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pulpotomies > pulp theory for primary molars > Flashcards

pulp theory for primary molars Flashcards

1
Q

Which 4 techniques come under the umbrella terms of pulp therapy?

A
  1. Indirect Pulp Capping
  2. Direct Pulp Capping
  3. Vital Pulpotomy
  4. Pulpectomy
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2
Q

What are 3 reasons for primary molar morphology being susceptible to caries progression and loss of vitality?

A
  1. Wide approximal contact areas.
  2. Large pulp chamber compared to permanent teeth.
  3. Thinner enamel.
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3
Q

What are bifurcation radiolucencies a sign of?

A

Pulpal infection.

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4
Q

Why are pulpal sensibility tests not recommended in primary dentition?

A

Because they are unreliable in primary dentition.

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5
Q

What 3 pieces of information do radiographs provide?

A
  1. Extent of caries and proximity.
  2. Presence of pathological or physiological root resorption
  3. Presence of a permanent successor.
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6
Q

Primary molars with extensive caries are kept when a patient is at a higher risk from having them extracted.

What are 2 reasons for this?

A
  1. Bleeding disorders.
  2. Hereditary antio-oedema.
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7
Q

Primary molars with extensive caries are kept when a patient is at a higher risk from having general anaesthesia prior to XLA.

What are 2 possible medical reasons for this?

A
  1. Cardiac Conditions.
  2. Cystic Fibrosis.
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8
Q

Tooth Factors:

What are 4 potential reasons we might keep primary molars with extensive caries?

A
  1. Solitary or minimal teeth with extensive caries.
  2. Hypodontia of the permanent dentition.
  3. Preventing mesial migration of the first permanent molars.
  4. Iatrogenic pulpal exposure during caries removal.
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9
Q

In what kind of patient might we consider leaving carious primary molars?

A
  1. Good compliance.
  2. Regular attender.
  3. Parents positive about treatment.
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10
Q

Which MEDICAL factors may mean it is better to extract carious primary molars?

A

Immunocompromised patients or those who are susceptible to infective endocarditis.

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11
Q

Tooth Factors:

What are 5 potential reasons we might EXTRACT primary molars with extensive caries?

A
  1. Tooth unrestorabel after pulp therapy.
  2. Extensive internal root resorption.
  3. Large number of teeth with pulpal involvement.
  4. Tooth close to exfoliation.
  5. Extensive pathology or acute facial swelling.
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12
Q

Which patient social factors may indicate XLA of carious primary molars?

A
  1. Poor compliance.
  2. Irregular attendance.
  3. Negative parental attitude to treatment.
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13
Q

What are 3 signs of a normal pulp?

A
  1. Asymptomatic (no previous history of pain or swelling)
  2. No mobility or pain on occlusal pressure.
  3. No clinical/radiographic signs of radicular infection.
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14
Q

What are 3 signs of a VITAL pulp?

A
  1. Short duration pain relieved by over the counter painkillers / removal of pain stimulus.
  2. No mobility or pain on occlusal pressure.
  3. No signs of irreversible pulpitis/radicular infection.
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15
Q

Signs of a vital pulp NOT CAPABLE OF HEALING.

A
  1. History of spontaneous or unprovoked pain.
  2. Sinus tract / abscess.
  3. Mobility.
  4. Furcational / apical radiolucency.
  5. Internal / external resorption.
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16
Q

Which 3 techniques can be performed if the pulp is vital or capable of recovery?

A
  1. Indirect pulp treatment.
  2. Direct pulp cap.
  3. Vital pulpotomy.
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17
Q

What is indirect pulp treatment?

A

Incomplete caries removal (especially at the base) to avoid pulpal exposure.

Sealed in by a PMC or excellent composite.

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18
Q

What type of carious management is indirect pulp treatment an example of?

A

Biological method.

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19
Q

What is involved in a direct pulp cap?

A

Complete caries removal and covering of exposed pulp tissues with Biodentine / MTA.

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20
Q

Is direct pulp capping recommended in primary dentition?

A

No as there are other less invasive options.

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21
Q

What are other less invasive options instead of direct pulp capping?

A
  1. PMC
  2. Indirect Pulp Capping
  3. Stepwise Caries Removal.
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22
Q

Which type of pulp tissues are removed in a vital pulpotomy?

A

Infected coronal pulp tissues.

23
Q

What is the aim of a vital pulpotomy?

A

To maintain pulp vitality.

24
Q

When can a vital pulpotomy be performed?

A

Only in teeth with extensive caries WITHOUT evidence of radicular pathology.

25
Q

How can a post puloptomy seal be achieved?

A

With a PMC or excellent composite restoration.

26
Q

Which 2 treatment options should be considered when the pulp is NON VITAL or capable of recovery?

A
  1. Pulpectomy
  2. Extraction
27
Q

What is a pulpectomy?

A

Removal of coronal and radicular pulp tissues.

same principle as RCT

28
Q

What should be present radiographically in order to carry out indirect pulp treatment?

(think PMC)

A

A band of sound dentine between the lesion and the pulp.

29
Q

When is direct pulp capping recommended?

A

ONLY for traumatic / iatrogenic exposures.

NOT for carious pulp exposures unless the tooth is close to exfoliation.

30
Q

What is the aim of a vital pulpotomy?

A

Removal of irreversibly inflamed coronal pulp.

Maintain healthy/reversibly inflamed radicular pulp.

31
Q

When would a vital pulpotomy be performed?

A
  1. Carious exposure of vital coronal pulp tissue.
  2. No periapical periodontitis or sepsis.
32
Q

What are the 6 stages of a pulpotomy?

A
  1. LA & Rubber Dam
  2. Access and caries removal.
  3. Complete removal of pulp chamber roof.
  4. Remove coronal pulp tissue.
  5. Achieve pulpal haemostasis.
  6. Evaluate pulp stumps.
33
Q

What would indicate a SUCCESSFUL removal of inflamed coronal pulp tissue?

A

Bright red pulp stumps and haemostasis achieved after 3-5 minutes.

34
Q

What would indicate unsuccessful removal of inflamed coronal pulp tissue?

A

Deep crimson colour and continued bleeding after 3-5 minutes.

35
Q

After confirming normal bleeding and non-inflamed pulp stumps, what would come next?

A
  1. Apply medicament to pulp stumps:
    - 15.5% Ferric Sulphate for 15 seconds.
    - MTA
    - Layer of well condensed pure Ca(OH)2
    - Biodentine
  2. Apply GIC lining.
  3. Definitive restorations.
36
Q

What would cause failure of a pulpotomy?

A

Bacterial ingress.

37
Q

What is the ideal response of the radicular pulp upon follow up?

A

Asymptomatic without adverse clinical signs or symptoms.

38
Q

When would a tooth require XLA following a pulpotomy?

A

If resorption has caused perforation, loss of supportive bone and clinical signs of infection or inflammation.

39
Q

What does MTA stand for?

A

MINERAL TRIOXIDE AGGREGATE

40
Q

What are the 6 components of MTA?

A
  1. Tricalcium silicate.
  2. Dicalcium silicate.
  3. Tricalcium aluminate.
  4. Tetraalcium aluminoferrite.
  5. Calcium sulphate.
  6. Bismuth oxide.
41
Q

What is the pH of MTA?

A

12.5

42
Q

What kind of effect does MTA have on cemtoblasts?

A

Inductive

43
Q

What is the effect of MTA on the PDL?

A

Facilitates its regeneration.

44
Q

How is MTA prepared and used?

A

Mixed with sterile water.

Sandy consistency.

Gently packed against the radicular pulp stumps.

45
Q

How long does MTA take to set?

A

4 hours.

46
Q

What happens in a pulpectomy?

A
  1. Irreversibly inflamed or necrotic pulp tissue is removed.
  2. Root canals are cleaned and irrigated.
  3. Obdurate with a filling material that will resorb at the same rate as the primary tooth.
47
Q

In cases indicating pulpectomy, what is the state of the pulp?

A

Symptoms of irreversible pulpitis and a NON VITAL radicular pulp.

48
Q

What clinical findings could be expected of a tooth requiring a pulpotomy?

A

Profuse haemorrhage following pulpectomy.

49
Q

When would it be advised to carry out a pulpectomy?

A

When there is a missing permanent successor so a greater need to retain the primary molar.

or

MH meaning extraction should be avoided.

50
Q

Complicating factors of a pulpectomy:

A
  • Unpredictable radicular morphology in primary molars.
  • Physiological root resorption not present/minimal.
  • Proximity to permanent successor when instrumenting root canals.
  • Requires excellent patient cooperation for success.
51
Q

What is the likely recall for a patient with pulp treated primary teeth?

A

6 months until exfoliation.

52
Q

What are 3 signs of clinical failure in pulp treated primary teeth?

A
  1. Pathological mobility.
  2. Fistula / chronic sinus.
  3. Pain
53
Q

What are 3 signs of radiographic failure for a pulp treated primary tooth?

A
  1. Increased radiolucency.
  2. Internal / external resorption.
  3. Furcation bone loss.

pulpotomies (8 decks)

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