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Pediatric Dentistry I > EXAM I: Pulp Therapy > Flashcards

EXAM I: Pulp Therapy Flashcards

1
Q

what is the primary objective of pulp therapy int he primary dentition?

A

prevent or eradicate infection and to maintain integrity and health of the teeth and their supporting tissues

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2
Q

what are some other objectives of pulp therapy in the primary dentition?

A
  • prevent space loss and malocclusion
  • aid in mastication
  • preserve the primary tooth in the case of hypodontia
  • prevent possible speech problems
  • maintain esthetics
  • prevent aberrant tongue habits
  • prevent potentially damaging psychosocial effects
  • maintain normal eruption patterns and timing
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3
Q

in a tooth with a normal pulp, when all caries is removed for a restoration, a ___ may be placed in the deep areas of the preparation to minimize injury to the pulp, promote pulp tissue healing, and/or minimize post-operative sensitivity

A

protective liner

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4
Q

what 3 materials are commonly used as protective liners?

A
  • GLUMA - 5% gluteraldehyde and 35% HEMA
  • glass ionomers
  • RMGI
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5
Q

___ is indicated in a tooth with no pulpitis or with reversible pulpitis when the deepest carious dentin is not removed to avoid a pulp exposure; the pulp is judged by clinical and radiographic criteria to be vital and able to heal from the carious insult

A

indirect pulp cap

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6
Q

how are protective liners placed?

A
  • prep tooth
  • remove caries
  • place protective liner
  • restore with well-sealed restoration
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7
Q

how are indirect pulp caps placed?

A
  • prep tooth
  • establish caries free margins, excavate gross caries and infected dentin
  • stop short of pulpal exposure (affected dentin remains)
  • radiopaque base placed over caries
  • restore with a material that seals
  • consider SSC
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8
Q

what materials are used for an indirect pulp cap?

A
  • calcium hydroxide - glass ionomer or reinforced ZOE should be placed over it to provide a seal against microleakage
  • ZOE
  • mineral trioxide aggregate (MTA)
  • RMGI
  • glass ionomer cement
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9
Q

in indirect pulp capping, why is it necessary to place glass ionomer or ZOE over the calcium hydroxide?

A
  • to provide a seal against microleakage, since calcium hydroxide has a high solubility, poor seal, and low compressive strength
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10
Q

___ of a carious pulp exposure in a primary tooth is not recommended

A

direct pulp capping

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11
Q

___ is indicated in a tooth with a normal pulp following a small mechanical or traumatic exposure wen conditions for a favorable response are optimal

A

direct pulp cap

**this procedure is not recommended for a carious pulp exposure**

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12
Q

how is a direct pulp cap placed?

A
  • mechanical or traumatic exposure
  • radiopaque base placed over pulp
  • restore with a material that seals
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13
Q

what are the materials used in a direct pulp cap?

A
  • calcium hydroxide
  • mineral trioxide aggregate (MTA)
  • glass ionomer or ZOE should be placed in addition to provide a seal against microleakage since these materials have a high solubility, poor seal, and low compressive strength
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14
Q

___ is indicated when caries removal results in pulp exposure in a primary tooth with a normal pulp or reversible pulpitis or after a traumatic pulp exposure

A

pulpotomy

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15
Q

how is a pulpotomy performed?

A
  • prep tooth for full coverage
  • excavate caries
  • unroof pulp chamber - large access; do not perforate pulpal floor
  • remove coronal pulp, obtain hemostasis with pressure
  • apply medicaments
  • dry chamber with cotton pellets
  • seal chamber
  • place sealing restoration, crown
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16
Q

what are the materials used in a pulpotomy?

A
  • devitalization/fixation - formocresol
  • preservation - ferric sulfate and chlorhexidine
  • regeneration - MTA
  • ZOE (IRM) is the gold standard for sealing and filling the coronal pulp chamber
17
Q

___ is indicated in a primary tooth with irreversible pulpitis or necrosis or a tooth treatment planned for pulpotomy in which the radicular pulp exhibits clinical signs of irreversible pulpitis; roots should exhibit minimal or no resorption

A

pulpectomy

18
Q

what are the materials used in a pulpectomy?

A
  • ZOE
  • iodoform paste - bacteriocidal, resorbable
19
Q

what are the 4 keys to success in pulp therapy?

A

diagnosis, isolation, technique, seal

20
Q

what are some contraindications to pulp therapy in primary teeth?

A
  • pathologic internal or external root resorption
  • close to exfoliation
  • periapical abscess formation with swelling and drainage, unless the tooth is deemed important
  • cellulitis
  • unrestorable tooth
  • medically complex patients - transplants, cancer, immunosuppression
21
Q

what is the difference in protective liners in immature permanent teeth vs primary teeth?

A

no difference

22
Q

what is the difference in an indirect pulp cap in immature permanent teeth vs primary teeth?

A

no difference

23
Q

what is the difference in direct pulp cap in immature permanent teeth vs primary teeth?

A

no difference

24
Q

what is the difference in a pulpotomy in immature permanent teeth vs primary teeth?

A
  • more conservative pulpal access
  • use reparative and regenerative materials such as calcium hydroxide and MTA to promote tooth maturation and apexogenesis
  • temporary crown?
25
Q

what is the difference in a pulpectomy in immature permanent teeth vs primary teeth?

A
  • more conservative pulpal access
  • use reparative and regenerative materials such as calcium hydroxide and MTA to promotes tooth maturation and apexification
  • endodontic referral
  • temporary crown?
26
Q

is pulp therapy indicated for a child who complains of a toothache coincident with or immediately after a meal?

A

not likely

the pain associated with meals does not necessarily indicate extensive pulpal inflammation

27
Q

is pulp therapy indicated for a child with a history of a severe toothache at night?

A

this usually signals extensive degeneration of the pulp and calls for more than conservative pulp therapy

28
Q

is pulp therapy indicated for a child with a spontaneous toothache of more than momentary duration occuring at any time of the day?

A

this usually means that pulpal disease has progressed too far for treatment, even with a pulpotomy

29
Q

what are some clinical signs and symptoms of diseased pulp?

A
  • gingival abscess or a draining fistula associated with deep caries lesion - usually resolved only with endo therapy or extraction
  • abnormal tooth mobility
  • sensitivity to percussion or pressure
30
Q

describe the benefit of the alkalinity of calcium hydroxide

A
  • the high alkalinity is caustic and causes a superficial necrosis of vital pulp tissue when it comes in contact
  • this stimulates the development of a calcified border
31
Q

what is the purpose of ferric sulfate in pulp therapy?

A

it agglutinates blood proteins and controls hemorrhage in the process without clot formation

32
Q

what are the positive properties of MTA?

A
  • biocompatibility
  • good sealing
  • antimicrobial
  • ability to set in the presence of moisture and blood
33
Q

what are the negative properties associated with MTA?

A
  • difficult to hand
  • high cost
34
Q

what 3 materials can cause pulp canal obliteration?

A

MTA, formocresol, ferric sulfate

35
Q

it has been suggested that ___ is the first choice for primary molar pulpotomies, unless cost is an issue, in which case ___ may be the best choice

A
  • MTA
  • ferric sulfate
36
Q

what is the cause and treatment for early exfoliation of primary teeth with pulp treatments?

A
  • cause - it is believed that it is the result of a low-grade, chronic, asymptomatic, localized infection
  • treatment is to manage space with a space maintainer
37
Q

what is the cause and treatment for over-retention of primary teeth with pulp treatments?

A
  • cause - possibly due to the bulky amount of cement contained in the pulp chamber, which is resorbed at a slower rate than smaller quantities
  • treatment - extraction if the retained tooth is interfering with normal eruption and affecting occlusion

Pediatric Dentistry I (8 decks)

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