PAEDS PULP THERAPY

Question 1

Why is pulp therapy more difficult in deciduous dentition?

Answer 1

Pulp horns are bigger
Easier to get pulp exposure
Canal are finner, narrower, more branching
Difficult to clean
Canals are less densely innervated
Pain response vague in children

Question 2

Pulp vitality testing in deciduous teeth?

Answer 2

Inconclusive

Question 3

Types of pulp therapies?

Answer 3

Vital and non vital therpies

Question 4

What are the types of vital pulp therpies?

Answer 4

Direct/indirect pulp capping
Pulpotomy

Question 5

What are the types of non vital therapies?

Answer 5

Pulpectomy

Question 6

What is the best restorative material following pulp therapy

Answer 6

Stainless steel crown

Question 7

What is a hyperemic pulp?

Answer 7

Excess bloodflow, continuous bleeding

Question 8

What teeth should have vital pulp therapy?

Answer 8

Primary teeth diagnosed with reversible pulpitis

Question 9

For what pulpal diagnosis can you do an indirect pulp cap?

Answer 9

Healthy asymptomatic pulp or reversible pulpitits

Question 10

Which has a better prognosis: deciduous indirect pulp cap or pulpotomoy?

Answer 10

Indirect pulp cap

Question 11

Which has a worse prognosis? Direct or indirect pulp cap following carious exposure

Answer 11

Direct pulp cap - never do in deciduous teeth with carious pulp exposure

Question 12

When doing an indirect pulp cap, do you need complete caries removal?

Answer 12

No, as long as you have a hella good seal.

Question 13

What material would you use for an indirect pulp cap?

Answer 13

CaOH2

Question 14

When would you do a direct pulp cap in deciduous teeth?

Answer 14

Only when there is mechanical/trauma pulp exposure

Question 15

What material should you use for a direct pulp cap?

Answer 15

MTA or CAOH2

Question 16

What is a pulptomy?

Answer 16

Coronal pulp tissue is removed and radicular pulp tissue is left behind

Question 17

When is pulpotomy indicated?

Answer 17

Mechanical exposure of primary teeth
Caries involving the coronal pulp with no inflammation in the radicular pulp
No abscess or fistula
History of spontaneous pain
No inter-radicular bone loss in xray
When we remove coronal portion of pulp, should shoud be bright red and controllable.

Question 18

Contraindications for pulpotomy?

Answer 18

History of tooth symptoms
TTP+ve
When more than 1/3rd of root is resorbed
Large cavities
Uncontrollable haemorrhage
Heart disease and immunocompromised children.

Question 19

If there are periapical pathosis or pathological resorption involved can you do a pulpotomy?

Answer 19

No

Question 20

What materials do you use in a pulptomy?

Answer 20

MTA or ferric sulphate

Question 21

What materials do you use in a pulpotomy?

Answer 21

MTA or ferric sulphate

Question 22

What materials do you use in a pulpotomy?

Answer 22

MTA or ferric sulphate

Question 23

What is a pulpectomy?

Answer 23

Complete removal of all coronal and radicular pulp tissue

Question 24

Indications for pulpectomy?

Answer 24

Diagnosis with irreversible pulpectomy
Tooth still restorable
PA or furcation involvement
Buccal or E/O swelling
Persistent bleeding during pulpotomy

Question 25

Contraindications for pulpectomy?

Answer 25

Med hx: immunocompromised, heart disease
Tooth unrestorable
Pathologic resorption of >1/3rd of tooth
Internal rot resorption
Mechanical or carious pulpal exposure of floor of pulp chamber

Question 26

What are the best materials for pulpectomies?

Answer 26

Iodoform (KriTM) paste
Iodoform (KriTM) paste + CAOH2 (Vitapex TM)

Question 27

Which has better prognosis pulpotomy vs pulpectomy?

Answer 27

Pulpotomy, only do pulpectomy if essential to preseve tooth

Question 28

Success rate of pulpectomy?

Answer 28

75-95%

Question 29

How often should you review pulp-treated teeth?

Answer 29

6 monthly

Question 30

Why cant you use GP for pulpectomies?

Answer 30

GP won’t resorb as the tooth root is resorbing during exfoliation.

Question 31

What is the clnical procedure for pulpectomies?

Answer 31

1. Pre op radiograph (WL 1mm short of apex)
2. LA
3. Rubber dam
4. Remove caries
5. Access pulp chamber
6. Remove coronal pulp
7. Instrument canals with K files < size 30
8. Irrigate with NaOCl (2.25-5%) +/- chlorhexidine 0.12%
9. Dry canals with paper point
10. Obturate canals with syringe or lentulo spiral, place medicament in canals and pulp chamber floor
11. Restore coronal cavity - IRM + GIC double seal
12. Post op radiograph
13. Restore with SSC>
14. Review 6 monthly