Pulp Therapy for Primary Teeth

Question 1

Why do we fix baby teeth?

Answer 1

1. pain
2. infection and hospitalizations
3. space loss and subsequent eruption problems in the permanent dentition
4. Esthetics

Question 2

What is the goal for fixing baby teeth?

Answer 2

treat a primary tooth ONCE in its lifetime

Question 3

Primary teeth have ___ enamel and dentin, ___ pulp chambers relative to crown, pulp horns closer to the ___ surface, ___ constriction of the crown, ___ prominent cervical contour, and ___, ___ proximal contacts.

Answer 3

thinner; larger; outer; greater; more; broad, flat

Question 4

What is critical to the successful treatment of the tooth?

Answer 4

an accurate diagnosis

Question 5

___ ___ are given by questioning the child and parent. ___ ___ come with clinical and radiographic examinations.

Answer 5

subjective symptoms; objective signs

Question 6

T/F. The chief complaint is a subjective symptom.

Answer 6

True.

Question 7

Objective signs are obtained with a thorough intra- and extraoral examination. What should you look for?

Answer 7

soft tissue infections
pathologic mobility
sensitivity to palpation and/or percussion
pulp testing?
radiographic signs
direct inspection of the pulp

Question 8

T/F. Pulp testing can be evaluated with sensitivity to cold or heat and electric pulp testing but it is NOT reliable in primary dentition.

Answer 8

True.

Question 9

T/F. Cold, electric pulp tests and percussion are all good tests to evaluate the pulp in primary dentition.

Answer 9

False. cold and electric pulp testing are poor and percussion is good (however use with caution)

All are good with permanent teeth.

Question 10

What are you looking for with direct inspection of the pulp?

Answer 10

presence of hemorrhage
quality and quantity of hemorrhage
dry chamber
purulent exudate or malodor

Question 11

What type of pulp is capable of healing? what type of therapy is used?

Answer 11

reversible pulpitis

VITAL pulp therapy (indirect and direct pulp cap and pulpotomy)

Question 12

What type of pulp is incapable of healing? What type of therapy is used?

Answer 12

irreversible pulpitis

NON-VITAL pulp therapy (pulpectomy or extraction)

Question 13

What are indications for VITAL pulp therapy?

Answer 13

intermittent, short duration

thermal or chemical stimulation

Question 14

Spontaneous, nocturnal, or prolonged pain, soft tissue signs, pathologic mobility, furcation/apical radiolucency, and radiographic evidence of internal/external resorption are all indications for what type of therapy?

Answer 14

NON-VITAL

Question 15

What is the selection criteria for performing an indirect pulp cap?

How successful is this procedure

Answer 15

restorable tooth, near pulp exposure radiographically, VITAL pulp (NO spontaneous pain, clinical or radiographic signs)

excellent prognosis with >90% success rates reported

Question 16

T/F. With a IPC procedure, one should excavate but leave the deepest caries behind to avoid a pulp exposure then place a protective liner (GI).

Answer 16

True.

The seal is the deal!

Question 17

T/F. Direct pulp caps are indicated for carious exposures in primary teeth.

Answer 17

False, Direct pulp caps are NOT indicated for carious exposures in primary teeth.

Question 18

What is the selection criteria for performing a pulpotomy?

Answer 18

restorable tooth with carious pulp exposure
VITAL pulp (NO spontaneous pain, clinical or radiographic signs)

Question 19

T/F. With a pulpotomy, you should careful remove ALL the coronal pulp tissue but leave behind the caries.

Answer 19

False, With a pulpotomy, you should careful remove ALL the coronal pulp tissue and remaining caries

Question 20

What is the chamber sealed with during a pulpotomy?

Should interproximal contacts be broken?

Answer 20

IRM

yes, break interproximal contacts

Question 21

What are the pulpotomy medicaments?

Answer 21

1. formocresol
2. ferric sulfate
3. mineral trioxide aggregate (MTA)

Question 22

Formocresol contains ___, so it creates a zone of fixation at the surface of the radicular pulp.

Answer 22

formaldehyde

Question 23

What medicament is used at OSU?

Answer 23

ferric sulfate

Question 24

Ferric ions interact with blood proteins leading to ___, which forms a physical plug to occlude canal orifices.

Answer 24

agglutination

It has the potential to ‘mask’ hyperemic appearances of pulp so be sure to assess pulp status with cotton pellets first.

Question 25

Describe MTA.

Answer 25

1. ricalcium silicate, tricalcium aluminate, silicate oxide + bismuth
2. high alkalinity is antibacterial
3. high biocompatibility
4. excellent seal
5. promotes hard tissue formation
6. more expensive

Question 26

What is the selection criteria for performing a pulpectomy?

Answer 26

restorable tooth
irreversible pulpitis or necrotic pulp
spontaneous pain
clinical signs
radiographic signs

Question 27

During a pulpectomy procedure, fill with ___ material such as ZOE, iodoform-based paste, iodoform + calcium hydroxide.

Answer 27

resorbable

Question 28

T/F. It is better to UNDERfill than OVERfill during a pulpectomy procedure.

Answer 28

True.

Question 29

Although stainless steel crowns are considered the best, when would you consider using composite or amalgam?

Answer 29

with sufficient tooth structure and a tooth that will exfoliate within 2 yrs

Question 30

What are the pros and cons to using preformed zirconia crowns?

Answer 30

pros:
esthetics
clinical success in adults

cons: 
moisture contamination
steep learning curve
aggressive prep
Costs?

Question 31

What are some are some other treatment considerations?

Answer 31

1. medical history and COOPERATION
2. restorability and space loss due to caries
3. caries risk
4. how long does the tooth have to last?
5. importance of tooth to overall development