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Paediatrics > Pulp Therapy > Flashcards

Pulp Therapy Flashcards

1
Q

What are the disadvantages of early primary tooth loss

A
  • Loss of space with an increased risk of malocclusion
  • Decreased masticatory function
  • Speech impedance
  • Psychological disturbance
  • Trauma from anaesthesia/surgery
  • If a C is lost unilaterally, you may get a centreline shift
  • If an E is lost before 6 you can get bodily movement of the 6 and therefore space loss
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2
Q

How are primary molars different to permanent in terms of caries progression

A
  • Rapid caries progression
  • Thin enamel and thin dentine
  • Broad contact points
  • Small teeth with relatively large pulp chambers
  • Irreversible pathological changes before pulp exposure
  • Early radicular pulp involvement

-Primary teeth show pulpal inflammation much earlier than in permanent dentition particularly if caries is inter-proximal

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3
Q

Where is on the tooth is caries susceptible to pulpal involvement

A
  • Primary teeth show pulpal inflammation much earlier than in permanent dentition particularly if caries is inter-proximal
  • But remember pulp can heal
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4
Q

Considerations for doing an endo on primary tooth

A
  • Root morph and number
  • Coronal structure remaining
  • Root canal pattern
  • Patient fear
  • Secondary dentine
  • Porous plural floor with accessory canals
  • Physiological resorption
  • Risk of damage to permanent successor
  • Small mouths- restricted access
  • Restorability and carious severity
  • Frank L
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5
Q

What are the stages before diagnosing in pulpal therapy

A

History
Clinical examination
Radiographs

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6
Q

Difference between irreversible and reversible pulpits and examples of what may suggest each

A

IRREVERSIBLE

  • Inflamed pulp is incapable of healing
  • Spontaneous unprovoked pain
  • Sinus tract
  • Soft tissue inflammation not resulting from gingivitis or periodontitis
  • Excessive mobility not associated with trauma or exfoliation
  • Furcation involvement
  • Radiographic evidence of internal/external resorption

REVERSIBLE

  • Pulp is capable of healing
  • Provoked pain of short duration relieved by OTC analgesia, by brushing, or upon removal of stimulus and without signs or symptoms of irreversible pulpitis
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7
Q

What are three pulp treatment techniques available for primary teeth and what does it depend on

A

-Depending on severity of caries:

  • Indirect pulp cap
  • Pulpotomy
  • Pulpectomy
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8
Q

Similarity between IPC and pulpotomy

A

-Material or medicament used has to be put close or direct contact with living pulp tissue

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9
Q

Most common materials for IPC

A
  • Calcium hydroxide
  • MTA
  • Adhesive
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10
Q

Most common materials for pulptoomy

A
  • Ferric sulphate
  • Calcium hydroxide
  • MTA
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11
Q

What is important to remember when doing a pulpectomy of a primary tooth

A
  • Material has to be placed in the space created by pulp removal
  • Material should not prevent resorption of primary tooth’s root
  • To allow proper evolution of permanent tooth
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12
Q

Indications for pulp treatment

A

Good co-operation
-Regular attender

MH precludes extraction
-Haematological condition eg haemophilia

Missing permanent successor
-Second premolar

Over-riding necessity to preserve the tooth
-Space maintainer

Developmental state of tooth

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13
Q

Contra-Indications for pulpal treatment

A
  • Poor cooperation
  • Poor dental attendance
  • MH eg cardiac arrest
  • Multiple carious teeth
  • Advanced root resorption
  • Severe recurrent pain
  • Close to exfoliation (>2/3rds root resorption)
  • Extensive internal root resorption
  • Cellulitis
  • Pus in pulp chamber
  • Gross bone loss
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14
Q

Classify pulp therapies

A

Vital Pulp Therapy

  • Direct pulp aping NOT recommended for primary molars
  • IPC
  • Vital pulpotomy

Non-Vital Pulp Therapy
-Pulpectomy

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15
Q

Rationale for IPC

A
  • Arrest carious process and provide conditions conducive to the formation of reactionary dentine beneath the stained dentine and remineralisation of remaining carious dentine
  • Promote pulpal healing and preserve/maintain vitality of pulp tissue
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16
Q

Indications for IPC

A

-Tooth with. deep carious lesion and no signs or symptoms indicative of pulpal pathosis

17
Q

Procedure for IPC

A
  • LA and rubber dam
  • Removal of all caries at EDJ
  • Removal of soft deep carious dentine overlying the pulp region with care to avoid a pulpal exposure
  • Placement of lining material such as RMGIC or CaOH
  • Definitive restoration to achieve optimum external coronal seal idealy a PMC
18
Q

When would u do a vital pulpotomy

A

-Carious or traumatic exposure of a bleeding pulp

19
Q

In basic terms what happens during vital pulpotomy

A
  • Coronal pulp removed
  • Radicular pulp preserved
  • Tooth exfoliation as normal
20
Q

Clinical indicators for pulpotomy

A
  • Pulp minimally inflamed/reversible pulpits
  • Caries extending more than 2/3rds into dentine on rx
  • Any doubt that pulp is exposed
21
Q

Procedure for vital pulptomy

A
  • LA
  • Rubber dam
  • Remove caries
  • Remove roof of pulp chamber
  • Remove coronal pulp with sterile excavator or slow hand piece
  • Ferric sulphate for 15-30 seconds and check bleedingg
  • Zinc oxide eugenol in pulp chamber
  • Restore with PMC
22
Q

Technique for a vital pulptoomy

A

Access

  • Caries
  • Roof of pulpal chamber

Amputation

  • Remove coronal pulp (sterile excavator/large round steel bur)
  • Haemorrhage control
  • Evaluate pulp stumps
  • Place ferric sulphate over root stumps for 15s followed by thorough rinsing and drying
  • Evalute root stumps

Restore

  • Cover stumps with reinforced ZOE paste
  • Place a GIC core
  • PMC with optimum external coronal seal
23
Q

How to judge between and inflamed pulp and abnormal pulp when doing the procedure

A
  • Normal bleeding is an uninformed pulp
  • Bright red colour
  • good haemostats
  • Abnormal bleeding is inflamed pulp
  • Crimson deep
  • Continued bleeding after pressure
24
Q

Different materials that can be used in pulpotomy and explanation

A

Ferric sulphate

  • 15% solution
  • Haemostatic

CaOH

  • Clasically associated with internal resorption
  • Powder is promising

MTA
-Expensive

Odontopaste should be used in emergencies only

25
Q

Options for a primary molar tooth with a non-vital pulp

A
  • Pulpectomy

- XLA

26
Q

Aim of pulpectomy

A

-Used to control infection by removing the non-vital pulp and obdurating the canals with a material that will resorb WITH the primary tooth roots

27
Q

How to spot a non-vital primary molar

A

Symptoms

  • Spontaneous pain
  • Pain on biting
  • Gum boil
  • Bad taste
  • Facial swelling

Signs

  • Sinus
  • Discolouration

Special Ix

  • Mobility
  • TTP
  • Furcation or apical rl on rx
  • Pathological root resorption

Clinical findings
-Hyperaemic pulp

28
Q

Method of pulpectomy

A
  • Non-vital/hyperaemic pulp
  • Open roof of pulp chamber
  • Remove contents of chamber
  • Use files to remove pulpal tissues from the canals and prepare the canal
  • Canal irrigation using sterile saline, LA, CHX
  • Obturate canals with creamy mix of vitapex
  • Seal with thick mix of ZOE or IRM
  • Restore with PMC
29
Q

How far from apex should root canal prep be

A

2mm

30
Q

When would u review pulp tx pts

A

Clinically 6 monthly
Rx 12-18 monthly
But if pulpectomy, a rx should be taken 12 months post op to assess healing

31
Q

Clinical failure of pulp tx

A
  • PAthological mobility
  • Fistula/chronix sinus
  • Pain
32
Q

Rx failure of pulp tx

A
  • Increased radiolucency
  • External/internal resorption
  • Furcation bone loss
33
Q

Evidence for primary tooth pulp therapy

A
  • MTA had higher success rate than Ferric sulphate and CaOH in pulpotomies
  • IPC and lining material had no affect on success of IPT
  • Highest levels of success and quality of evidence supported IPT and pulpotomy techniques with MTA
34
Q

Read papers on iPad

A

-You heard me

35
Q

What are some of the anatomical considerations that we must take into account when planning pulp therapy in primary teeth

A
  • Wide accessory canals on pulpal floor
  • Thin enamel and thinner dentine
  • How close to exfoliation the tooth is
  • Larger pulp chambers
  • Open apices and partially resorbed teeth
36
Q

When would you provide a DPC

A

-Only if traumatic exposure

37
Q

What special investigations may be required before providing pulpal therapy

A
  • Vertical Bws (Proximity of caries to pulp , root resorption, furcation RL)
  • TTP
  • Mobility (non-physiological or periodontal)
38
Q

5 yo patient attends with mother saying they are having pain in the upper right quadrant. Frank L 4. Deep carious lesion extending into middle third of dentine. Clinically visible lesion. What questions do you need to ask to help you plan and diagnose

A
  • Pain history (where, when did it begin, what does it feel like, does it go anywhere else, anything make it worse/better, fever, spontaneous, severity)
  • Medical history (bleeding disorders, cardiac issues)
  • Caries risk assessment (diet, OH, siblings)
  • Dental history (how has patient coped with previous treatment)
39
Q

Tooth is displaying signs of reversible pulpits. Tx options?

A
  • Carious excavation and indirect pulp cap if no pulpal exposure
  • DPC limited

Main 2 options:

  • Hall crown (esp if caries far from pulp)
  • Pulpotomy inc La rubber dam

If child has symmetrical lesions, don’t do pulpotomy

Paediatrics (16 decks)

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