Pulp therapy Flashcards
Describe the pulp in primary teeth
Relatively large pulp chamber compared to small tooth size
Why is there early pulp involvement in primary teeth?
Thinner enamel and dentine and larger pulps
Disadvantages of early tooth loss
Risk of space loss and centre line shifting Decreased masticatory function Impeded speech Psychological disturbance Trauma from anaesthesia/surgery
What is at risk in primary endodontics?
Damage to permanent successor
How to diagnose pulp status in children
History
Examination
Radiographs
Other special tests are unreliable
What ix do we avoid in children?
TTP and electrical pulp tests, cold tests
Irreversible pulpitis symptoms and signs
Spontaneous, unprovoked pain Sinus tract/ soft tissue inflammation Excessive PATHOLOGICAL mobility Furcation radiolucency Radiographic evidence of internal/external resorption
Reversible pulpitis symptoms
Provoked pain of short duration that does not linger
Relieved with analgesics
What are the tpes of pulp therapy in primary teeth
(Direct pulp cap)
Indirect pulp cap
Pulpotomy
Pulpectomy
What is pulpotomy also called?
Vital pulp therapy
Indications for pulp therapy
- 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
Contraindications for pulp therapy
- 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
List medicaments used in pulp therapy
Ferric sulphate
Calcium hydroxide
MTA
Is odontopaste used?
It can be if the pt in pain or the tooth will be extracted eventually
It causes pulpal necrosis
Irrigants used in primary teeth
Saline
LA
CHX
What irrigant is NOT used in children
SODIUM HYPOCHLORITE !!!!
When is LA a useful irrigant
Hyperaemic pulp
Indications for direct pulp cap
Asymptomatic tooth with small, traumatic pulpal exposure (non-carious)
Rationale of direct pulp cap
Dentine bridge formation at the point of exposure to preserve vitality
Success of direct pulp caps
VERY POOR - not done in children
Indications for indirect pulp capping
Primary molars with deep caries
No signs/symptoms/history of pulpal pathology
Rationale of indirect pulp cap
Arrest carious process and provide conditions conductive for the formation of reactionary dentine to remineralise retained caries
Success of indirect pulp cap in primary teeth
VERY SUCCESSFUL
>90% clinical success observed
What is a pulpotomy
Partial removal of the pulp
Indications for pulpotomy
- Carious or traumatic exposure of a vital pulp
- Pulp minimally inflamed/reversible pulpitis
Rationale of pulpotomy
Affected pulp removed and remaining pulp is preserved, thus maintaining vitality and allowing tooth to exfoliate naturally
What type of bleeding is normal in pulpotomy
Bright red blood that achieves good haemostasis after gentle pressure with ferric sulphate
What type of bleeding is abnormal in pulpotomy
Deep crimson colour which doesn’t achieve haemostasis
What does abnormal bleeding in pulpotomy indicate
Extensive inflammation - most likely irreversible pulpitis
Indications for pulpectomy
- Irreversible pulpitis
- Non-vital pulp or hyperaemic pulp
- Profuse bleeding during pulpotomy
Aims of pulpectomy
Control infection by removing non-vital or hyperaemic pulp and obtruate canals with resorbable material allowing the tooth to exfoliate naturally
When is one stage pulpectomy done
In absence of infection bc the canals can be dried
When is two stage pulpectomy done
When there is infection or profuse bleeding preventing drying of the canals
When should the tooth be extracted
Signs of cellulitis or severe infection, especially if it is recurring
or if MH indicates immunocomp
When should the PMC be placed and why?
Ideally in the same appt as it improves overall prognosis
When should the patient be reviewed after pulp therapy
Every 6 months until the tooth exfoliates
When should radiographs be taken after pulp therapy
Every 12-18 months until exfoliated
Clinical signs of failed pulp therapy
Pathological mobility
Fistula or chronic sinus
Pain
Radiographic signs of failed pulp therapy
Increased or new radiolucency
External/internal resorption
Furcation bone loss
