pulp therapy in the primary dentition

Question 1

what reasons may you not extract?

Answer 1

-loss of space-malocclusuion
-mastication
-speech
-aesthetics
-avoid GA

Question 2

describe the morphology of primary teeth?

Answer 2

-can have multiple foramina
-can have multiple accessory canals
-primary root canals are more ribbon-like
-very fine canals

Question 3

how does the morphology affect dental work?

Answer 3

-canal debridement more difficult
-complete extirpation almost impossible

Question 4

what can cause irreversible pulpits?

Answer 4

-caries
-trauma
-tooth wear

Question 5

what are the symptoms of irreversible pulpits?

Answer 5

-pain that keeps you awake at night
-pain even when stimulus is removed
-continuous and prolonged pain
-TTP
-Mobile tooth
-abscess

Question 6

can you tell on radiograph if pulp us involved?

Answer 6

yes- however, if a third or more of the marginal wall is broken down- pulp is likely involved.

Question 7

what is carious exposure?

Answer 7

the point where there is communication between the pulp and oral cavity

Question 8

what is a pulp polyp?

Answer 8

very necrotic pulp tissue that has overgrown out of the cavity-often looks like gingiva.

Question 9

what are condraindications of pulp therapy?

Answer 9

-uncooperative pt
-minimal tooth tissue remaining
-orthodontic extractions
-medical conditions such as bleeding disorders

Question 10

what are the 3 methods of pulp therapy for a vital tooth?

Answer 10

-pulp capping
-pulpotomy
-desensitising pulp therapy

Question 11

what is pulp capping?

Answer 11

technique used if you’re close or if you expose the pulp

Question 12

what are the two forms of pulp capping?

Answer 12

direct and indirect

Question 13

what is indirect pulp capping?

Answer 13

-within 0.5mm of the pulp
-place CaOH to encourage new dentine growth
-for pri and perm dentition

Question 14

what is direct pulp capping?

Answer 14

-microexposure in caries free tooth
-place CaOH at micro exposure
-not for primary dentition as tooth will eventually abscess cause pain

Question 15

what is pulpotomy therapy?

Answer 15

-when you remove the diseased coronal portion of pulp only
-and apply medicaments to remaining pulp to maintain vitality
-restore tooth

Question 16

where is coronal pulp found?

Answer 16

in the crown of the tooth
aka-pulp chamber

Question 17

what is radicalur pulp?

Answer 17

present within the root canals

Question 18

what are the contraindications of pulpotomy?

Answer 18

unhealthy radicular pulp

i.e
-abcessed tooth
-excessive bleeding (inflamed r pulp)
-no bleeding (necrotic pulp)

Question 19

what are 4 medicaments that can be used in pulpotomies?

Answer 19

-formocresol
-ferric sulphate
-gluteraldehyde
-CaOH

Question 20

how does formocresol work?

Answer 20

-renders tissue inert- making it resistant to biological breakdown

Question 21

why is formocresol no longer used?

Answer 21

-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

Question 22

what are the ingredients of formocresol?

Answer 22

-tricesol- antiseptic
-formalin-tissue fixative

Question 23

what is the function of ferric sulphate?

Answer 23

haemostatic- stops bleeding-not fixative

Question 24

how is ferric sulphate applied?

Answer 24

15% ferric sulphate is placed on pulp stumps and held for 15 seconds.

Question 25

how does gluteraldehyde work?

Answer 25

tissue fixative- but toxic effects have been identified- is not a likely substitute to formocresol.

Question 26

how does CaOH work?

Answer 26

-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

Question 27

describe the pulpotomy technique

Answer 27

-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

Question 28

if bleeding is not controlled at stage of applying medicament or if there is no bleeding at all, what do you do?

Answer 28

cannot continue-

excessive bleeding- inflamed radicular pulp

no bleeding- necrotic radicular pulp

Question 29

if bleeding is controlled in pulpotomy, what do you do next?

Answer 29

-restore tooth
-place CaOH on base
-fill cavity will zinc oxide and eugenol mix
-if molar- place ssc
-if anterior- place composite

Question 30

if radicular pulp is inflammed- excessive bleeding, what should be carried out?

Answer 30

desensitising pulpotomy-for vital pulp

Question 31

why is desensitising pulpotomy carried out?

Answer 31

-to reduce inflammation/symptoms
-to facilitate extraction/pulpectomy
-dress tooth and revisit within 7-14 days

Question 32

what is another reason you would carry out desensitising pulp therapy?

Answer 32

-hyperalgesic pulp

Question 33

what is the technique for desensitising pulp

Answer 33

-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.

Question 34

what is ledermix?

Answer 34

steroidal antibiotic paste

Question 35

what are the pulp therapy options for non-vital teeth, other than extraction?

Answer 35

pulpectomy- not in our remit but removes necrotic tissue