pulp therapy in the primary dentition Flashcards
what reasons may you not extract?
-loss of space-malocclusuion
-mastication
-speech
-aesthetics
-avoid GA
describe the morphology of primary teeth?
-can have multiple foramina
-can have multiple accessory canals
-primary root canals are more ribbon-like
-very fine canals
how does the morphology affect dental work?
-canal debridement more difficult
-complete extirpation almost impossible
what can cause irreversible pulpits?
-caries
-trauma
-tooth wear
what are the symptoms of irreversible pulpits?
-pain that keeps you awake at night
-pain even when stimulus is removed
-continuous and prolonged pain
-TTP
-Mobile tooth
-abscess
can you tell on radiograph if pulp us involved?
yes- however, if a third or more of the marginal wall is broken down- pulp is likely involved.
what is carious exposure?
the point where there is communication between the pulp and oral cavity
what is a pulp polyp?
very necrotic pulp tissue that has overgrown out of the cavity-often looks like gingiva.
what are condraindications of pulp therapy?
-uncooperative pt
-minimal tooth tissue remaining
-orthodontic extractions
-medical conditions such as bleeding disorders
what are the 3 methods of pulp therapy for a vital tooth?
-pulp capping
-pulpotomy
-desensitising pulp therapy
what is pulp capping?
technique used if you’re close or if you expose the pulp
what are the two forms of pulp capping?
direct and indirect
what is indirect pulp capping?
-within 0.5mm of the pulp
-place CaOH to encourage new dentine growth
-for pri and perm dentition
what is direct pulp capping?
-microexposure in caries free tooth
-place CaOH at micro exposure
-not for primary dentition as tooth will eventually abscess cause pain
what is pulpotomy therapy?
-when you remove the diseased coronal portion of pulp only
-and apply medicaments to remaining pulp to maintain vitality
-restore tooth
where is coronal pulp found?
in the crown of the tooth
aka-pulp chamber
what is radicalur pulp?
present within the root canals
what are the contraindications of pulpotomy?
unhealthy radicular pulp
i.e
-abcessed tooth
-excessive bleeding (inflamed r pulp)
-no bleeding (necrotic pulp)
what are 4 medicaments that can be used in pulpotomies?
-formocresol
-ferric sulphate
-gluteraldehyde
-CaOH
how does formocresol work?
-renders tissue inert- making it resistant to biological breakdown
why is formocresol no longer used?
-shown to be dangerous to cells-mutagenic/carcinogenic in animals
-may extrude via apical foramen and damage permanent tooth germ
-likely devitalises healthy radicular pulp
what are the ingredients of formocresol?
-tricesol- antiseptic
-formalin-tissue fixative
what is the function of ferric sulphate?
haemostatic- stops bleeding-not fixative
how is ferric sulphate applied?
15% ferric sulphate is placed on pulp stumps and held for 15 seconds.
how does gluteraldehyde work?
tissue fixative- but toxic effects have been identified- is not a likely substitute to formocresol.
how does CaOH work?
-encourages new dentine formation- results in dentine bridge
-barrier between pulp and oral environment- barrier to bacterial invasion - allows pulp to heal
-already used- no toxic side effects
-has been shown to cause internal resorption of tooth tissue
-equal efficacy to formocresol
describe the pulpotomy technique
-LA
-isolate- rubber dam
-large access cavity accessed with high speed to access all pulp horns- will see bleeding
-when bur drops into pulp chamber use slow speed to remove coronal pulp chamber- be careful not to penetrate floor
-remove diseased pulp with excavator
-DO NOT air dry as air 02 bubbles may get into blood stream- may cause emphysema
-irrigate with saline solution
-press lightly with cotton wool to control bleeding
-apply medicament on cotton pellet and place on chamber floor for 15 seconds with ferric sulphate or formocresol for 4-5 mins
-reapply if bleeding continues
if bleeding is not controlled at stage of applying medicament or if there is no bleeding at all, what do you do?
cannot continue-
excessive bleeding- inflamed radicular pulp
no bleeding- necrotic radicular pulp
if bleeding is controlled in pulpotomy, what do you do next?
-restore tooth
-place CaOH on base
-fill cavity will zinc oxide and eugenol mix
-if molar- place ssc
-if anterior- place composite
if radicular pulp is inflammed- excessive bleeding, what should be carried out?
desensitising pulpotomy-for vital pulp
why is desensitising pulpotomy carried out?
-to reduce inflammation/symptoms
-to facilitate extraction/pulpectomy
-dress tooth and revisit within 7-14 days
what is another reason you would carry out desensitising pulp therapy?
-hyperalgesic pulp
what is the technique for desensitising pulp
-after placing medicament
-place cotton pellet with ledermix over exposure sit
- temp dressing of kalzinol
-leave for 2 weeks then proceed with pulpotomy if vital and pulpectomy/extraction if not.
what is ledermix?
steroidal antibiotic paste
what are the pulp therapy options for non-vital teeth, other than extraction?
pulpectomy- not in our remit but removes necrotic tissue
