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Paediatric Dentistry > Pulp therapy > Flashcards

Pulp therapy Flashcards

1
Q

Describe the pulp in primary teeth

A

Relatively large pulp chamber compared to small tooth size

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2
Q

Why is there early pulp involvement in primary teeth?

A

Thinner enamel and dentine and larger pulps

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3
Q

Disadvantages of early tooth loss

A 
Risk of space loss and centre line shifting 
Decreased masticatory function 
Impeded speech 
Psychological disturbance 
Trauma from anaesthesia/surgery
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4
Q

What is at risk in primary endodontics?

A

Damage to permanent successor

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5
Q

How to diagnose pulp status in children

A

History
Examination
Radiographs

Other special tests are unreliable

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6
Q

What ix do we avoid in children?

A

TTP and electrical pulp tests, cold tests

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7
Q

Irreversible pulpitis symptoms and signs

A 
Spontaneous, unprovoked pain 
Sinus tract/ soft tissue inflammation 
Excessive PATHOLOGICAL mobility 
Furcation radiolucency 
Radiographic evidence of internal/external resorption
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8
Q

Reversible pulpitis symptoms

A

Provoked pain of short duration that does not linger

Relieved with analgesics

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9
Q

What are the tpes of pulp therapy in primary teeth

A

(Direct pulp cap)
Indirect pulp cap
Pulpotomy
Pulpectomy

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10
Q

What is pulpotomy also called?

A

Vital pulp therapy

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11
Q

Indications for pulp therapy

A
  • Evidence of pulpal symptoms
  • Regular attender
  • Restorable
  • Overriding need to retain tooth as space maintainer e.g. missing successor or long time until exfoliation
  • No other teeth requiring pulp therapy
  • Developmental state of tooth
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12
Q

Contraindications for pulp therapy

A
  • Poor coop/attendance
  • Medical contraindications
  • Unrestorable
  • Multiple grossly carious teeth w pulp symptoms
  • Advanced root resorption
  • Severe or recurring pain
  • Close to natural exfoliation
  • Cellulitis
  • Gross bone loss
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13
Q

List medicaments used in pulp therapy

A

Ferric sulphate
Calcium hydroxide
MTA

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14
Q

Is odontopaste used?

A

It can be if the pt in pain or the tooth will be extracted eventually
It causes pulpal necrosis

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15
Q

Irrigants used in primary teeth

A

Saline
LA
CHX

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16
Q

What irrigant is NOT used in children

A

SODIUM HYPOCHLORITE !!!!

17
Q

When is LA a useful irrigant

A

Hyperaemic pulp

18
Q

Indications for direct pulp cap

A

Asymptomatic tooth with small, traumatic pulpal exposure (non-carious)

19
Q

Rationale of direct pulp cap

A

Dentine bridge formation at the point of exposure to preserve vitality

20
Q

Success of direct pulp caps

A

VERY POOR - not done in children

21
Q

Indications for indirect pulp capping

A

Primary molars with deep caries

No signs/symptoms/history of pulpal pathology

22
Q

Rationale of indirect pulp cap

A

Arrest carious process and provide conditions conductive for the formation of reactionary dentine to remineralise retained caries

23
Q

Success of indirect pulp cap in primary teeth

A

VERY SUCCESSFUL

>90% clinical success observed

24
Q

What is a pulpotomy

A

Partial removal of the pulp

25
Q

Indications for pulpotomy

A
  • Carious or traumatic exposure of a vital pulp

- Pulp minimally inflamed/reversible pulpitis

26
Q

Rationale of pulpotomy

A

Affected pulp removed and remaining pulp is preserved, thus maintaining vitality and allowing tooth to exfoliate naturally

27
Q

What type of bleeding is normal in pulpotomy

A

Bright red blood that achieves good haemostasis after gentle pressure with ferric sulphate

28
Q

What type of bleeding is abnormal in pulpotomy

A

Deep crimson colour which doesn’t achieve haemostasis

29
Q

What does abnormal bleeding in pulpotomy indicate

A

Extensive inflammation - most likely irreversible pulpitis

30
Q

Indications for pulpectomy

A
  • Irreversible pulpitis
  • Non-vital pulp or hyperaemic pulp
  • Profuse bleeding during pulpotomy
31
Q

Aims of pulpectomy

A

Control infection by removing non-vital or hyperaemic pulp and obtruate canals with resorbable material allowing the tooth to exfoliate naturally

32
Q

When is one stage pulpectomy done

A

In absence of infection bc the canals can be dried

33
Q

When is two stage pulpectomy done

A

When there is infection or profuse bleeding preventing drying of the canals

34
Q

When should the tooth be extracted

A

Signs of cellulitis or severe infection, especially if it is recurring
or if MH indicates immunocomp

35
Q

When should the PMC be placed and why?

A

Ideally in the same appt as it improves overall prognosis

36
Q

When should the patient be reviewed after pulp therapy

A

Every 6 months until the tooth exfoliates

37
Q

When should radiographs be taken after pulp therapy

A

Every 12-18 months until exfoliated

38
Q

Clinical signs of failed pulp therapy

A

Pathological mobility
Fistula or chronic sinus
Pain

39
Q

Radiographic signs of failed pulp therapy

A

Increased or new radiolucency
External/internal resorption
Furcation bone loss

Paediatric Dentistry (11 decks)

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