Pulp treatment in primary teeth Flashcards
Describe primary molars
- Large pulp chambers
- large pulp horns
- Wide dentinal tubules
- Porous pulp floor with accessory canals
The fact that piracy molars have large pulp chambers means what
Pulpal involvement can occur more easily when a tooth gets caries
What happens before a carious lesion reaches the pulp in a primary molar
Marginal ridge breakdown leading to pulpal inflammation
Is pulpal inflammation reversible
It is but can quick become irreversible if the tooth isnt treated appropriately
Why do we restore some primary teeth
- Alleviate tooth ache
- Abscesses
- Early tooth loss can lead to future orthodontic problems
- To avoid damage to the permanent successor
How can carious or infected teeth damage the permanent successor
Local hypoplasia can arise duet o chronic infection of a primary tooth
2. This can lead to ‘turner’ tooth
List some factors that influence our decision to carry out pulpal treatment rather than extract a tooth
- Quality of tooth
- Presence of successor
- Age of patient
- Behaviour
- Presence of infection
- Medical hisotry
List some contraindication that may arise in a Childs medical history that may prompt us to extract rather than restore
- Patients with cardiac disease are at an increased risk of infective endocarditis
- Immunocompromised children
list some dental factors that indicate tooth retention over extraction
- Minimal number of carious primary teeth (less than 3)
- Hypodontia of permanent dentition
- Where prevention of espial migration of the 6s is desirable
List some dental factors that indicate tooth extraction over retention
- Tooth is unrestorable after pulp therapy
- Extensive internal root resorption
- Large number of carious teeth with pulpal involvement
- Tooth is close to exfoliation
- Contra lateral tooth is already lost
- Extensive pathology or acute facial swelling
Give examples of treatment options we can use to restore teeth
- Indirect pulp therapy
- Pulpectomy
- Pulpotomy
What happens to the pulp at eth end of indirect pulp therapy
Tooth is vital and pulp has not been removed
What happens to the pulp at the end of a Pulpotomy
Tooth is vita and some of the pulp has been removed
What happens to the pulp at the end of a pulpectomy
Tooth is non vital and pulp has been removed
How do we deiced which pulpal tratmetn to carry out
Dependent on pulpal status
What is a contra indication in inflamed primary teeth
Pulp capping
What is the aim of indirect pulp therapy
- To arrest the carious process and provide condition conducive to the formation of reactionary dentine an demineralisation of remaining carious dentine
- To promote pulpal healing and preserve/ maintain the vitality of pulp tissue
Give some indications for indirect pulp therpay
- Tooth with deep carious lesion
- No signs and symptoms indicating pulpal pathology
How successful is indirect pulp therapy
90% clinical success at 3 year follow up
What do we do in indirect pulp therpay
- Clear margins to create a coronal seal
- Remove soft dentine
- Leave hard discoloured dentine
What is the aim of a pulpotomy
To remove the coronal pulp which has been clinically diagnosed as irreversibly inflamed
this leaved begins a possible healthy or reversibly inflamed radicular pulp
Give some indications of a pulpotomy
- Asymptomatic tooth or only transient pain
- A carious or mechanical exposure of vital coronal pulp
- No mobility
- No sinus/ abscess
- No history of swelling
- No intra radicular radiolucency on radiograph
- Bleeding pulp that stops with pressure
How sucessful are pulpotomys
90% success
Give some s signs a pulp may be non vital
- Mobile
- Presence of abscess/ sinus
- History of swelling
- Intra radicular radiolucency on a radiograph
- Spontaneous pain that doesn’t resolve quickly
- Necrotic pulp
- Furcation pathology
Give examples of pulp medication we can use when carrying out a pulpotomy
1, Ferric sulphate
2. MTA
3. Calcium hydroxide
4. Electrosurgery
5. Laser treatment
6. Ledermix
7. Formocresol
How strong is the ferric sulphate we use for a pulpotomy
15.5%
What does ferric sulphate do
It promotes pulpal haemostasis
What is the succes rate for ferric sulphate
90%
Name an alternative to ferric sulphate we may use on clinic
MTA
What is MTA
Mineral trioxide aggregate
What does MTA doe
It releases cytokines from fibroblasts
these cytokines stimulate tissue formation
What is the main disadvantage for using MTA
Expensive
1What can we use to remove the coronal pulp in a pulpotomy
- Round burr
- sHARP excavator
How do we control the haemorrhage during a pulpotomy
Cotton roll socked in saline
When is pulp capping contra indicated
In inflamed primary teeth
After placing ferric sulphate what do we do
- DONT wash pulp chamber
- Restore with zinc oxide eugenol cement
- Pack well
- Place stainless steel crown
What is the aim of a pulpectomy
- To remove irreversibly inflamed or necrotic radicular pulp tissue and gently clean the root canal system
- To obturate the root caries with a filling material that will resorb the same rate as the primary tooth
List the indications for a pulpectomy
- Tooth diagnosed as having irreversible pulpits
- Non vital radicular pulp with/ without associated infections
- Good patient compliance
How successful are pulpectomy
80% clinical success at 3 years
What are we aiming to do in a pulpectomy
- Gain access to root canals
- Remove as much infected material as possible
- Fill canals with suitable material
