pulp therapy for primary teeth

Question 1

what are the techniques we can use for pulp therapy in primary teeth

Answer 1

indirect pulp therapy
pulpotomy
pulpectomy

Question 2

what is the difference between primary and permanent teeth

Answer 2

much larger pulp chambers
larger pulp horns
wider dentinal tubules
porous pulp floors with accessory canals

Question 3

why should we restore primary teeth

Answer 3

tooth ache

abscess

Question 4

what can form if we leave the caries

Answer 4

a turner tooth

Question 5

what is a turner tooth

Answer 5

local hypoplasia due to chronic infection of primary predecessor

Question 6

what is the issue with turner tooth

Answer 6

early loss can lead to ortho problems and damage to the permanent successor

Question 7

what do we need to consider when thinking when to treat a tooth

Answer 7

the quality of the tooth
presence of the successor
age of patient-close to exfoliation
presence of infection and degree of tooth

Question 8

what do we need to consider with the MH

Answer 8

shouldn’t carry out tx in immunocomprosed teeth or cardiac disease or haemophilic disorders

Question 9

what are the indications for tooth retention

Answer 9

medical factors-
risk of XTA
risk of GA

Question 10

what are some treatment options

Answer 10

indirect pulp therapy
pulpotomy
pulpectomy

Question 11

what is a indirect pulp therapy

Answer 11

tooth is vital and we need to have a good plural seal

Question 12

what is pulpotomy

Answer 12

vital tooth and removal of some pulp

Question 13

what is a pulpectomy

Answer 13

non vital and remove all the pulp

Question 14

do we carry out pulp capping

Answer 14

contra indicated in inflamed primary teeth

Question 15

how do we carry out indirect pulp therapy

Answer 15

we are going to arrest the caries process and allow for healing

Question 16

indications for indirect pulp therapy

Answer 16

Tooth with deep carious lesions
No signs or symptoms of pulpal pathosis
More than 90% clinical success after 3 year follow up

Question 17

indications for pulpotomy

Answer 17

asymptomatic tooth

carious or mechanical exposure of vital coronal pulp

Question 18

technique of a pulpotomy

Answer 18

1. Pre op radiograph
   
   2. LA + rubber dam
   3. Caries removal
   4. Access cavity
   5. Remove the coronal pulp
   6. Control of haemorrhage
   7. Application of medicament
      Some are
      Formocresol
      Ferric sulphate - cheaper much more available
      MTA- bit expensive
      Calcium hydroxide
      Electrosurgery
      Ledermix
   8. Restoration of pulp chamber
   9. Stainless steel crown
   10. Follow up

Question 19

what are some medicaments used in pulpotomies

Answer 19

formocresol 
ferric sulphate 
MTA 
CaOH 
electrosurgery 
ledermix

Question 20

describe ferric sulphate 15.5%

Answer 20

used for pulpotomy in primary molars
promotes pulp haemostats
success rate is greater than 90% at 2 years

Question 21

describe MTA

Answer 21

mineral trioxide aggregate
release of cytokines from fibroblasts
cytokines stimulate hard tissue formation
more expensive

Question 22

steps of a pulpotomy

Answer 22

Control the haemorrhage:
Cotton wool soaked in saline
And control the haemorrhage with gentle pressure for 30s-1min if not consider pulpectomy

Application of ferric sulphate for 15-20s

Restore of pulp:
Do not wash pulp out
With zinc oxide eugenol cement
And pack well

Top with a stainless steel crown

Follow up
Review clinically
Review radiographically - we want to see the zinc eugenol cement go into the pulp canals

Question 23

indications of a pulpectomy

Answer 23

Tooth diagnosed as having irreversible pulpitis on symptoms and clinical findings 
Non vital radicular pulp without/without infection 
Good pt compliance 
Mobility 
Spontaneous pain 
Furcation pathology 
Uncontrollable pulp haemorrhage 
Necrotic pulp 
Sinus/abscess

Question 24

AIMS OF THE pulpectomy

Answer 24

Access to root canals

Remove as much infected material as possible

Question 25

technique of a pulpectomy

Answer 25

Technique:

1. LA and rubber dam 
2. Access 
3. Identify canals 
4. Instrument 20-25 
5. ZnO cement in canals - vitapex trade name 
6. To restore pulp canals 
7. SSC to finish