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Paediatrics > Pulp therapy in primary molars > Flashcards

Pulp therapy in primary molars Flashcards

1
Q

What are the 4 stages of the pulp status?

A

Healthy, reversible pulpitis, irreversible pulpitis, pulpal necrosis, infection

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2
Q

Which teeth cannot have an SSC placed on them?

A

teeth tender to touch
teeth with interradicular bone loss
teeth with abscesses
teeth with pathological mobility

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3
Q

How to diagnose pulp status

A

Symptoms
Clinical findings
Special investigations
Pain/sensitivity to hot and cold
Mobility (pathological vs exfoliation)

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4
Q

What are the symptoms of reversible pulpitis

A

provoked
disappears on removal of stimulus
shorter duration
relieved with analgesia
sharp pain

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5
Q

What are the symptoms of irreversible pulpitis

A

spontaneous
constant
long duration
not always relieved with analgesia
dull throbbing ache
sleep disturbances

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6
Q

Vitality testing in primary teeth

A

Has no benefit

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7
Q

Medical factors causing teeth to be retained?

A

Bleeding disorders
Patients at risk of GA if required for XGA

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8
Q

Reasons to extract teeth?

A

Immunocompromised patients
Cardiac disorders -> risk of infective endocarditis

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9
Q

Behavioural and social factors to consider when extracting or restoring?

A

Dental awareness
Motivation and compliance
Pattern of attendance
Co-operation and compliance
Age of child (how long does tooth need to last)

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10
Q

Dental factors to consider when extracting/restoring?

A

Gross dental neglect
Restorability of teeth
Acute infection/pathology

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11
Q

What to consider if a tooth is near exfoliation/lots of root resorption?

A

If tooth is due to exfoliate in a year, provisional restoration of XLA

IF tooth is >1y from exfoliation with minimal tooth resorption, retain with a definitive restoration

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12
Q

Other dental factors to consider?

A

Strategic value of the tooth
Hypodontia
Effect on developing dentition
Future crowding
Orthodontic consideration

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13
Q

What are the options for a vital pulp?

A

Pulp capping (direct/indirect)
Pulpotomy (vital and desensitising)

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14
Q

What are the options for a non-vital pulp?

A

Pulpectomy
Extraction

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15
Q

What is a vital pulp cap?

A

Method of maintaining the vitality of the pulp by placing a dressing either directly on to an exposed pulp or onto residual dentine left over a nearly exposed pulp.

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16
Q

What is the aim of a direct pulp cap?

A

Promote pulpal healing
Can be direct or indirect

17
Q

What medicament is usually used for a direct pulp cap?

A

Calcium hydroxide
Aim to promote dentine bridge formation over exposure and to preserve vitality
successful in iatrogenic pulpal exposures

NOT recommended in carious primary molars as rarely iatrogenic and non inflammed

18
Q

What are the aims of an indirect pulp cap?

A

Arrest caries
Allow for formation of reactionary define and remineralisation of dentine
Promote pulp healing and preserve vitality

Indications
Deep carious lesions
No signs/symptoms of pulpal pathosis

SOUND coronal seal is essential

19
Q

What is a pulpotomy?

A

Removal of the coronal part of the pulp tissue
Assuming this part is irreversibly inflamed
Intention to maintain vitality of radicular pulp
Vital, asymptomatic or transient pain, no radiological pathology

20
Q

What haemostatic agent is used in pulpotomies?

A

Ferric sulphate (15s)
ZnOE placed at orofices of canals
Then a hard setting cement and SSCs

21
Q

How does ferric sulphate work?

A

Haemostatic agent
Agglutination of blood proteins
reaction of blood and ferric sulphate ions to form barrier
Healthy pulp should clot
Inflamed pulp will ooze so need to check if caries has spread into radicular pulp

22
Q

What other pulpotomy medicaments can be used?

A

Calcium hydroxide - high failure rate and internal resorption

MTA - Expensive and currently not readily available

Which leave ferric sulphate

23
Q

What is the rationale behind a desensitising pulpotomy?

A

reduce pulpal inflammation or symptoms to facilitate subsequent pulp therapy

hyperalgesic pulp
poor compliance

+/- LA
Ledermix (triamcinolone and demeclocyline)
GIC temp for 1/2-52 and then definitive restoration

24
Q

What are the options for non vital teeth?

A

Pulpectomy
XLA/XGA

25
Q

What is a pulpectomy?

A

Extirpation of soft tissues content from the coronal pulp chamber and root canals

Placement of resorbable dressing, (pure ZoE, iodoform, calcium hydroxide, ledermix and vitapex)

26
Q

What are the indications for a pulpectomy?

A

Irreversible pulpitis or pulpal necrosis
Hyperaemic pulp

Paediatrics (13 decks)

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