EXAM I: Pulp Therapy Flashcards
what is the primary objective of pulp therapy int he primary dentition?
prevent or eradicate infection and to maintain integrity and health of the teeth and their supporting tissues
what are some other objectives of pulp therapy in the primary dentition?
- 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
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
protective liner
what 3 materials are commonly used as protective liners?
- GLUMA - 5% gluteraldehyde and 35% HEMA
- glass ionomers
- RMGI
___ 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
indirect pulp cap
how are protective liners placed?
- prep tooth
- remove caries
- place protective liner
- restore with well-sealed restoration
how are indirect pulp caps placed?
- 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
what materials are used for an indirect pulp cap?
- 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
in indirect pulp capping, why is it necessary to place glass ionomer or ZOE over the calcium hydroxide?
- to provide a seal against microleakage, since calcium hydroxide has a high solubility, poor seal, and low compressive strength
___ of a carious pulp exposure in a primary tooth is not recommended
direct pulp capping
___ is indicated in a tooth with a normal pulp following a small mechanical or traumatic exposure wen conditions for a favorable response are optimal
direct pulp cap
**this procedure is not recommended for a carious pulp exposure**
how is a direct pulp cap placed?
- mechanical or traumatic exposure
- radiopaque base placed over pulp
- restore with a material that seals
what are the materials used in a direct pulp cap?
- 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
___ 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
pulpotomy
how is a pulpotomy performed?
- 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
what are the materials used in a pulpotomy?
- devitalization/fixation - formocresol
- preservation - ferric sulfate and chlorhexidine
- regeneration - MTA
- ZOE (IRM) is the gold standard for sealing and filling the coronal pulp chamber
___ 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
pulpectomy
what are the materials used in a pulpectomy?
- ZOE
- iodoform paste - bacteriocidal, resorbable
what are the 4 keys to success in pulp therapy?
diagnosis, isolation, technique, seal
what are some contraindications to pulp therapy in primary teeth?
- 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
what is the difference in protective liners in immature permanent teeth vs primary teeth?
no difference
what is the difference in an indirect pulp cap in immature permanent teeth vs primary teeth?
no difference
what is the difference in direct pulp cap in immature permanent teeth vs primary teeth?
no difference
what is the difference in a pulpotomy in immature permanent teeth vs primary teeth?
- more conservative pulpal access
- use reparative and regenerative materials such as calcium hydroxide and MTA to promote tooth maturation and apexogenesis
- temporary crown?
what is the difference in a pulpectomy in immature permanent teeth vs primary teeth?
- 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?
is pulp therapy indicated for a child who complains of a toothache coincident with or immediately after a meal?
not likely
the pain associated with meals does not necessarily indicate extensive pulpal inflammation
is pulp therapy indicated for a child with a history of a severe toothache at night?
this usually signals extensive degeneration of the pulp and calls for more than conservative pulp therapy
is pulp therapy indicated for a child with a spontaneous toothache of more than momentary duration occuring at any time of the day?
this usually means that pulpal disease has progressed too far for treatment, even with a pulpotomy
what are some clinical signs and symptoms of diseased pulp?
- 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
describe the benefit of the alkalinity of calcium hydroxide
- 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
what is the purpose of ferric sulfate in pulp therapy?
it agglutinates blood proteins and controls hemorrhage in the process without clot formation
what are the positive properties of MTA?
- biocompatibility
- good sealing
- antimicrobial
- ability to set in the presence of moisture and blood
what are the negative properties associated with MTA?
- difficult to hand
- high cost
what 3 materials can cause pulp canal obliteration?
MTA, formocresol, ferric sulfate
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
- MTA
- ferric sulfate
what is the cause and treatment for early exfoliation of primary teeth with pulp treatments?
- 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
what is the cause and treatment for over-retention of primary teeth with pulp treatments?
- 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
