Pulp therapy for primary teeth Flashcards
Early pulpal involement
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
Primary molars anatomical features:
Thick enamel/dentine Large pulp chamber Large pulp horns Wide dentinal tubules Porous pulp floor with accessory canals
Why restore?
Toothache
Abscess
Early loss- orthodontic problems
Damage to the permanent successor
Pulp treatment vs extraction?
Quality of tooth Presence of successor Age of patient- tooth close to exfoliation? Behaviour (ability to cope) Presence of infection Medical history
What is a ‘Turner’ tooth?
Local hypoplasia due to chronic infection of the primary predecessor
Indications for tooth retention
Medical Factors:
Dental Factors:
Social Factors:
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
Indications for tooth extraction
Medical Factors:
Dental Factors:
Social Factors:
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
Treatment options
Indirect pulp therapy- vital, no pulp removed
Pulpotomy- vital, removal of some pulp
Pulpectomy- non-vital, removal of all pulp
Indirect pulp therapy
Rationale:
Indication:
Clinical outcome:
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
Indirect pulp therapy things to remember?
Clear margins (coronal seal)
Removes soft dentine (infected)
Leave hard discoloured dentine (affected)
Pulpotomy
Rationale:
Indications:
Clinical outcomes:
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%
Pulpotomy indications
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
Pulpotomy technique:
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
Considersation when removing caries during pulpotomy
Clear all remaining caries before removing the caries adjacent to the pulp
Considerations when access cavity during pulpotomy
Access cavity- remove caries, identify exposure, remove roof of pulp chamber (no deeper)
Considerations remove roof of pulp during pulpotomy
Remove roof of pulp chamber using a fissure bur, remove coronal pulp with an excavator
Remvoal of coronal pulp, round bur, sharp excavator
Control of haemorrhage during pulpotomy
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
placing a restoration during pulpotomy
Restoration of pulp chamber, do not wash pulp chamber out, restore with zinc oxide eugenol cement, pack well
good success review clinically and radiographically
Vital pulpotomy indications
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
Pulp medication
Formocresol Ferric sulphate MTA Calcium hydroxide Electrosurgery Laster treatment ledermix
Formocresol contains?
19% formaldehyde
35% tricresol
15% glycerol
31% water
Formocresol Mechanism of action:
Bactericidal/ devitalising -converts bacteria and pulp tissue into inert compounds/ numerous studies suggest success rates of 90-100%
Formocresol Concerns:
links to nasopharyngeal cancer and leukaemia, systemic toxicity, damage to a permanent successor, mutagenic, carcinogenic
Pulpotomy technique:
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
