Pulp therapy for primary teeth Flashcards

1
Q

Early pulpal involement

A

Rapid involvement of pulp
Marginal ridge breakdown- pulp inflammation
Pulpal inflammation occurs before exposure
Pulpal inflammation quickly becomes irreversible IF the tooth is not treated appropriately
-the pulp in primary molars actually has great healing potential

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2
Q

Primary molars anatomical features:

A
Thick enamel/dentine
Large pulp chamber
Large pulp horns
Wide dentinal tubules
Porous pulp floor with accessory canals
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3
Q

Why restore?

A

Toothache
Abscess
Early loss- orthodontic problems
Damage to the permanent successor

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4
Q

Pulp treatment vs extraction?

A
Quality of tooth
Presence of successor
Age of patient- tooth close to exfoliation?
Behaviour (ability to cope)
Presence of infection
Medical history
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5
Q

What is a ‘Turner’ tooth?

A

Local hypoplasia due to chronic infection of the primary predecessor

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6
Q

Indications for tooth retention
Medical Factors:
Dental Factors:

Social Factors:

A

Medical factors: ‘at risk’ from an extraction, ‘at risk’ of GA
Dental factors: minimal number of extensively carious primary teeth [<3], hypodontia of permanent dentition, where prevention of mesial migration of 6’s is desirable
Social factors: regular attendee with good compliance and positive parental attitudes

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7
Q

Indications for tooth extraction
Medical Factors:
Dental Factors:

Social Factors:

A

Medical factors: ‘at risk’ from residual infection
Dental factors: tooth un-restorable after pulp therapy, extensive internal root resorption, large number of carious teeth with likely pulpal involvement, tooth close to exfoliation [>2/3 root resorption], contralateral tooth already lost, extensive pathology or acute facial swelling
Social factors: irregular attender, with poor compliance and unfavourable parental attitudes

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8
Q

Treatment options

A

Indirect pulp therapy- vital, no pulp removed
Pulpotomy- vital, removal of some pulp
Pulpectomy- non-vital, removal of all pulp

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9
Q

Indirect pulp therapy
Rationale:

Indication:

Clinical outcome:

A

Rationale: to arrest the carious process and provide conditions conducive to the formation of reactionary dentine and remineralisation of remaining carious dentine, to promote pulpal healing and preserve/maintain the vitality of pulp tissue
Indication: tooth with deep carious lesion, no sign or symptoms indicative of pulpal pathosis
Clinical outcome: >90% clinical success at 3 year follow-up

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10
Q

Indirect pulp therapy things to remember?

A

Clear margins (coronal seal)
Removes soft dentine (infected)
Leave hard discoloured dentine (affected)

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11
Q

Pulpotomy
Rationale:

Indications:

Clinical outcomes:

A

Rationale: to remove the coronal pulp, which has been clinically diagnosed as irreversibly inflamed, leaving behind a possibly healthy or reversible inflamed radicular pulp
Indications: Asymptomatic tooth, or only transient pain, a carious or mechanical exposure of vital coronal pulp Clinical outcome: >90%

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12
Q

Pulpotomy indications

A

Asymptomatic or transient pain- reversible pulpitis,
Carious or mechanical exposure of vital pulp tissue,
no mobility,
no sinus/abscess,
no history of swelling,
no intraradicular radiolucency on radiographs,
bleeding pulp- stops with pressure

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13
Q

Pulpotomy technique:

A
preoperative radiograph, 
LA + rubber dam isoaltion,
caries removal, 
access cavity, 
remove coronal pulp, 
control of haemorrhage, application of choosen pulp medication
Restorations of pulp chamber,
stainless steel crown, 
follow up
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14
Q

Considersation when removing caries during pulpotomy

A

Clear all remaining caries before removing the caries adjacent to the pulp

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15
Q

Considerations when access cavity during pulpotomy

A

Access cavity- remove caries, identify exposure, remove roof of pulp chamber (no deeper)

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16
Q

Considerations remove roof of pulp during pulpotomy

A

Remove roof of pulp chamber using a fissure bur, remove coronal pulp with an excavator
Remvoal of coronal pulp, round bur, sharp excavator

17
Q

Control of haemorrhage during pulpotomy

A

Contol of haemorrhage cotton wool (soaked in saline), if unable to control haemorraghe with gently pressure for 30’s - 1min, consider pulpectomy
Application of ferric sulphate
Cotton wool pleget, remove excess, apply to pulp chamber

18
Q

placing a restoration during pulpotomy

A

Restoration of pulp chamber, do not wash pulp chamber out, restore with zinc oxide eugenol cement, pack well
good success review clinically and radiographically

19
Q

Vital pulpotomy indications

A
Asymptomatic or transient pain, 
carious/mechanical exposure of vital pulp tissue, 
no mobility, 
no sinus/absecss,
 no history of swelling,
 no interradicular area, 
bleeding pulp that stops with pressure
20
Q

Pulp medication

A
Formocresol
Ferric sulphate
MTA
Calcium hydroxide
Electrosurgery
Laster treatment
ledermix
21
Q

Formocresol contains?

A

19% formaldehyde
35% tricresol
15% glycerol
31% water

22
Q

Formocresol Mechanism of action:

A

Bactericidal/ devitalising -converts bacteria and pulp tissue into inert compounds/ numerous studies suggest success rates of 90-100%

23
Q

Formocresol Concerns:

A

links to nasopharyngeal cancer and leukaemia, systemic toxicity, damage to a permanent successor, mutagenic, carcinogenic

24
Q

Pulpotomy technique:

A

preoperative radiograph, LA + rubber dam isolation, caries removal, access cavity, remove the coronal pulp, control of haemorrhage, application of chosen pulp medication
Restorations of the pulp chamber, stainless steel crown, follow up

25
Q

pulpotomy technique: Clear all remaining…..

Access cavity……

A

caries before removing the caries adjacent to the pulp

- remove caries, identify exposure, remove the roof of pulp chamber (no deeper)

26
Q

Pulpotomy technique: Remove roof of pulp chamber using

A

a fissure bur, remove the coronal pulp with an excavator

Removal of coronal pulp, round bur, sharp excavator

27
Q

Pulpotomy technique: Control of haemorrhage

A

cotton wool (soaked in saline), if unable to control haemorrhage with gentle pressure for 30’s - 1min, consider pulpectomy
Application of ferric sulphate
Cotton wool pleget, remove excess, apply to pulp chamber

28
Q

Pulpotomy technique: Restoration of pulp chamber

A

do not wash pulp chamber out, restore with zinc oxide eugenol cement, pack well
good success review clinically and radiographically

29
Q

Stainless steel crowns

A

Restore all pulp treated primary teeth with SSC
Often very little tooth substrate remaining
What is left is brittle
Reduce micro leakage- best coronal seal

30
Q

Summary:

A

Primary teeth become pulpally involved early
Treatment option
-indirect pulp cap- vital
-pulpotomy- vital
-pulpectomy- non vital
All pulp treated primary teeth should be restored with SSC