pulp therapy for primary teeth

Question 1

What are the options for vital pulp?

Answer 1

Indirect pulp therapy- stepwise/partial caries removal (for vital asymptomatic) PMC/RMGIC+composite

Direct pulp capping- CaOH/MTA/Biodentine (dubious outcome, maybe for small traumatic exposure, well isolated, high risk of internal resorption, necrosis)

Pulpotomy-
Fixation/denaturation- formocresol/glutaraldehyde
Regeneration of hard tissue- MTA/CaOH/Biodentine/Ca enriched cement
Arrest bleeding- ferrous sulphate/
/electrosurgery/bioaggregate/YAG laser/Ankaferd blood stopper

Question 2

Why don’t we use formocresol?

Answer 2

Contains formaldehyde- carcinogen

Question 3

What is Ferric sulphate?

Answer 3

Haemostatic agent
Clot acts as barrier to further pulpal injury
Similar success to formocresol
ZOE- directly over may cause internal resorption

Apply w micro brush for 20s
Wash w sterile water gently
Repeat if persists

Question 4

What is MTA?

Answer 4

Grey/white
Good biocompatibility
Induced hard tissue formation
Expensive

Promotes revascularisation
Antibacterial
Stimulates collagen formation
Releases growth factors from dentine
Promoted dentine-like formation

Question 5

How do you manage an irreversibly inflamed or non vital tooth?

Answer 5

Pulpectomy- 1 or 2 stages (2 if excess bleeding/purulent)

1. ZOE
2. CaOH +/- iodoform pastes
3. Antibiotic preps

Question 6

How do you perform a pulpectomy?

Answer 6

1. Preop radiograph
2. LA and rubber dam
3. Identify root canals
4. Irrigate w saline/CHX/NaOCl (0.5-1%)
5. EWL 2mm short of apex
6. Gentle filing
7. Irrigate and dry
8. If infection dress w CaOH and temporise (continue 2 weeks later)
9. Obturate w slow setting ZOE, non setting CaOH, premixed CaOH and iodoform paste (Vitapex)
10. Restore

Question 7

What is lesion sterilisation and tissue repair therapy?

Answer 7

Not done by us

Place mixture of metronidazole, ciprofloxacin and minocycline in pulp chamber for short period OR seal in tooth permanently

Question 8

What is Ledermix?

Answer 8

Desensitising paste
Contains steroid- triamcinalone acetonide
Contains antimicrobial- demethylchorotetracycline
Little evidence for use in primary

Question 9

What is odontopaste?

Answer 9

ZO based paste
Contains broad spectrum antibiotic- clindamycin hydrochloride
Contains steroid- triamcinolone acetonide
Direct contact w inflamed tissue
No evidence for use in primary

Question 10

What should be used for pulpotomy/pulpectomy?

Answer 10

MTA/ferric sulphate
No reliability of one tx over another

For pulpectomy- CaOH/iodoform better results than ZOE