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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
found in 77% of furcation area of primary molars
accessory canals
26
pulpal diagnostic terms
- normal pulp - reversible pulpitis - irreversible pulpitis - pulp necrosis
27
pulpal diagnosis: normal pulp
- symptom free - normally responsive to vitality testing
28
pulpal diagnosis: reversible pulpitis
- inflammation of pulp resolves - pain is short but never spontaneous
29
pulpal diagnosis: irreversible pulpitis
- pulp is incapable of healing - asymptomatic and symptomatic
30
pulpal diagnosis: symptomatic reversible pulpitis
- sharp pain upon thermal stimulus - spontaneous pain - referred paom
31
pulpal diagnosis: symptomatic reversible pulpitis
- sharp pain upon thermal stimulus - spontaneous pain - referred pain
32
pulpal diagnosis: asymptomatic reversible pulpitis
- no clinical symptoms - inflammation produced by caries, caries excavation, trauma
33
pulpal diagnosis: pulp necrosis
- death of pulp - non-responsive to vitality test
34
periapical diagnostic terms
- normal apical tissue - asymptomatic apical periodontitis - symptomatic apical periodontitis - acute apical abscess - chronic apical abscess
35
periapical diagnosis: normal apical tissue
- not abnormally sensitive to percussion or palpation - intact and uniform lamina dura
36
periapical diagnosis: asymptomatic apical periodontitis
- inflammation and destruction of apical periodontium - apical radiolucent area and no clinical symptoms
37
periapical diagnosis: symptomatic apical periodontitis
- inflammation of apical periodontium producing clinical symptoms - may or may not be associated with apical radiolucent area
38
periapical diagnosis: acute apical abscess
- inflammatory reaction to pulpal infection and necrosis - rapid onset of spontaneous pain, tenderness of tooth, pus formation and swelling of associated tissue
39
periapical diagnosis: chronic apical abscess
- inflammatory reaction to pulpal infection and necrosis - gradual onset; little or no discomfort - intermittent discharge of pus through sinus tract
40
treatment options: vital pulp diagnosed with normal pulp or reversible pulpitis
- protective base - indirect pulp capping - direct pulp capping - pulpotomy
41
treatment options: non-vital pulp diagnosed with irreversible pulpitis or necrotic pulp
pulpectomy
42
removal of coronal pulp which has been clinically diagnosed as irreversibly inflamed, leaving behind a possibly healthy or reversible inflamed radicular pulp
pulpotomy
43
pulpotomy: objectives
- preserve vitality of radicular pulp - removal of infected or inflamed pulp - maintain tooth in a physiologic condition
44
pulpotomy: clinical indications
- mechanical pulp exposure - inflammation limited to coronal pulp - absence of spontaneous pain - absence of swelling and/or alveolar abscess
45
pulpotomy: radiographic indications
- 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
where incompletely formed apices are usually found
1st permanent molars or central incisors
47
time it takes for closure of apices in permanent teeth
3 years
48
pulpotomy: contraindications
- 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
example of medically-compromised px that contraindicates pulpotomy
px with congenital heart conditions; at risk for bacterial formation (endocarditis bacteremia)
50
gold standard of pulpotomy
formocresol
51
formocresol aka
Buckley's solution
52
pulpotomy: failures
- internal and external root resorption - big pulpal exposure = more bacterial invasion - perforation of the floor = continuous bleeding
53
pulpotomy: ideal dressing material
- bactericidal - harmless to pulp and surrounding structures - promotes healing of radicular pulp - does not interfere with physiologic root resoprtion
54
pulpotomy: classification of medicaments
1. devitalization (mummification, cauterization) 2. preservation (minimal devitalization) 3. regeneration (inductive, reparative)
55
pulpotomy: devitalization medicaments
- formocresol - glutaraldehyde - electrosurgery - laser
56
pulpotomy: preservation medicaments
- ferric sulfate - sodium hypochlorite
57
pulpotomy: regeneration medicaments
- calcium hydroxide - mineral trioxide aggregate (MTA) - calcium-enriched mixture (CEM)
58
formocresol: success rate
70-98%
59
formocresol: components
- 19% formaldehyde - 35% cresol - 15% glycerin - 31% water
60
formocresol: MOA
tissue fixation
61
glutaraldehyde: properties
- superior fixative properties - low antigenicity - low toxicity
62
electrosurgery: advantages
- no chemical coagulation or systemic involvement - less chair time
63
electrosurgery: disadvantage
needs further clinical studies
64
laser: advantages
- hemostasis - preservation of vital tissues near tooth apex - absence of vibration and odor
65
laser: disadvantage
- less successful than conventional pulpotomy
66
ferric sulfate: advantages
- inexpensive solution - no concerns of toxicity and carcinogenicity
67
ferric sulfate: major failure
internal resorption
68
sodium hypochlorite: advantages
- antimicrobial - amp
69
calcium hydroxide: advantage
stimulate formation of new dentin
70
calcium hydroxide: disadvantage
- chronic inflammation - internal resorption
71
mineral trioxide aggregate (MTA): types
1. gray 2. white
72
mineral trioxide aggregate (MTA): advantages
- biocompatible - bactericidal - induction of cementogenesis
73
mineral trioxide aggregate (MTA): success rate
94-100%
74
calcium-enriched mixture (CEM) cement: physical properties
- 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
pulpectomy: Layman's term
RCT for kids
76
color of traumatized teeth indicated for pulpectomy
black or pink
77
pulpectomy: objectives
- 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
pulpectomy: indications
- 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
pulpectomy: contraindications
- 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
pulpectomy: criteria for ideal obturation material
- antiseptic - resorbable - harmless to adjacent tooth germ - radiopaque - non-impinging on erupting permanent tooth - easily inserted and removed - biocompatible
81
pulpectomy: obturating materials
- zinc oxide eugenol (ZOE) - Kri paste - Vitapex - Endoflas
82
pulpectomy evaluation: clinical success
- absence of spontaneous pain - chronic or acute abscess - absence of fistula - absence of excessive mobility
83
pulpectomy evaluation: radiographic success
- presence of normal PDL space - absence of furcal radiolucency - absence of pathologic root resorption or root canal calcification
84
features of successful pulp therapy
- 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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