Pulp Therapy of Primary Teeth

Question 1

give 5 characteristics of primary molars.

Answer 1

• thick enamel and dentine
• large pulp chamber
• large pulp horns
• wide dentinal tubules
• porous pulp floor with accessory canals

Question 2

why would teeth with pulpal issues be restored in deciduous teeth?

Answer 2

• tooth ache
• abscess
• too much of an early loss - lead to ortho problems
• can cause damage to permanent successor

Question 3

what must you question when determining either pulp treatment tor extraction?

Answer 3

• quality of tooth
• prescence of successor
• age of patient
• cooperation
• infection?
• medical history

Question 4

what would be concerns in the medical history?

Answer 4

bleeding disorders - rather not extract

contra-indications
- cardiac disease - increase risk of infective endocarditis
- immunocompromised children

Question 5

what would be indications to retain the root?

Answer 5

• extraction risks
• GA risks
• little number of carious teeth
• hypodontia of permanent teeth
• don’t want mesial migration of 6’s
• regular attender, good compliance of parent and child

Question 6

what would be the indications to extract?

Answer 6

• risk of infection if retained
• if tooth is unrestorable
• extensive root resorption
• lots of carious teeth
• tooth close to exfoliation
• contralateral tooth already lost - tooth has no purpose then
• extensive pathology
• poor attendance, poor compliance of child and parent

Question 7

what are the 3 forms of pulp therapy?

Answer 7

indirect pulp therapy
pulpotomy
pulpectomy

Question 8

describe indirect pulp therapy.
what it promotes, its indications and clinical outcome

Answer 8

• pulp = vital
• no pulp removed
• aim is to arrest caries progress
• promote reactionary dentine and reminieralisationn
  = promote pulpal healing, maintain vitality

indications
- tooth with deep carious lesion
- no signs of pulpal pathosis

clinical outcome
- 90% success rate

Question 9

describe pulpotomy. aim, indication and success rate

Answer 9

• pulp = vital
• some pulp removed
• aim - remove coronal pulp, leaving healthy or reversible inflamed radicular pulp

indication
- asymptomatic tooth
- carious or mechanical exposure of coronal pulp
- bleeding pulp
- no mobility, abscess, swelling, radicular radiolucency

• 90% success

Question 10

describe pulpectomy. aims, indications and success

Answer 10

• pulp = non vital
• removal of all pulp
• aim is to remove irreversibly inflamed or necrotic radicular pulp tissue
• obturate root canals

indications
- irreversible pulpitis
- non-vital pulp
- good patient compliance

success = 86%

Question 11

when must you not pulp cap?

Answer 11

when primary tooth is inflamed

Question 12

how do you perform indirect pulp therapy?

Answer 12

• clear margins at ADJ
• remove infected dentine
• leave affected dentine

Question 13

how is a pulpotomy performed?

Answer 13

• radiograph
• LA
• rubber dam
• caries removal
• access cavity
• remove coronal pulp
• control haemorrhage
• apply pulp medicament - ferric sulfate or MTA
• restore pulp chamber with zinc oxide eugenol cement
• stainless steel crown
• follow up

Question 14

what is ferric sulfate?

Answer 14

15.5% medicament for pulpotomy in primary molar
- an astringent
- promotes pulpal haemostasis

good success

Question 15

what is MTA?

Answer 15

mineral trioxide aggregate
- promotes cytokines to release from fibroblast
- cytokine stimulate hard tissue formation
- expensive £££

good success

Question 16

what is biodentine?

Answer 16

• calcium silicate
• biocompatible
• good success

Question 17

when doing a pulpotomy, when would you consider doing a pulpectomy?

Answer 17

if unable to control haemorrhage for 30seconds-1min

Question 18

how is ferric sulfate applied?

Answer 18

with cotton wool