy fails
  • High SBE risk patients
  • immunosuppressed patients
  • poor healing potention
    • uncontrolled diabetes
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7
Q

Radiographic Assessment

A

Primary molars

  • BW
    • evaluate
      • depth of decay
      • furcation area
        • furcation radiolucency occurs in primary teeth first
  • PA
    • internal root resorption
    • external root resorption
  • compare lamina dura w/adjacent and contralateral teeth
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8
Q

In primary teeth, where are most accessory canals located?

A
  • Furcation
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9
Q

In permanent teeth, where are most accessory canals located?

A

apex

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10
Q

Value of involved teeth

A
  • how long before expected exfoliation
  • position in arch
  • Overall health of dentition
    • previous space loss from extractions or caries
    • health of remaining teeth
  • Level of parents desire and motivation in maintaining oral health
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11
Q

Signs of reversibe pulpitis

A
  • Pain provoked by a stimulus
    • hot, cold, or sweets
    • NOT spontaneous
    • relieved by removing stimulus or covering exposed dentin
  • soft tissue
    • within normal limits
    • free of abscess or fistula
  • not sensitive to percussion
  • No:
    • lymphadenapthy and fever
    • internal or external root resorption
    • furcation radiolucency
  • Pain relieved by OTC analgesics
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12
Q

Signs of irreversible pulpitis or necrosis

A
  • Pain is spontaneous
    • especially at night and persists
  • Soft tissue:
    • inflammation or swelling
      • not related to perio condition
  • Sensitive to percussion or mobile
    • not related to trauma or exfoliation
  • Lymphadenapathy and/or fever
  • Abcess or fistula
  • Internal/external resorption
  • furcation radiolucency
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13
Q

Vital Therapy Techniques is used to treat what?

A
  • Tx reversible pulpitis
    • to retain tooth
    • maintain function
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14
Q

Vital therapy techniques goal in primary teeth is to

A
  • preserve tooth until it naturally exfoliates
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15
Q

What are the Vital Therapy Techniques:

A
  • Protective liner
  • caries control
  • indirect pulp treatment (“Cap”)
  • Direct pulp cap
  • Pulpotomy
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16
Q

Protective Liner

A
  • thin liqued on pulpal surface of deep cavity prep
  • covers exposed dental tubules
  • acts as a protective barrier b/w restorative material/cement and the pulp
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17
Q

Protective liner examples

A
  • calcium hydroxide
  • Glass ionomer
  • dentin bonding agent
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18
Q

Cavity Liners

A
  • suspensions of calcium hydroxide in water or organic liquid
  • barrier
  • neutralizes acids
19
Q

Protective Liners Indications

A
  • minimize injury to pulp
  • promote pulp tissue healing
  • minimize post-op sensitivity
20
Q

Objectives for use of a protective liner

A
  • Preserve vitality
  • promote pulp tissue healing and tertiary dentin formation
  • Minimize bacterial microleakage
  • No adverse post-op signs or symptoms
    • sensitivity
    • swelling
    • pain
21
Q

Caries control procedure is indicated when

A
  • extensive caries-adverse pulpal consequences are likely to occur soon
  • goal of tx is to remove the focus of the infection
  • extensive caries that cannot or should not be permanently restored due to inadequate time or questionoable pulp prognosis
22
Q

caries control

A
  • urgent/emergency procedure
  • slows the progression of the decay process
  • minimizes sensitivity to hot, cold and sweets
  • prevents food impaction
  • Only for
    • reversible pulpitis
    • asympmtomatic vital teeth
23
Q

Caries control procedure

A
  • rapid removal of caries
  • placement of temporary restoration
  • reschedule for permanent restoration
    • gives pulp time to recover
    • better assessment of pulp status
  1. no local anesthetic
  2. Superficial decay removed
  3. Seal lesion w/temporary material (IRM or glass ionomer cement)
24
Q

Indirect Pulp Treatment indications

A
  • no pulpitis or reversible pulpitis or asyptomatic
    • when deepest carious (hard) dentin is not removed to avoid pulp exposure
    • no decay left on walls
  • Deep decay that approaches the pulp
  • no evidence of pathology
  • Pulp evaled by clinical and radiograph criteria to be vital and able to heal
25
Indirect Pulp Treatment: Objectives
* Restoration should seal the dentin from oral enviroment complement * Preserve tooth vitality * No post-op signs or symptoms * sensitivity * pain * swelling * No radiographihc evidence of: * external or interal resorption * other pathologic changes * No harm to succedaneous tooth
26
Silver Diamine Fluoride: Indications vs contraindications
* indications: * High caries risk * behavior management challenges * multiple caries * limited access to care * Contraindications: * symptomatic * pulpal involvement
27
What is the purpose of indirect pulp cap?
* Arrest caries process * promote dentin sclerosis * formation of tertiary dentin * Remineralize carirous dentin
28
Indirect Pulp Cap materials used:
* Calcium hydroxxide * Zink Oxide Eugenol * Glass Ionomer * Resin-modified calcium cilicate
29
Direct Pulp cap indications
* Small mechanical exposure * Asymptomatic immature permenent teeth * limited to: * small exsposures produced by trauma * pinpoint carious exposure w/sound dentin around it and no bleeding at site
30
Direct Pulp Cap Materails
* Hard setting calcium hydroxide or MTA (mineral Trioxide aggregate)
31
Primary Tooth Pulpotomy
* most frequent technique used for asymptomatic primary teeth w/deep caries * Remove coronal pulp * Remaining pulp is treated w/a medicament to preserve health * Tooth restored with SSC * protects from microleakage
32
Primary Tooth Pulpotomy: indications
* extensive caries * w/no evidence of radicular pathology * caries removal causes a carious or mechanical pulp exposure * Asymptomatic or reversible pulpitis * inflammation limited to coronal pulp * Radicular pulp * vital
33
Primary Tooth Pulpotomy: Contraindications
* Spontaneous pain * Fistula or swelling * Necrosis * Periapical or furcal pathosis * uncontrolled pulpal bleeding * Internal/external root resorption * non-restorable tooth * tooth near exfoliation or no bone over succedaneous tooth
34
Clinical Criteria for Pulpotomy
* Asymptomatic pulp or reversible pulpitis * Radiographic * no furcal or PA radiolucency * no internal/external resorption * No soft tissue swelling or mobility * Direct pulp assessment * red (not purple) bleeding * Hemostasis obtained in 5 mins w/cotton pressure
35
Ideal characteristics of Pulpotomy medicament
* Bactericidal * Harmless to pulp and surrounding structures * promotes healing of radicular pulp * does not interfere w/physiologic root resorption * inexpensive
36
Medicaments of Pulpotomy
* Formocresol * Ferric Sulfate * Calcium Hydroxide * MTA (mineral Trioxide Aggregate) * Sodium Hypochlorite * Glutaraldehyde
37
Filling canals of Primary teeth
* material must be resorbable * no resistance to eruption of permanent teeth * gutta percha contraindicated
38
Pulpectomy: Indications
* Can't obtain hemostasis during pulpotomy * inflammation has extended to radicular pulp * Irreversible inflamed or necrotic pulp * Root canals
39
What is the purpose of pulpectomy
* Primary Dentition space maintenance * don't lose tooth
40
Pulpectomy: Contraindications
* PA or interradicular infection involving the crypt of succedaneous tooth * can't debride canals thoroughly * unrestorable or nonstrategic tooth * Mechanical or carious perforations of pulp chamber floor * Excessive pathologic root resorption more than a 1/3 of root or advanced internal/external resorption * Excessive pathologic loss of bone support * lost PDL * Dentigerous or follicular cyst * medical contraindications
41
Ideal characteristics of primary root canal filling material
* Resorb at similar rates as primary root * readily resorb if pressed beyond apex * Harmless to periapical tissues and permanent tooth germ * antiseptic * fill canals easily * adhere to walls * no shrink * easily removed * radiopaque * no discoloration of tooth
42
Materials for pulpectomy
* ZOE * most common * does not resorb at same rate as tooth * Iodoform * resorbs rapidly if extruded * Calcium hydroxide * rarely used by itself * good when mixed with iodoform (Vitapex)
43

week 60 (9 decks)

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