Pulp therapy Flashcards
What are the features of the primary tooth crowns?
Shorter relative to their root length
Occlusal table is constricted buccolingually and narrower mesiodistally.
Thinner enamel and dentin (Half the thickness of of permanent teeth)
Direction of the enamel rods in the cervical area is angled towards the occlusal surface
Significant cervical constriction
Pronounced buccal cervical bulge
Contact areas are flat and very broad buccolingually
Whiter and a lighter shade
What are the features of the primary anterior tooth roots?
Mesio-distal width is much narrower than the crown when compared to the permanent teeth
What are the features of the roots of primary molars?
Primary molars exhibit a greater flare to accomodate developing successor teeth
Roots are relatively longer and more slender
What are the features of the pulp and root canal system of primary teeth?
Size of pulp relative to the crown is larger
Pulp horns are higher and closer to the DEJ and to the outer surface of the crown.
Mesial pulp horns are higher than distal pulp horns.
Pulp horns are present under each cusp of the primary molars
Large pulp chambers (mandibular molars are larger than maxillary molars)
RCS of primary molars are extremely tortuous and complex
Root canal system has many accessory canals
What are the goals of pulp therapy?
Retain tooth in non-pathologicla state
Maintain original arch length (Tooth is a great space maintainer)
Prevent malocclusion, aesthetic, phonetic and functional problems
What are the treatment options based on?
Patient’s medical history
Value of each involved tooth in relation to the child’s overall development
Alternatives to pulp treatment
Restorability of the tooth
What is examined in a patient before pulp therapy is decided?
Patient’s history related to discomfort
Thermal, chemical, or pressure stimuli (ask simple questions)
Carious destruction of marginal ridge
Soft tissue swelling or sinus tract
Mobility (Normal exfoliation vs abnormal root resorption)
What should be considered when making a diagnosis that leads to pulp therapy?
Pain
Pulp testing (questionable value in primary teeth)
Percussion (Pain on percussion indicates inflammation in supportive periodontal structures)
Soft tissue examination
Mobility
Radiographs
Patient/parent cooperation
Stages of dental development
Degree of difficulty in performing this treatment
Location of tooth
Ability to restore tooth
How can pain be understood better in children?
Question parents (Children can be unreliable)
Persistent pain = advanced inflammation
Spontaneous pain = advanced inflammation
Absence of pain = inconclusive
What should be examined in soft tissue?
Swelling (Non-vital tooth)
Exudate usually tracks buccally resulting in intra-oral or extra-oral swelling.
Intra-oral swelling more common in primary teeth because furcations are usually occlusal to the muscle attachments.
What does mobility mean?
Pathological mobility is due to resorption of bone, root, or both
Occurs with long term inflammation
Associated with non-vital primary tooth
What should be examined with radiographs?
Furcation area using a periapical or bitewing film
Depth of caries
Presence of calcified body in the pulp
Furcation involvement
Bone resorption
Internal and External root resorption
What are the contra-indications to pulp therapy?
Medical disorder (heart disease such as bacterial endocarditis)
Immuno-compromised children
Caries in root canal/root surface
Un-restorable tooth
Less than 2/3 of root remained
What are the levels of pulp therapy?
Indirect pulp capping
Direct pulp capping
Pulpotomy
Partial pulpectomy
Pulpectomy
What is indirect pulp capping?
Caries closest to the pulp is left in place and covered with a biocompatible material.
