Pulp Therapy In Primary Molars

Question 0

What are the symptoms of irreversible pulpitis?

Answer 0

Spontaneous and constant not related to certain stimuli
Long duration of pain
Can not always be relieved with analgesics
Dull throbbing ache
Keeps them awake at night

Question 1

What are the symptoms of reversible pulpitis?

Answer 1

Provoked by certain stimuli and disappears on removal
Shorter duration of pain
Relieved with analgesia
Sharp pain

Question 2

Where does pulpal involvement usually show in primary teeth radiographically?

Answer 2

Can often see radiolucency interradicularly because there are many accessory canals which can be a source of bacteria getting into the pulp

Question 3

What medical factors need to be considered before restoring or extracting primary molars?

Answer 3

Retain the tooth if child has a bleeding disorder or risk of GA

Extract the tooth if the child is immune compromised or has a cardiac disorder and is at risk of IE

Question 4

What behavioural and social factors need to be considered before restoring or extracting primary molars?

Answer 4

Dental awareness
Compliance and motivation 
Pattern of attendance 
Co operation 
Age of the child- how long does the tooth need to last

Question 5

What dental factors need to be considered before restoring or extracting primary molars?

Answer 5

Do they have gross dental neglect or is it a isolated problem
Is it restorable
Acute infection or pathology
How long til exfoliation or level of root resorption - if needed for more than a year should try to restore
Orthodontic considerations

Question 6

What is the difference between a pulpectomy and a pulpotomy?

Answer 6

A pulpectomy is removal of the entire pulp

A pulpotomy is removal of the coronal portion of the pulp

Question 7

What is pulp capping?

Answer 7

A method of maintaining the vitality of the pulp and promote pulpal healing by placing a dressing either directly onto an exposed pulp or onto residual dentine

Question 8

What is the difference between direct and indirect pulp capping?

Answer 8

Direct the Ca(OH)2 is placed directly onto the pulp
Direct not suitable in primary teeth
Indirect there is partial caries removal to arrest caries in deep carious lesions and reactionary dentine is promoted

Question 9

Why is the diagnosis of pulp status important?

Answer 9

Because asymptomatic vital pulps can recover

Question 10

What are the different pulp therapy options?

Answer 10

Vital pulp (deep caries, reversible pulpitis, asymptomatic) - indirect pulp capping and halls crowns
Vital pulp (with pulp exposure) - ferric sulphate pulpotomy 
Irreversible pulpitis or necrosis- pulpectomy or extraction