Pulp therapy for children Flashcards
Clinical indications for a vital pulpotomy?
Avoid XLA
Good co-operation
Pulp minimally inflamed
Caries extending 2/3 into dentine on radiograph
Space maintenance
When no permanent successor
What are the aims of vital pulpotomy?
To enable a vital primary molar with pulpal disease to be retained free from pain and infection until exfoliation
Stop bleeding
Disinfection
Preserve vitality of apical portion of radicular pulp
When is a pulpotomy for primary molars (vital pulp therapy) indicated?
Irreversible pulpitis
Primary molar with advanced carious lesion with no clear band of dentine visible radiographically that separates the lesion and pulp
What can you do for uncertain diagnosis of reversible pulpitis symptoms before electing to carry out vital pulpotomy?
Place a temporary dressing in the cavity and review the patient 3-7 days later to check symptoms.
If symptoms resolve, will indicate pulpitis was reversible and pulpotomy not necessary.
If symptoms stay the same or do not resolve - pulpotomy should be carried out
Contra-indications of pulp therapy in primary teeth?
Congenital heart disease
Immunosuppression
Severe pain/ infection
Teeth close to exfoliation
Un-restorable teeth
Pre-co-operative children
Immunocompromised children
Cases that require multiple pulpotomies = indicated for extraction
What is the primary molar pulpotomy technique?
LA + rubber dam
Large access cavity
Remove contents of pulp chamber
Irrigate with water from 3 in 1
Identify canal orifices
If still bleeding - arrest haemorrhage by placing cotton wool with FERRIC SULPHATE
If bleeding cannot be arrested or pulp necrosis evident, consider pulpectomy or extraction
Remove cotton wool and place MTA (or other material)
Fill cavity with ZOE cement and PMC conventional prep
What is the technique of primary molar pulpectomy?
LA + rubber dam
Access
Coronal pulp extirpation
Root canal prep (2mm short of apex)
Obturation - CaOH iodoform paste
GIC core
PMC conventional prep
How is failure of pulpotomy measured clinically?
Mobility
Pain
Fistula
Chronic sinus
How if failure of a pulpotomy measure radiographically?
Radiolucency
External/ internal resorption
Furcation bone loss
