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xD2 Pedo > Pedo Pulp Therapy > Flashcards

Pedo Pulp Therapy Flashcards

1
Q

What can result in the reversal of pulpal inflammation?

A

Elimination of minor lesions

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2
Q

When are pulpal changes observed?

A

At initiation of a carious lesion in enamel

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3
Q

How do the irreversible changes to the pulp due to caries begin: centrally or near the irritant?

A

Close to infecting agent leading to regional necrosis prior to complete pulpal necrosis

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4
Q

What type of pain is stimulated/solicitated, sharp, short lasting?

A

Acute

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5
Q

What does spontaneous pain indicate?

A

Pulpal degeneration

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6
Q

What type of pain is unstimulated/ unsolicited?

A

Chronic

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7
Q

Chronic pain (pain unsolicited by stimulation) is a good indication of what?

A

Pulpal degeneration

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8
Q

Does the absence of pain automatically mean the tooth is healthy?

A

No

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9
Q

What should be looked for clinically both around the symptomatic or asymptomatic tooth as well as the entire mouth?

A

Redness, parulis, swelling
Mobility
Percussion sensitivity

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10
Q

Is mobility always a sign of pathology in a pedo patient?

A

No, but can be. E.g. a mandibular 1st molar would be normally mobile in a 10 year old for exfoliation, while it would indicate pathology in a 6 year old

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11
Q

What are 3 things to look for on radiograph?

A
  1. Depth and location of caries
  2. Presence of abnormal calcified masses
  3. Presence and degree of bone and root resorption
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12
Q

What are 4 options for pulp therapy?

A
  1. Indirect Pulp Cap
  2. Direct Pulp Cap
  3. Pulpotomy
  4. Pulpectomy
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13
Q

Placing a base and liner over caries that would otherwise result in a pulp exposure is known as what?

A

Indirect pulp cap

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14
Q

What are 3 indications for an Indirect pulp cap?

A
  1. No pulp exposure indicated
  2. No unstimulated or long term pain
  3. No signs or symptoms of pulpal degeneration
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15
Q

Do most dentists reenter after they have performed an indirect pulp cap?

A

No

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16
Q

When doing caries excavation with anticipated Pulp cap, what is a method to reduce the risk of carious exposure to the pulp?

A

Partial caries removal (as opposed to complete caries removal)

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17
Q

When you leave a bit of caries to purposely avoid a pulp exposure, what is the character of the dentin?

A

Unbroken layer of firm, leathery dentin covering pulp

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18
Q

What is the most appropriate treatment for symptom-free primary teeth with deep caries?

A

Indirect Pulp cap

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19
Q

What is the key to success for an Indirect Pulp Cap? (DrBerry says this is a good exam question)

A

Leakage-free restoration

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20
Q

Is an indirect pulp cap indicated if the caries is obviously in the pulp?

A

No

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21
Q

Recent literature has shown what has the longer term success rate: (1) Indirect Pulp Cap (IPT), (2) formocresol and ferric sulfate pulpotomy, or (3) pulpotomy (excluding MTA pulpotomy)

A

Indirect Pulp therapy

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22
Q

Placing a base and liner over a small mechanical pulp exposure is known as what?

A

Direct Pulp Cap

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23
Q

Is a direct pulp cap indicated for primary teeth?

A

No, do a pulpotomy

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24
Q

What is the term for amputation of the coronal portion of the pulp?

A

Pulpotomy

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25
Q

What is the status of the remaining pulp tissue in the roots after the coronal portion of the pulp has been amputated in a Pulpotomy

A

Vital radicular pulp tissue

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26
Q

If the patient has a history of spontaneous/persistent pain, is a pulpotomy indicated?

A

No

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27
Q

If have a carious pulp exposure is a pulpotomy indicated?

A

Yes

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28
Q

How long should it take to control the bleeding after a pulp exposure for a pulpotomy to be indicated?

A

3-5 min

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29
Q

How should the blood appear in the pulp for a pulpotomy to be indicated?

A

Red and normal

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30
Q

How much tooth root should be present for a pulpotomy to be indicated?

A

Two thirds of the root length must be remaining

31
Q

If have radiographic indication of pulp exposure, what can be indicated treatment?

A

Pulpotomy

32
Q

If have a clinical carious pulp exposure, what can be indicated treatment?

A

Pulpotomy

33
Q

What are 5 contraindications for pulpotomy?

A
  1. Unrestorable tooth
  2. Bi or trifurcation involvement
  3. Presence of an abscess
  4. Less than 2/3 root remaining
  5. Permanent successor close to eruption
34
Q

What are 2 indicators of an abscess that would contraindicate pulpotomy?

A
  1. Clinical parulis

2. Radiolucency at apex or in furcation

35
Q

Should you do proximal slices before or after doing pulpotomy?

A

Slices after pulpotomy. If slice before, blood could confuse about pulp status

36
Q

What are the 6 steps of a pulpotomy?

A
  1. Remove caries and determine site of pulp exposure
  2. Remove roof of pulp chamber
  3. Remove coronal pulp tissue
  4. Control bleeding
  5. Appropriate pulpal medicament
  6. Fill up pulp chamber with cement/restore
37
Q

What is the procedure for controlling bleeding during a pulpotomy using formocresol?

A

Soak pellet in diluted formocresol then squeeze out pellet. Place in chamber for 5 minutes. Acts through vapors NOT liquid.

38
Q

Should formocresol be put on controlled bleeding?

A

No

39
Q

What effect does formocresol have on the pulp?

A
  1. Bactericidal
  2. Devitalizes (the top layer)
  3. Fixation (cellular detail preserved, inhibits autolytic changes and bacterial growth)
40
Q

Does Formocresol treatment cause dentinal bridging or calcific changes?

A

Calcific changes, no dentinal bridging

41
Q

What is the composition of Formocresol?

A

19% Formaldehyde
Cresol
Glycerin
Water

42
Q

What is Buckley’s formocresol concentration?

A

1:5 concentration

43
Q

What is the concern using formocresol?

A

Caustic to tissue

44
Q

Is Ferric Sulfate used before or after bleeding is controlled during a pulpotomy?

A

After bleeding controlled

45
Q

For how long should you apply Ferric Sulfate during pulpotomy?

A

15 sec, rinse, dry with a cotton pellet

46
Q

What is the mechanism of action for Ferric Sulfate?

A

Ferric ion-protein complex with blood formed that occludes the capillary orifices

47
Q

Does Ferric Sulfate action penetrate remaining pulp tissue?

A

No

48
Q

What is the concentration of Ferric Sulfate?

A

15.5%

49
Q

What is a pulp capping powder composed of tricalcium silicate, bismuth oxide, dicalcium silicate, tricalcium aluminate, tetracalcium aluminoferrite, and calcium sulfate dehydrate?

A

MTA

50
Q

What does MTA stand for?

A

Mineral Trioxide Aggregate

51
Q

How is MTA applied for pulpotomy?

A

Control bleeding, place MTA over dry pulp stumps, restore

52
Q

Why is Calcium Hydroxide never used in primary teeth?

A

Because it causes internal resorption

53
Q

What are 4 criteria for successful pulpotomy?

A
  1. Elimination of infection within tooth
  2. Tooth preserved in healthy, non-pathologic condition
  3. Arch space maintained
  4. Normal resorption of primary tooth and eruption of permanent successor
54
Q

A failed pulpotomy is usually due to what?

A

Extended pathology (nonvital root canal tissue or periapical or radicular pathology)

55
Q

If close to the pulp, but are unsure of the status what should be done?

A

When in doubt, take the pulp out

56
Q

What is the term for removal of tissue from the coronal pulp chamber and the root canals?

A

Pulpectomy

57
Q

Are primary root canals well formed or ribbon shaped?

A

Ribbon shaped, makes conventional endo impossible

58
Q

What are indications/situations for Pulpectomy?

A

Inflammation extends beyond coronal pulp Primary teeth with necrotic pulp
Roots and surrounding cone must be pathology free
At least 1⁄2 of root length remains
Second primary molars retention for erupting permanent first molars

59
Q

What are the steps for pulpectomy?

A
  1. Remove caries and determine site of pulp exposure
  2. Remove root pulp chamber
  3. Remove coronal pulp tissue and id root canals
  4. Clean out canals and remove pulp tissue
  5. Dry canals with paper points
  6. Fill root/coronal chamber with ZOE and restore
60
Q

Are rotary instruments used for cleaning and shaping the canals in a pulpectomy?

A

No, only use hand files

61
Q

What goes in the canal, and what goes in the chamber: Vitapex and ZOE (zinc oxide eugenol)?

A

Canal: Vitapex
Chamber: ZOE

62
Q

What are the components of Vitapex?

A

Iodoform and calcium hydroxide (small percentage of COH)

63
Q

When would ZOE be used in a canal for a pedo pulpectomy?

A

ZOE for short fills

Vitapex in long fills

64
Q

Are pulpotomies on anterior teeth successful?

A

Rarely

65
Q

What is better treatment for anterior pulp breach: pulpotomy or pulpectomy?

A

Pulpectomy

66
Q

Why are pulpotomies less successful in anterior teeth?

A

Large pulp chambers are difficult to seal

67
Q

What are the indications of a successful pulpectomy?

A
  1. Elimination of infection in the tooth and surrounding tissues
  2. Tooth preserved in healthy, non-pathologic condition
  3. Arch space is maintained
68
Q

Should material be forced down the root and past the apex and why?

A

No, could damage underlying tooth

69
Q

What are dental schools teaching as the material to restore with after the Indirect pulp cap?

A

Glass ionomer and don’t reenter

70
Q

What is the risk associated with pulpectomy in anterior teeth?

A

Study found 20% incidence of anterior crossbite due to #8, #9 erupting palatally after pulpectomies on #E,#F

71
Q

Is formocresol being used more or less now?

A

Less

72
Q

Is ferric sulfate being used more or less now

A

More

73
Q

What is the preferred base for a pulpotomy?

A

ZOE

74
Q

What pulpectomy filler is now more frequently used?

A

Vitapex (Iodoform, calcium hydroxide)

xD2 Pedo (5 decks)

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