Endodontics in Primary Molars

Question 1

what are some consequences that may occur if there is inadequate endodontic treatment in carious affected primary molars?

Answer 1

• pain
• infection
• damage to permanent successor
• loss of space if primary molar is extracted & arch isn’t spaced

Question 2

what are some endodontic considerations in primary molars?

Answer 2

• rapid caries progression
• small teeth with relatively large pulp chambers
• broad contact areas
• irreversible pathological changes before pulp exposure
• early radicular pulp involvement

Question 3

what are some indications for pulp treatment in primary molars?

Answer 3

• medical history preludes extraction (bleeding disorder etc)
• lack of permanent successor
• age of patient
• ortho considerations

Question 4

when would you decide against pulp treatment in primary molars?

Answer 4

• poor cooperation from child
• age of patient
• ortho considerations
• sever/recurrent pain
• advanced root resorption
• cellulitis
• pus in pulp chamber
• gross bone loss

Question 5

what endodontic procedure can be done on a VITAL primary tooth?

Answer 5

pulpotomy

Question 6

what endodontic procedure can be done on a NON-VITAL primary tooth?

Answer 6

pulpectomy

Question 7

what are some clinical indications for a pulpotomy in primary teeth?

Answer 7

• pulp minimally inflamed / reversible pulpitis
• marginal ridge destroyed
• caries extending > 2/3 into dentine on radiograph

Question 8

what are the aims of a vital pulpotomy?

Answer 8

• stop bleeding
• disinfection
• preserve vitality of apical portion of radicular pulp

Question 9

how is a vital pulpotomy performed?

Answer 9

LA / dental dam / access achieved

• caries removal
• remove ROOF OF PULP CHAMBER (coronal pulp)
• use a sterile excavator/large round steel burr)
• haemorrhage control
• place ferric sulphate (on a cotton pledget) over root stump for 20 secs
• cover root stumps with Ca OH or MTA
• restore with stainless steel crown

Question 10

how can bleeding of the pulp determine if the pulp is inflamed?

Answer 10

inflamed pulp =

• deep crimson blood
• continued bleeding after pressure

uninflamed pulp =

• bright red colour
• good haemostasis

Question 11

what are some signs of a non-vital molar that the dentist may recognise?

Answer 11

• hyperaemic pulp (excess bleeding)

- pulp necrosis & furcation involvement

Question 12

what are some symptoms of a non-vital molar?

Answer 12

• irreversible pulpitis
• periapical periodontitis
• chronic sinus

Question 13

how is the primary pulpectomy technique carried out?

Answer 13

• access pulp
• coronal pulp extirpation
• root canal prep (2mm short of apex)
• obturation using CaOH iodoform paste
• GIC core
• stainless steel crown