Pee Dos Flashcards

1
Q

How do we determine vitality of Primary teeth?

  • 4 tests
  • unreliable in Primaries
A

Thermal

Percussion

Palpation

Mobility

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2
Q

How do we determine vitality of Immature Permanent Teeth?

*useful to establish baseline in trauma

A

Electric

Thermal

Percussion

Palpation

Mobility

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3
Q

How do we determine viability of Permanent Teeth?

A

Electric

Thermal

Percussion

Palpation

Mobility

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4
Q

Feel changes in alveolus/furcation/mobility

Infection leads to Resorption leads to Mobility

A

True

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5
Q

T/F

Never base Tx decisions on sensibility tests/feedback

A

True

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6
Q

Tx exposes pulp, how determine Pulp Status?

*2 options

A

Purulent/profuse bleeding - Irreversible Pulpitis

Bright red/arrests 5 min. - Reversible Pulpitis

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7
Q

12/24 month (general) Success Rate: MTA

FS:

FMC:

Laser:

ZOE:

CaOH

A

100 98

86 86

96 85

93 78

92 68

86 53

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8
Q

What is the best filler for Pulpotomy?

A

MTA

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9
Q

4 reasons MTA best filler for Pulpotomy:

A

Bioactive glass/ceramic

biocompatible (non-toxic)

Minimal inflammatory response

HA forms dentin and filling material

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10
Q

What is a dentinal bridge?

A

Reparative Dentin laid down after Pulpotomy

*MTA

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11
Q

3 Protective Liner Meds (Primary and Permanent)

A

GI (Vitrebond/Fuji IX)

CaOH

Dentin Bonding Agent

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12
Q

4 Direct Pulp Cap Meds (Primary/Permanent)

A

MTA (Mineral trioxide aggregate)

BIO

CaOH

RMGI/GI

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13
Q

What 2 products would you NEVER USE for Pulpotomy for Permanent teeth?

What 2 products are ok to use?

A

FMC or FS

MTA or CaOH

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14
Q

6 Pulpotomy meds:

*that can be used on Primary teeth

A

Formocresol (FMC)

Ferric Sulfate

MTA

Electrosurgery/Laser

TempIt (ZOE)

NaOCl (bleach)

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15
Q

Primary Pulpotomy Meds: FMC ___ application, is _____

Ferric Sulfate ____ application, is _______

MTA/Endosequence, ________

Electrosurgery/Laser, careful of…

ZOE, aka…

NaOCl, similar success rate to ______

A

5 minute, bactericidal

15 second, coagulant

leave it in

exces heat/energy

TempIt

FMC

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16
Q

4 Indirect Pulp Tx Meds (Primary/Permanent)

A

GI

RMGI

CaOH

ZOE/IRM

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17
Q

3 Pulpectomy Meds to never use with Primary teeth:

Why?

A

IRM, MTA, Gutta Percha

non resorbing

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18
Q

IRM, MTA, GP never used for Pulpectomy on Primary teeth (non resorbing), what do you use instead?

A

Vitapex

followed by ZOE/GI

*flush canals w/ NaOCl 1%

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19
Q

there is a tendency to ______ Vitapex and ______ ZOE

*primary pulpectomy

A

overfill Vitapex

underfill Zoe

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20
Q

What are the steps for Immature Permanent Apexification?

A

(like pulpectomy) Irrigate NaOCl

CaOH 2 wks for disinfection

Apical collagen as needed

MTA (moist pellet 24 hrs)

check MTA after 24 hrs, Place GP

***MTA/composite fill for reinforcement of immature root (this is apexification)

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21
Q

What is used for Apexification?

A

MTA/composite fill to reinforce immature root

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22
Q

What are the filling (obturating) materials for the chamber?

A

ZOE (IRM)

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23
Q

FMC has similar success to FS and Bleach

A

True

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24
Q

If the Pulp is Vital, what procedures can you do?

A

Direct Pulp Cap

Pulpotomy

Indirect Pulp Cap

Revascularization

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25
If the Pulp is Non-Vital, what procedures can you do?
Pulpectomy
26
Use a Protective Liner in Normal Pulp for what?
Dentinal tubules exposed by prep
27
A Protective Liner is only used when what 2 conditions are met?
All decay removed no pulp exposure
28
When can you use a Direct Pulp Cap? 2 conditions
Vital Small/pinpoint exposure (less than 1mm)
29
A Direct Pulp Cap is NOT recommended for a Primary tooth when?
if carious exposure *internal resorption
30
Pulpotomy on a Primary, do when the Tooth is Vital, or ______ pulpitis And the tooth is restorable
Reversible Pulpitis
31
3 options if you have a Vital tooth and a Large exposure due to caries on a Permanent tooth:
Direct pulp cap Partial pulpotomy Pulpotomy
32
Direct Pulp Cap, Partial Pulpotomy, and Pulpotomy for large carious exposure, vital tooth absence of _______, no radiographic pathology And what?
spontaneous pain open apex
33
For an Indirect Pulp Tx on Primary you must remove what? Re-enter? Caries should be __ mm from the pulp
All caries that would potentially expose pulp no 1 mm
34
When would you do a Pulpectomy on a Primary?
Non vital Strategic Resorable Adequate root
35
Immature Permanent Apexification:
RCT
36
Vital Pulp Tissue Dentin pulp complex free of bacteria Creation of new pulp for Apexogenesis
Revascularization
37
Procedure that addresses the shortcomings involved with capping the inflamed dental pulp of an incompletely developed (immature) permanent tooth. The goal is the preservation of vital pulp tissue so that continued root development with apical closure may occur on its own naturally
Apexogenesis
38
Achieving artificial closure of the Apex, pulp is non vital in immature permanent teeth, tooth discontinues its natural maturation process and can be weakened
Apexification
39
Primary Pulpectomy, can't use what 2 products? Use what instead?
MTA/IRM Vitapex
40
Which medications/Tx are not used in Permanent Pulpotomies? *why?
FS/FMC *don't want existing vital pulp inert/leave clot
41
In what scenario do we not perform a direct pulp cap? why?
Carious pulp exposure, Primary teeth mesenchymal cells differentiating into odontoclasts and resorbing the pulp internally
42
How do we promote apexogenesis in pulpally involved teeth?
Vital no RCT, pulpectomy, apexificatoin vital pulp therapy options instead
43
Where would a Primary Pulpectomy be a good Tx option? Where do we NOT do them?
necrotic, strategic, restorable primary 1st Molars
44
Apexogenesis is used... Apexification is used...
normal natural closure of root for Immature Permanent artificial closure (RCT) ***vital vs non-vital
45
When would you remove a tooth instead of doing a Pulp Therapy?
infection uncontrolled Bony support can't be regained inadequate tooth structure excessive root resorption not strategically important
46
Good pain often sharp Bad pain often throb
True True
47
What is the most reliable pulp test? Electric, Thermal, Percusssion/palpation/mobility
Percussion/Palpation/Mobility
48
Never base Tx on sensibility tests alone. They are only one possible indication of pulp vitality
True
49
2 indications, Irreversible Pulpitis: 2 indications, Reversible Pulpitis:
Profuse Bleeding, purulent exudate bright red, 5 min arrested
50
What isn't recommended in a Primary Tooth with Carious Exposure?
Direct Pulp Cap
51
Primary tooth w/ Carious Exposure, no Direct Pulp Cap What instead?
Pulpotomy
52
Biocompatibility is a function of...
Microleakage
53
IPT (indirect pulp treatment) is better than what? __% at 3 years
Formocresol 94%
54
ITR (Interim Therapeutic Restoration) will successfully diagnose treateable vital pulp therapy teeth ___% of the time
98%
55
Early tooth extraction may decrease the length of stay in the hospital
True
56
ABCDE: missing E: Missing D: Missing E on both sides: Missing D on both sides
distal shoe banded loop Nance/Transpalatal Arch Two banded loops (or Transpalatal Arch)
57
ONMLK: Missing K Missing L (after 1st molars in)
LLHA Do nothing
58
Most reliable pulp test for Primaries:
Percussion Mobility Palpation
59
When evaluating Primary for pulp Vitallity, what x-rays are the most helpful:
BW PA
60
8 y/o, tooth 30, deep lesion, vital, all decay removed, moderate sized pulp exposure: What meds?
Pulpotomy MTA
61
6 y/o, tooth K, deep lesion, all decay removed, no exposure: Meds:
Liner GI
62
10 y/o, tooth 3, deep lesion, vital, potential for pulp exposure: Meds:
Indirect pulp therapy RMGI
63
5 y/o, tooth D, deep lesion, non-vital, moderate sized pulp exposure, pulpal necrosis/purulence
Extraction
64
T/F | A tooth cannot be fractured without having had an associated displacement injury
True
65
Prognosis of crown fracture: depends upon ______ to PDL
concomitant injury
66
Age of pulp exposure, extent of dentin exposed, stage of root development at the time of injury secondarily affect the tooth's prognosis
True
67
Crown/root fractures: When the primary tooth can't be restored, entire tooth removed unless?
Retrieval apical fragments might damage Succedaneous Tooth
68
Root fracture involves what?
dentin, cementum, pulp
69
Reduce/reposition a root fracture and space in a ______ splint for ______ rinse with what? Prognosis: In the event that the pulp becomes necrotic... If necrotic part removed:
non rigid, 4 weeks CHX, antibiiotics improves w/ fracture closer to Apex radiolucency at fracture site apical segment continues to develop/calcify
70
T/F | It is typical for slight root resorption to occur at the fracture site early in the healing process
True
71
Follow up timeline for a fracture: 4 week splint removal 4 month splint: 4 weeks splint removal: 2 week splint removal:
apical third and mid root fractures root fracture near cervical area lateral luxation, alveolar involvement intrusion alveolar fracture
72
Splinting should be non-ridig, passive atraumatic, with small diameter ortho wire measuring:
.014 - .015 or monofilament fishing line + composite
73
Splinting involves 2 non-affected teeth on either side and must allow movement, otherwise...
risk ankyloses
74
4 things requiring 2 week splint: 3 things requiring 4 week splint:
subluxation, extrusion, intrusion, avulsion lateral luxation, delayed avulsion, root fracture
75
ECC, presence of ____ decayed/missing/filled in any primary tooth in a child ____ months or younger
1+ 71 months
76
Severe ECC any smooth surface lesions in a child younger than...
3 y/o
77
From ages 3-5, one or more cavitated/missing/filled smooth surface where? or...
Primary Mx Anterior decayed/missing/filled score
78
What meds do we Never use on a Permanent tooth? What do we use instead?
FMC/FS MTA/CaOH
79
4 options for Vital Pulp therapy:
Liner Indirect Pulp Cap Direct Pulp Cap Pulpotomy
80
Never do a Direct Pulp cap if there is what? ***Primary tooth
Carious lesion
81
3 meds suitable for a Direct Pulp Cap:
DiCal, MTA, CaOH
82
FMC, time... FS, time...
5 minutes 15 seconds
83
Depth of a Partial Pulpotomy in a Permanent tooth:
1-3 mm
84
Primary Pulpectomy, never use... Instead use...
MTA, IRM Vitapex, ZOE
85
IRM is reinforced ______ Therefore, you can't use IRM in a Primary Pulpectomy, but you can use...
ZOE
86
Apexification:
Collagen plug, GP
87
Revascularization, make the canal ______, then do what?
Sterile puncture alveolus, bleed, creates scaffolding that creates new pulp
88
Pulp vitality in Primary teeth: (3 things) Also what?
percussion, mobility, palpation Hx
89
4 y/o, tooth T, deep lesion, no exposure:
Liner
90
5 y/o S and L extracted, what is space management?
LLHA or Band/Loop * **in this case, go with 2 Band/Loop * **if M also gone, LLHA (but warn about linguals)
91
Primary pulpectomy, don't use IRM or MTA why?
don't resorb
92
Why would we do a Pulpectomy in a Primary tooth?
non vital root intact Anterior Teeth 2nd Primary Molars
93
Apexogenesis: Apexification:
natural growth of the root collagen Plug (non-vital, immature)
94
PERRLA:
Pupils equal, Round, Responsive to Light, Accommodation
95
4 types of Displacement Injuries:
Concussion Subluxation Luxation (3 subtypes) Avulsion
96
3 types of Luxation:
Extrusion Lateral Intrusion
97
Injury to tooth-supporting structures without abnormal loosening or displacement of the tooth
Concussion
98
Prognosis for Primary Concussion:
53% discolor
99
PRIMARY/Permanent Concussion Tx: ____ radiograph Pulp sensibility tests: Observation ____ diet ____ week follow up _____ week follow up w/ radiograph Follow for ______ and signs of necrosis
1 occlusal don't do (perm: should be negative) soft 1 week (perm: 4 weeks) 6-8 week 1 year
100
Radiographic evidence Pulp Necrosis: Inflammatory resorption: Replacement resorption:
2 weeks 3 weeks 6 weeks
101
Injury to tooth-supporting structures with Loosening but no displacement
Subluxation
102
Subluxation will get bleeding from where? because PDL is _____ Radiographs show no ______ and minimal PDL thickening
sulcus torn displacement
103
PRIMARY Subluxation Tx: ____ radiograph sensibility tests? Observation and ____ diet ____ week follow up _____ week follow up w/ radiograph Prognosis:
1 occlusal no soft 1 6-8 week possible discoloration, can lead to pulp canal obliteration
104
Permanent Subluxation Tx: 1 occlusal radiograph, Splint for ______ weeks ___week follow up ______ week follow up w/ radiograph Follow for ___ signs necrosis Prognosis open apex: Prognosis Closed apex:
2 weeks 4 week 6-8 week 1 year minimal risk necrosis slight risk necrosis (15%)
105
While Splinting, _____ is required ____ times/day
CHX 2x
106
Displacement of the tooth axially PDL partially/totally separated * tooth appears elongated * negative pulp tests
Extrusion Luxation
107
Extrusion Luxation, reposition/splint Primary tooth is less than ___ mm extrusion Extract if....
3 mm greater than 3 mm
108
How long to splint Extrusion Luxation?
2 weeks
109
The need to Splint Extrusively luxated Primary Tooth is likely an indication for what?
Extraction
110
Permanent Extrusion Luxation Tx: splint: Follow ups at: Prognosis for Open Apex Prognosis for Closed Apex:
2 weeks 1, 2, 4, 8 weeks, 6 months, 1 year, follow annually 5 yrs best necrosis/obliteration common Ankylosis
111
Lateral Luxation Primary Tx, if Crown displaced labially: follow ups: Prognosis:
Extract 1 week, 2-3 weeks (splint), 6-8 weeks (radiographs) if repositioned, pulp necrosis increases
112
Lateral Luxation Permanent Tx: when reposition? follow ups: Prognosis Open Apex Prognosis Closed Apex:
immediately 2, 4, 6-8 weeks, 6 months, 1 yr, annually 5 yrs best necrosis/obliteration common
113
Lateral Luxation in Permanent tooth has ___% chance of necrosis:
75%
114
Primary Apical Luxation Tx: displaced labially: displaced lingually: if extract?
re-eruption extraction radiograph every yr until permanent erupts
115
___% of intruded teeth will re-erupt spontaneously
90%
116
Intrusion Luxation Permanent Tx: remove splint when? If Immature: If mature:
2 weeks spontaneous eruption (ortho after 3 wks) reposition ASAP surgically
117
Intrusion: if Apex is Open, when allow spontaneous eruption? When ortho/surgical If Apex Closed, when allow spontaneous eruption? When ortho/surgical?
up to 7 mm more than 7 mm up to 3 mm ortho 3-7, surgical more than 7
118
Most complicated luxation injury
Ankylosis
119
Avulsion for Primary Teeth:
Never Replant
120
Avulsion Tx permanent:
put back in right away
121
Avulsion Tx, if less than 60 minutes: if more:
replant will Ankylose and fail - replant for esthetic, delayed resorption
122
Any immature tooth out for less than 1 hour is worth replanting
True
123
Mature Apex (closed) tooth Avulsion, pulpectomy when?
within 7-10 days *before removal of splint
124
Avulsion: Mature apex replant? don't replant?
less than 1 hr more than 1 hr
125
Partial pulpotomy removes 1-3 mm and is called what? What is goal?
Cvek apexogenesis
126
If a fracture is near the cervical area the Splint should be kept in how long?
4 months
127
In order, the best transport medium for teeth: never:
put in socket, hanks, milk, saliva water