Pulp therapy in primary molars Flashcards
What are the 4 stages of the pulp status?
Healthy, reversible pulpitis, irreversible pulpitis, pulpal necrosis, infection
Which teeth cannot have an SSC placed on them?
teeth tender to touch
teeth with interradicular bone loss
teeth with abscesses
teeth with pathological mobility
How to diagnose pulp status
Symptoms
Clinical findings
Special investigations
Pain/sensitivity to hot and cold
Mobility (pathological vs exfoliation)
What are the symptoms of reversible pulpitis
provoked
disappears on removal of stimulus
shorter duration
relieved with analgesia
sharp pain
What are the symptoms of irreversible pulpitis
spontaneous
constant
long duration
not always relieved with analgesia
dull throbbing ache
sleep disturbances
Vitality testing in primary teeth
Has no benefit
Medical factors causing teeth to be retained?
Bleeding disorders
Patients at risk of GA if required for XGA
Reasons to extract teeth?
Immunocompromised patients
Cardiac disorders -> risk of infective endocarditis
Behavioural and social factors to consider when extracting or restoring?
Dental awareness
Motivation and compliance
Pattern of attendance
Co-operation and compliance
Age of child (how long does tooth need to last)
Dental factors to consider when extracting/restoring?
Gross dental neglect
Restorability of teeth
Acute infection/pathology
What to consider if a tooth is near exfoliation/lots of root resorption?
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
Other dental factors to consider?
Strategic value of the tooth
Hypodontia
Effect on developing dentition
Future crowding
Orthodontic consideration
What are the options for a vital pulp?
Pulp capping (direct/indirect)
Pulpotomy (vital and desensitising)
What are the options for a non-vital pulp?
Pulpectomy
Extraction
What is a vital pulp cap?
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.
What is the aim of a direct pulp cap?
Promote pulpal healing
Can be direct or indirect
What medicament is usually used for a direct pulp cap?
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
What are the aims of an indirect pulp cap?
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
What is a pulpotomy?
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
What haemostatic agent is used in pulpotomies?
Ferric sulphate (15s)
ZnOE placed at orofices of canals
Then a hard setting cement and SSCs
How does ferric sulphate work?
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
What other pulpotomy medicaments can be used?
Calcium hydroxide - high failure rate and internal resorption
MTA - Expensive and currently not readily available
Which leave ferric sulphate
What is the rationale behind a desensitising pulpotomy?
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
What are the options for non vital teeth?
Pulpectomy
XLA/XGA
What is a pulpectomy?
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)
What are the indications for a pulpectomy?
Irreversible pulpitis or pulpal necrosis
Hyperaemic pulp
