Pinkham - Chap 22 - Pulp Therapy for the Primary Dentition

Question 1

Location and characteristics of Odontoblastic layer?

Answer 1

Cells that line the periphery of pulp space
Extend cytoplasmic processes into dentinal tubules
Form Dentin
Size depends on functional activity
Cell Junctions are responsible for communication between odontoblasts and maintain their position relative to one another

Question 2

Cell Free Zone characteristics?

Answer 2

plexus of unmyelinated nerves and blood capillaries below the odontoblastic layer

Question 3

dental pulp core chars?

Answer 3

larger blood vessels and nerves surrounded by loose CT below cell free zone

Question 4

role of IEE and its basement membrane?

Answer 4

IEE presents bioactive molecules(growth factors) that send signals to dental papilla, inducing differentiation and making odontoblasts

Question 5

where are odontoblast cells derived from?

Answer 5

ectomesenchymal cells of the dental papilla

Question 6

which dentin is deposited at initiation of dentinogenesis and how is it mineralized?

Answer 6

mantle dentin, thru mediation of matrix vesicles

Question 7

what dentin is produced by Odontoblasts after mantle dentin?

Answer 7

ODB cells produce matrix dentin

Question 8

what direction do odontoblast cells move after laying down matrix dentin and what do they leave behind?

Answer 8

pulpally, leave a single cytoplasmic process embedded in a dentinal tubule in the matrix

Question 9

characteristics of physiologic secondary dentin?

Answer 9

secreted at slower rate throughout life of tooth which is why you get slow reduction of pulp chamber

Question 10

lifespan of ODB cells?

Answer 10

survive life of the tooth unless subjected to injury

Question 11

how does pulp-dentin complex(PDC) respond to injury?

Answer 11

forms new hard tissue(tertiary and sometimes sclerotic dentin)

Question 12

ODB action in a mild injury? discontinuity of tubular structure?

Answer 12

ODB cells that laid down primary dentin may survive and produce reactionary dentin beneath injury site. No disc of tubular structure

Question 13

ODB action in severe injury? disc of tubular structure?

Answer 13

ODB beneath injury may die and a new generation of ODB like cells may differentiate, secreting reparative dentin. Will be disc of tubular structure with subsequent reduction in permeability

Question 14

how does PDC respond to caries?

Answer 14

forms sclerotic dentin by apposition of minerals into and b/w tubules and reactionary tertiary dentin is secreted

Question 15

Deep caries and relation of pulp vessels and inflammatory cells?

Answer 15

blood vessels of pulp dilate and scattered inflammatory cells are present

Question 16

What happens if deep caries is left in tooth?

Answer 16

becomes an exposure, and chronic pulpitis now becomes acute, abscess may form, pulp undergoes partial necrosis followed by total necrosis

Question 17

what factor determines whether partial or total necrosis will occur?

Answer 17

drainage. If drainage impeded by food or a restoration, total necrosis will occur

Question 18

how does PDC respond to operative procedures?

Answer 18

heat, desiccation and cutting of dentin lead to intra and intertubular mineralization resulting in sclerotic dentin followed by tertiary dentin formation

Question 19

Type of pain and relation to pulp status?

Answer 19

provoked pain, pulp is usually treatable

spontaneous pain - pulp not treatable

Question 20

internal root resorption indicates what about pulp?

Answer 20

indicates inflammation of vital pulp

Question 21

external root resorption indicates what about pulp?

Answer 21

indicates non vital pulp with extensive inflammation

Question 22

hemorrhaging pulp after pulpotomy and 5 mins of cotton pellet pressure indicates?

Answer 22

more extensive inflammation into radicular pulp and indicates a pulpectomy or ext

Question 23

GI used as a base and liner on pulpal and axial walls because?

Answer 23

dentin is thin and permeable in deep cavities and GI seals the dentin well.

Question 24

why are resin, GI cements and dentin bonding agents not used with amalgam?

Answer 24

Their insoluble adhesive layer prevents amalgam corrosion products from sealing the gap

Question 25

indications of Indirect PT and what dentin formation results?

Answer 25

Teeth with deep caries close to pulp with no signs/symptoms of pulp degeneration. tertiary dentin + peritubular/sclerotic dentin

Question 26

two most common materials used in IPT?

Answer 26

calcium hydroxide and ZOE paste

Question 27

Success in primary teeth of IPT?

Answer 27

over 90%, so its recommended in pts with no signs/symptoms of pulp degeneration. IPT success reported to be higher than direct pulp capping and pulpotomy for primary molars with caries*

Question 28

DPT indications

Answer 28

traumatic or mechanical pin pt exposure of pulp, tooth asymptomatic and free of oral contaminants. Generally No DPT in primary teeth unless tooth is 1-2 years from exfoliation. Use DPT in immature permanent teeth with pinpt traumatic/mechanical exposure

Question 29

what material is used in DPT?

Answer 29

CaOH placed over exposure site to stimulate dentin formation

Question 30

why is DPT unsuccessful in primary teeth?

Answer 30

due to high cellular content of primary pulp

Question 31

Pulpotomy contraindications?

Answer 31

swelling, fistula, pathologic mobility, ext/int root resorption, PARL, pulp calcifications, hemorrhaging from chamber

Question 32

ideal dressing for pulpotomy is ____ and why?

Answer 32

1:5 formocresol, bactericidal, harmless to pulp, allows healing of pulp, doesnt interfere with root resorption, doesnt cause int/ext root resorption(FC can but its not very high)

Question 33

pulpotomy clinical procedure?

Answer 33

remove pulp horns, remove coronal pulp with excavator or slow round bur, cotton pressure on stumps, then pellet with formocresol for 5 mins, place ZOE, place final restoration(SSC)

Question 34

after 5 mins of cotton/formocresol pressure, what color should the stumps appear?

Answer 34

dark brown or dark red

Question 35

Success and controversy with FC?

Answer 35

70-97% success rate. Controversy with how FC affects radicular pulp. Some claim it leads to chronic inflammation while others say partial or total necrosis of radicular pulp. Substitute medicaments are being researched.

Question 36

Glutaraldehyde?

Answer 36

Glutaraldehyde(less toxic, less penetration, less effect on PA tissues) as substitute for FC in pulpotomy.

Question 37

Ferric Sulfate?

Answer 37

hemostatic agent, Success rates similar to that of FC but FS has increased rates of internal resorption.

Question 38

MTA?

Answer 38

Doesn’t cause int root resorption, finding that is seen in FC and FS pulpotomys. MTA results in more pulp canal obliteration compared to FC

Question 39

Pulpectomy and root filling for primary teeth indications/contraindications?

Answer 39

indicated in chronic inflammation or necrosis in radicular pulp. Contraindicated in teeth with gross loss of tooth stx, advanced int/ext root resorption, or PARL involving crypt of succedaneous tooth. Often done in primary 2nd molars when 1st perm molar hasn’t erupted yet.

Question 40

Filling materials for pulpectomy/root filling of primary teeth?

Answer 40

ZOE, Iodoform paste, CaOH

Question 41

ZOE chars as filler for pulpectomy?

Answer 41

most common. Its rate of resorption differs from that of tooth and overfilling can cause mild foreign body rxn from body.

Question 42

Iodoform paste(KRI) as filler for pulpectomy chars?

Answer 42

resorbs rapidly, no undesirable efx on succedaneous tooth, if overfilled it is rapidly replaced with normal tissue

Question 43

CaOH by itself and Vitapex as pulpectomy filler?

Answer 43

CaOH not used by itself in primary teeth. Used when combined with iodoform(Vitapex).

Question 44

Vitapex chars as pulpectomy filler?

Answer 44

resorb rate slightly faster than roots, no toxic efx on succedaneous teeth, and radiopaque. Ideal primary tooth pulpectomy filler.

Question 45

criteria for clinical success of root treatments?

Answer 45

When there is no pathologic resorption associated with RL. Also considered successful are pulp treated primary teeth with minimal RL or pathologic root resorption in the absence of clinical signs/symptoms.