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BDS2 CDS Paedriatric > endodontics in primary molars > Flashcards

endodontics in primary molars Flashcards

1
Q

4 consequences of inadequate endodontic treatment of primary molars

A

Pain

Infection

Damage to permanent successor

Loss of space if primary molar is extracted and the arch isn’t spaced

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2
Q

5 endodontic considerations for primary molars

A

Rapid caries progression

Small teeth with relatively large pulp chambers

Broad contact areas

Irreversible pathological changes before pulp exposure

Early radicular pulp involvement

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3
Q

what happens when there is greater than 2/3 marginal ridge breakdown (in primary molars)

A

likely to be AT LEAST pulp horn inflammation and an increased likelihood of this inflammation extending into the rest of the pulp in the pulp chamber and even down the root canals

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4
Q

child indications for primary tooth pulp treatment

A

Good co-operation

Avoid GA

Medical history precludes extraction
- Bleeding disorder/ coagulopathies

Lack of permanent successor

Age of patient

Ortho considerations

space preservation

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5
Q

contraindications in child pulp treatment

A

Poor co-operation

Medical history precludes pulp treatment
- Cardiac/ Immunocompromise

Age of patient

Ortho considerations
- space closure desired

Severe/recurrent pain

Space management

Advanced root resorption

Cellulitis

Pus in pulp chamber

Gross bone loss

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6
Q

primary vital tooth endodontic treatment

A

pulpotomy

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7
Q

primary non-vital tooth endodontic treament

A

pulpectomy

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8
Q

assessment and diagnosis of endodontic treatment

A

History

Clinical examination

Radiographic examination
- extent of caries

Pulp status evaluation
- Healthy -> total pulp necrosis

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9
Q

clini cal indications for primary vital pulpotomy (4)

A

Pulp minimally inflamed/ reversible pulpitis

Marginal ridge destroyed

Caries extending > 2/3 into dentine on radiograph

Any doubt that pulp exposed

  • Caries
  • Iatrogenic
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10
Q

3 aims for primary vital pulpotomy

A

stop bleeding

disinfection

preserve vitality of apical portion of radicular pulp

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11
Q

technique for vital primary pulpotomy

A

LA

  • topical using cotton wool roll
  • can provide infiltration until first permanent molar erupts

Dental Dam (with clamp and floss for safety)

Access

  • caries removal
  • remove roof of pulp chamber using sterile diamond fissure but

amputation

  • remove coronal pulp (sterile excavator/large round steel bur)
  • haemorrhage control
  • evaluate pulp stumps

medication

  • Place ferric sulphate (on a cotton pledget) over root stumps for 20 secs
  • Remove cotton wool pledget

restoration
- Cover root stumps with CaOH or MTA
- GIC Core
Restore stainless steel crown

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12
Q

direct pulpal evaluation - normal bleeding

A

uninflammed pulp

  • bright red colour
  • good haemostasis
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13
Q

direct pulpal evaluation - abnormal bleeding

A

inflammed pulp

  • deep crimson
  • continued bleeding after pressure
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14
Q

how to spot a non vital molar

A

Signs:
- Hyperaemic pulp
bleeding lots
- Pulp necrosis & furcation involvement

Symptoms:

  • irreversible pulpitis,
  • periapical periodontitis
  • chronic sinus

NOTE: severe infection with facial swelling = extraction

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15
Q

signs of non vital molar

A
  • Hyperaemic pulp
    bleeding lots
  • Pulp necrosis & furcation involvement
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16
Q

symptoms of non vital molar

A
  • irreversible pulpitis,
  • periapical periodontitis
  • chronic sinus
17
Q

severe infection with facial swelling of molar needs

A

extraction

18
Q

treatment options for non-vital molars

A

extraction

pulpectomy

19
Q

indications for primary molar pulpectomy

A

excellent patient co-operation

20
Q

aim of primary molar pulpectomy

A

prevent/control infection by expiration of radicular pulp followed by cleaning and obturation of canals

21
Q

technique for primary molar pulpectomy

A

access

coronal pulp extirpation

root canal preparation
- (2mm short of apex)

obturation
- CaOH iodoform paste
(vitapex)

GIC core

stainless steel crown

22
Q

what do you use for obturation in primary pulpectomies

A

CaOH Iodoform paste (vitapex)

23
Q

what core is used in primary pulpectomies

A

GIC

24
Q

clinical problems encountered in primary pulpectomies

A

Child management difficulties

  • Unexpected pulp exposure & no LA given
  • Inadequate anaesthesia when performing pulpectomy
  • Child in acute pain - emergency / casual patient
25
Q

how to overcome pain problem in primary pulpectomies

A

control and prevent pain by

antiseptic/antibiotic dressing (Ledermix paste)

26
Q

how to apply antiseptic/antibiotic dressing in primary pulpectomy to reduce pain

A

Place directly over exposed pulp

Dress IRM and review within 1 week

Complete pulpectomy once symptoms subside

27
Q

2 potential complications of primary pulpectomies

A

early resorption leading to early exfoliation

over-preparation

28
Q

success rate of vital tooth pulp capping

A

poor

29
Q

success rate of vital pulpotmoy

A

85-100% (3 years)

30
Q

success rate of non vital pulpectomy

A

90%

31
Q

when is the clinical review of pulp therapies

A

6 months

32
Q

clinical failure of pulp therapies can be seen as

A

patological mobility

fistula/chronic sinus

pain

33
Q

when is radiographic review of pulp therapies

A

12-18 months

34
Q

radiographic failure of pulp therapies can be seen as

A

increased radiolucency

external/internal resorption

furcation bone loss

35
Q

medication used in vital primary pulpotomies

A

Place ferric sulphate (on a cotton pledget) over root stumps for 20 secs

Remove cotton wool pledget

36
Q

restoration used in primary molar pulpotomies

A

Cover root stumps with CaOH or MTA

GIC Core

Restore stainless steel crown

37
Q

what is the amputation step used in primary pulpotomies

A

remove coronal pulp (sterile excavator/large round steel bur)

haemorrhage control

evaluate pulp stumps

38
Q

what is used to cover root stumps in primary pulpotomies

A

CaOH or MTA

BDS2 CDS Paedriatric (7 decks)

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