Primary tooth pulp therapy and restorative Flashcards
What interview questions should be asked to determine the subjective symptoms?
Chief Complaint
Which tooth
What are you doing when it starts hurting?
How badly does it hurt? 1-10?
Does it hurt for a long time?
Beware of questionable reliability in reporting
What are the main components of an objective intra and extra oral examination?
Is it a tooth/which tooth? Soft tissue infection/facial cellulitis or parulis, fistula, abscess Pathologic mobility Sensitivity to palpation/percussion Pulp testing Radiographic signs Direct inspection of the pulp
What is the value of cold/heat/EPT vitality testing in primary teeth?
NOT reliable in primary dentition
False-positive results
Not reliable reporting
What is the best test for primary tooth pulps?
Percussion
Use with caution!
What are the radiographic signs of necrotic pulps?
Furcation radiolucencies, apicies of anterior teeth
Root resorption
What are the different presentations of damaged or necrotic pulps?
Presence of hemorrhage
Quality and quantity of hemorrhage
Dry chamber
Purulent exudate or malodor
What are the options for vital pulp therapy in primary dentition?
Indirect pulp treatment
Direct pulp cap
Pulpotom
What are the options for NON-vital pulp therapy in primary dentition?
Pulpectomy
Extraction is the other alternative
What are the indications for VITAL pulp therapy?
Intermittent, short duration
thermal or chemical stimulation
What are the indications for NON VITAL pulp therapy?
Spontaneous pain Nocturnal pain Prolonged pain Soft tissue signs Pathologic mobility Furcation/apical radiolucency Radiographic evidence of internal/external resorption
What are the indications for indirect pulp treatment?
Selection criteria
- -Restorable tooth
- -Near pulp exposure radiographically
- -Vital pulp: no spontaneous pain, no clinical signs, no radiographic signs
What is the procedure for indirect pulp treatment?
Excavate but leave the deepest caries behind to avoid a pulp exposure
Place protective liner such as RMGI
Restore: The SEAL is the deal
What is the selection criteria for direct pulp capping?
Restorable tooth Pulp exposed during carious dentin removal Pulp exposure is 1mm or less Vital pulp --No spontaneous pain --No clinical signs --No radiographic signs LOW quality evidence for success
What is the procedure for direct pulp capping in primary teeth?
Caries removal leads to pulp exposure
Apply medicament (CaOH, dentin bonding agents, MTA, formocresol)
Place protective liner such as RMGI
Restore: the SEAL is the deal
What is the selection criteria for pulpotomy?
Restorable tooth with carious pulp exposure VITAL pulp --No spontaneous pain --No clinical signs --No radiographic signs
What is the procedure for a pulpotomy?
LA and rubber dam isolation
Occlusal reduction
Access and completely de-roof pulp chamber– use 6 or 8 round bur
Careful removal of all coronal pulp tissue and remaining caries
Irrigate pulp chamber with water and dry with cotton pellets
Direct inspection of pulp (uncontrolled bleeding is a contraindication for pulpotomy)
Apply medicament (ferric sulfate at OSU) to surface of radicular pulp
Seal with IRM
Break contacts
Place SSC
What are the different types of intracanal medicaments?
Formocresol
Ferric sulfate
MTA
What are the functions of formocresol?
Long history of clinical success
Contains formaldehyde, creates a zone of fixation at the surface of the radicular pulp
Safety concerns?
What are the functions of ferric sulfate?
Ferric ions interact with blood proteins leading to agglutination (forms physical plugs to occlude canal orifices)
Potential to mask hyperemic appearance of pule (assess pulp status with cotton pellets first
What are the functions of MTA?
High alkalinity is antibacterial High biocompatibility Excellent seal Promotes hard tissue formation More expensive
What are the selection criteria for pulpectomies in primary teeth?
Restorable tooth Irreversible pulpitis or necrotic pulp Spontaneous pain Clinical signs Radiographic signs
What is the procedure for primary tooth pulpectomies?
LA, isolation with RD, prep, de-roof chamber
Debride and shape root canals with files
Irrigate canals with CHX or sodium hypochlorite and dry
Fill with resorbable material: ZOE, iodoform based paste, iodoform+calcium hydroxide
Under-fill>overfill
What the best restorations after pulp therapy?
SSCs
Composite or amalgam can be considered with sufficient tooth structure and a tooth that will exfoliate within 2 years
