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Pediatric Dentistry > Pulp Therapy in Children > Flashcards

Pulp Therapy in Children Flashcards

1
Q

objectives in pulp therapy in children

A
  1. preserve dental arch space
  2. prevent consequent malocclusion due to premature tooth loss
  3. maintain mastication function
  4. prevent possible abnormal tongue habit
  5. preserve aesthetics
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2
Q

etiology of pulp disease

A
  • bacterial
  • mechanical
  • thermal
  • electrical
  • chemical
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3
Q

most common cause of pulp disease

A

microorganism

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4
Q

etiology of pulp disease: bacterial

A
  • direct invasion
  • indirect invasion by toxins
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5
Q

etiology of pulp disease: mechanical

A
  • trauma
  • attrition
  • abrasion
  • erosion
  • cavity preparation
  • ortho movement
  • osteotomy
  • fracture
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6
Q

etiology of pulp disease: thermal

A
  • fraction during tooth cutting
  • exothermic reaction
  • conduction of heat
  • laser burn
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7
Q

etiology of pulp disease: electrical

A

galvanism

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8
Q

etiology of pulp disease: chemical

A
  • etchants
  • cements. cavity disinfectants, and desiccants
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9
Q

clinical assessment of pulp status

A
  1. subjective examination
  2. objective examination
  3. clinical tests
  4. radiographic examination
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10
Q

subjective examination

A
  • reported history of pain and symptoms from tooth
  • chief complaint
  • subjective to pain
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11
Q

why nocturnal pain occurs

A

pulpal pressure increases when px is lying down at night making it more painful

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12
Q

objective examination

A
  • extraoral examination
  • intraoral examination
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13
Q

extraoral examination

A
  • general appearance
  • skin tone
  • facial asymmetry
  • swelling
  • redness
  • enlarged lymph nodes
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14
Q

intraoral examination

A

(soft tissue)
- discoloration
- inflammation
- ulceration
- swelling
- sinus tract formation

(dentition)
- presence of caries: site and extent
- mobility

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15
Q

clinical tests: objective

A

discover which tooth is different from the patient’s other teeth

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16
Q

clinical tests: 2 types

A
  • periradicular test
  • pulp vitality test
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17
Q

clinical tests: periradicular test

A
  • percussion
  • palpation
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18
Q

clinical tests: only test that can be done to pedo px

A

periradicular tests

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19
Q

clinical tests: pulp vitality test

A
  • cold test
  • heat test
  • EPT
  • test cavity
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20
Q

why are pulp vitality tests misleading?

A
  • pedo px has low pain intolerance
  • px’s exaggerated reaction to test
  • pedo px have heightened senses and cognitive development is not fully developed; they might not understand what is happening
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21
Q

radiographic examination

A
  • extent of caries
  • pulpal involvement
  • furcation involvement
  • periapical involvement
  • root resorption
  • periodontal involvement
  • bone involvement
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22
Q

radiographic examination: landmark for periodontal involvement

A

PDL space (irregularities; widened)

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23
Q

radiographic examination: landmark bone involvement

A

lamina dura (discontinuity)

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24
Q

why it is important to check furcation involvement before periapical involvement

A
  • accessory canals in furcation area can indicate signs of irreversible pulpitis
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25
Q

found in 77% of furcation area of primary molars

A

accessory canals

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26
Q

pulpal diagnostic terms

A
  • normal pulp
  • reversible pulpitis
  • irreversible pulpitis
  • pulp necrosis
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27
Q

pulpal diagnosis: normal pulp

A
  • symptom free
  • normally responsive to vitality testing
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28
Q

pulpal diagnosis: reversible pulpitis

A
  • inflammation of pulp resolves
  • pain is short but never spontaneous
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29
Q

pulpal diagnosis: irreversible pulpitis

A
  • pulp is incapable of healing
  • asymptomatic and symptomatic
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30
Q

pulpal diagnosis: symptomatic reversible pulpitis

A
  • sharp pain upon thermal stimulus
  • spontaneous pain
  • referred paom
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31
Q

pulpal diagnosis: symptomatic reversible pulpitis

A
  • sharp pain upon thermal stimulus
  • spontaneous pain
  • referred pain
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32
Q

pulpal diagnosis: asymptomatic reversible pulpitis

A
  • no clinical symptoms
  • inflammation produced by caries, caries excavation, trauma
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33
Q

pulpal diagnosis: pulp necrosis

A
  • death of pulp
  • non-responsive to vitality test
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34
Q

periapical diagnostic terms

A
  • normal apical tissue
  • asymptomatic apical periodontitis
  • symptomatic apical periodontitis
  • acute apical abscess
  • chronic apical abscess
35
Q

periapical diagnosis: normal apical tissue

A
  • not abnormally sensitive to percussion or palpation
  • intact and uniform lamina dura
36
Q

periapical diagnosis: asymptomatic apical periodontitis

A
  • inflammation and destruction of apical periodontium
  • apical radiolucent area and no clinical symptoms
37
Q

periapical diagnosis: symptomatic apical periodontitis

A
  • inflammation of apical periodontium producing clinical symptoms
  • may or may not be associated with apical radiolucent area
38
Q

periapical diagnosis: acute apical abscess

A
  • inflammatory reaction to pulpal infection and necrosis
  • rapid onset of spontaneous pain, tenderness of tooth, pus formation and swelling of associated tissue
39
Q

periapical diagnosis: chronic apical abscess

A
  • inflammatory reaction to pulpal infection and necrosis
  • gradual onset; little or no discomfort
  • intermittent discharge of pus through sinus tract
40
Q

treatment options: vital pulp diagnosed with normal pulp or reversible pulpitis

A
  • protective base
  • indirect pulp capping
  • direct pulp capping
  • pulpotomy
41
Q

treatment options: non-vital pulp diagnosed with irreversible pulpitis or necrotic pulp

A

pulpectomy

42
Q

removal of coronal pulp which has been clinically diagnosed as irreversibly inflamed, leaving behind a possibly healthy or
reversible inflamed radicular pulp

A

pulpotomy

43
Q

pulpotomy: objectives

A
  • preserve vitality of radicular pulp
  • removal of infected or inflamed pulp
  • maintain tooth in a physiologic condition
44
Q

pulpotomy: clinical indications

A
  • mechanical pulp exposure
  • inflammation limited to coronal pulp
  • absence of spontaneous pain
  • absence of swelling and/or alveolar abscess
45
Q

pulpotomy: radiographic indications

A
  • intact lamina dura
  • intact periapical or furcation bone (no resorption)
  • at least 2/3 of root length still present
  • vital exposed pulp and incomplete formed apices
46
Q

where incompletely formed apices are usually found

A

1st permanent molars or central incisors

47
Q

time it takes for closure of apices in permanent teeth

A

3 years

48
Q

pulpotomy: contraindications

A
  • history of unprovoked pain
  • presence of fistula or swelling
  • evidence of necrotic pulp
  • uncontrolled pulpal hemorrhage
  • periapical or bifurcation radiolucency
  • pathologic resorption
  • calcification of pulp
  • more than 1/3 root resorption
  • non-resorbable
  • medically-compromised px
49
Q

example of medically-compromised px that contraindicates pulpotomy

A

px with congenital heart conditions; at risk for bacterial formation (endocarditis bacteremia)

50
Q

gold standard of pulpotomy

A

formocresol

51
Q

formocresol aka

A

Buckley’s solution

52
Q

pulpotomy: failures

A
  • internal and external root resorption
  • big pulpal exposure = more bacterial invasion
  • perforation of the floor = continuous bleeding
53
Q

pulpotomy: ideal dressing material

A
  • bactericidal
  • harmless to pulp and surrounding structures
  • promotes healing of radicular pulp
  • does not interfere with physiologic root resoprtion
54
Q

pulpotomy: classification of medicaments

A
  1. devitalization (mummification, cauterization)
  2. preservation (minimal devitalization)
  3. regeneration (inductive, reparative)
55
Q

pulpotomy: devitalization medicaments

A
  • formocresol
  • glutaraldehyde
  • electrosurgery
  • laser
56
Q

pulpotomy: preservation medicaments

A
  • ferric sulfate
  • sodium hypochlorite
57
Q

pulpotomy: regeneration medicaments

A
  • calcium hydroxide
  • mineral trioxide aggregate (MTA)
  • calcium-enriched mixture (CEM)
58
Q

formocresol: success rate

A

70-98%

59
Q

formocresol: components

A
  • 19% formaldehyde
  • 35% cresol
  • 15% glycerin
  • 31% water
60
Q

formocresol: MOA

A

tissue fixation

61
Q

glutaraldehyde: properties

A
  • superior fixative properties
  • low antigenicity
  • low toxicity
62
Q

electrosurgery: advantages

A
  • no chemical coagulation or systemic involvement
  • less chair time
63
Q

electrosurgery: disadvantage

A

needs further clinical studies

64
Q

laser: advantages

A
  • hemostasis
  • preservation of vital tissues near tooth apex
  • absence of vibration and odor
65
Q

laser: disadvantage

A
  • less successful than conventional pulpotomy
66
Q

ferric sulfate: advantages

A
  • inexpensive solution
  • no concerns of toxicity and carcinogenicity
67
Q

ferric sulfate: major failure

A

internal resorption

68
Q

sodium hypochlorite: advantages

A
  • antimicrobial
  • amp
69
Q

calcium hydroxide: advantage

A

stimulate formation of new dentin

70
Q

calcium hydroxide: disadvantage

A
  • chronic inflammation
  • internal resorption
71
Q

mineral trioxide aggregate (MTA): types

A
  1. gray
  2. white
72
Q

mineral trioxide aggregate (MTA): advantages

A
  • biocompatible
  • bactericidal
  • induction of cementogenesis
73
Q

mineral trioxide aggregate (MTA): success rate

A

94-100%

74
Q

calcium-enriched mixture (CEM) cement: physical properties

A
  • flow
  • film thickness
  • favorable primary setting time and setting in aq environment
  • hard tissue and hydroxyapatite formation
  • comparable MTA/CEM success
  • further investigations needed
75
Q

pulpectomy: Layman’s term

A

RCT for kids

76
Q

color of traumatized teeth indicated for pulpectomy

A

black or pink

77
Q

pulpectomy: objectives

A
  • to remove irreversibly inflamed or necrotic radicular pulp tissue and gently clean the root canal system
  • to obturate the root canals with a filling material that will resorb at the same rate as the primary tooth
78
Q

pulpectomy: indications

A
  • history of spontaneous unprovoked pain
  • primary tooth with irreversible pulpitis or necrosis
  • tooth tx planned for pulpotomy which exhibits clinical signs of necrosis
  • uncontrolled pulpal hemorrhage
  • adequate periodontal and bone support
  • more than 2/3 root remaining
  • good px compliance
79
Q

pulpectomy: contraindications

A
  • non-resorbable crowns
  • perforation of pulpal floor
  • internal root resorption
  • external root resorption of more than 1/3 of root
  • involving follicle of permanent tooth
  • tooth mobility
  • medically compromised children
80
Q

pulpectomy: criteria for ideal obturation material

A
  • antiseptic
  • resorbable
  • harmless to adjacent tooth germ
  • radiopaque
  • non-impinging on erupting permanent tooth
  • easily inserted and removed
  • biocompatible
81
Q

pulpectomy: obturating materials

A
  • zinc oxide eugenol (ZOE)
  • Kri paste
  • Vitapex
  • Endoflas
82
Q

pulpectomy evaluation: clinical success

A
  • absence of spontaneous pain
  • chronic or acute abscess
  • absence of fistula
  • absence of excessive mobility
83
Q

pulpectomy evaluation: radiographic success

A
  • presence of normal PDL space
  • absence of furcal radiolucency
  • absence of pathologic root resorption or root canal calcification
84
Q

features of successful pulp therapy

A
  • no purulent discharge from gingival margin
  • no abnormal mobility
  • no postoperative pain
  • no further resorption of root
  • resolution of sinus tract by 6 months

Pediatric Dentistry (10 decks)

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