Pulp therapy for primary teeth

Question 1

When to consider direct pulp caps?

Answer 1

Small traumatic pulp exposures in asymptomatic teeth
Use of rubber dam - CaOH, MTA or adhesive material
Internal resorption and necrosis common sequelae

Question 2

Indirect pulp therapy?

Answer 2

E.g. the hall technique
For vital asymp teeth
Stepwise (2 stage) or partial (1 stage) caries removal

Question 3

What to place over an indirect pulp cap?

Answer 3

Preformed metal crown
Resin modified GIC base and composite
90% success rate at 2 yr follow up

Question 4

Steps of a pulpotomy?

Answer 4

Fixation/denaturisation
Arrest bleeding
Regeneration of hard tissue

Question 5

Ferric sulphate pulpotomy?

Answer 5

Ferric sulphate 15.5% acts as a haemostatic agent = clot acts as a barrier to further pulpal injury
Zinc oxide eugenol directly over pulp tissue following ferric sulphate pulpotomy may cause internal resorption

Question 6

How to use ferric sulphate for a pulpotomy?

Answer 6

Arrest pulpal bleeding with moist cotton wool pledget and gentle pressure
Apply with microbrushes for 20 secs
Wash off with sterile water (repeat once if bleeding persists)
Redistribute into smaller syringes to avoid mess and wastage

Question 7

Mineral trioxide aggregate (MTA)?

Answer 7

Grey or white
Increasing use as endodontic material for permanent teeth
Good biocompatibility and induces hard tissue formation (May lead to total canal obliteration)
Expensive

Question 8

Cellular mechanisms of MTA?

Answer 8

Promotes revascularisation
Antibacterial
Stimulates collagen formation
Releases growth factors from dentine
Promotes dentine-like formation
94-100% 2 yr success rates

Question 9

Cellular mechanisms of biodentine? - Pulpotomy

Answer 9

Biocompatible
Releases CaOH on setting
Stimulates hard tissue formation

Question 10

How to manage irreversibly inflamed or non vital primary teeth?

Answer 10

Pulpectomy - one stage or 2 stage purulent or excessive bleeding

1. Zinc oxide eugenol
2. CaOH +/- iodoform pastes
3. Antibiotic preparations

Question 11

Pulpectomy clinical procedure?

Answer 11

Pre-op periapical radiograph
LA and rubber dam
Identify root canals 
Irrigate with normal saline; chlorhexidine or NaOCl 0.5-1%
EWL 2mm short of apex
Gentle filing with small files
Irrigate and dry canals

If infec present (sinus) dress root canals with CaOH paste and temporise - complete 2 weeks later
If canals can be dried, obturate canals by injecting/packing with slow setting pure ZOE, non-setting CaOH paste or premixed CaOH and iodoform paste
Success greater where canals underfilled rather than overfilled

Question 12

Pulpectomy - lesion sterilisation and tissue repair therapy? (dental hospital do NOT like)

Answer 12

Placement of 3 antibiotics in infected canals - mixture of metronidazole, ciprofloxacin, minocycline
Antibiotics placed in pulp chamber for a short period or sealed in tooth permanently

Question 13

Leadermix?

Answer 13

Used as a desensitising paste
Contains steroid and antimicrobial
Sparse evidence for primary teeth

Question 14

Odontopaste?

Answer 14

Zinc oxide based paste
Contains clindamycin hydrochloride (broad spec antibiotic) and triamcinolone acetonide (steroid based anti-inflam agent)
Acts through direct contact with the inflamed tissue
No evidence for primary teeth