Pulp treatment in primary teeth

Question 1

Describe primary molars

Answer 1

1. Large pulp chamber
2. Large pulp horns
3. Wide dentinal tubules
4. Porous pulp floor with accessory canals

Question 2

The fact that primary molars have a large pulp chamber means what

Answer 2

That there is easy pulpal involvement when a tooth gets caries

Question 3

What happens before a carious lesion reaches the pulp in a primary molar

Answer 3

Marginal ridge breakdown leading to pulp inflammation

Question 4

Is pulpal inflammation reversible

Answer 4

It is but it can quickly become irreversible if the tooth isn’t treated appropriately

Question 5

Why do we restore some primary teeth

Answer 5

1. Allieviate tooth ache
2. Abscesses
3. Early tooth loss can lead to future orthodontic problems
4. Damage to permanent successor

Question 6

How can carious or infected teeth damage permanent successor teeth

Answer 6

Local hypoplasia can arise due to chronic infection of a primary tooth
This can lead to ‘turner’ tooth

Question 7

List some factors that influence our decision to carry out pup treatment rather than extract a tooth

Answer 7

1. Quality of tooth
2. Presence of successor
3. Age of patient
4. Behaviour
5. Presence of infection
6. Medical history

Question 8

List some contraindication that may arise in a Childs medical history that may prompt us to extract rather than restore

Answer 8

1. Patients with cardiac disease are at an increased risk of infective endocarditis
2. Immunocompromised children

Question 9

List some dental factors that indicate tooth retention over extraction

Answer 9

1. Minimal number of carious primary teeth is less than 3
2. Hypodontia of permanent dentition
3. Where prevention of medial migration of 6s is desirable

Question 10

Give an example of a social factor that may indicate tooth retention over extraction

Answer 10

Patient is a regular attender with good compliance and positive parental attitude

Question 11

List some dental factors that indicate tooth extraction over retention

Answer 11

1. Tooth is unreotoabel after pulp therapy
2. Extensive internal root absorption
3. Large number of carious teeth with pulpal involvement
4. Tooth is close to exfoliation
5. Contralateral tooth is already lost
6. Extensive pathology or acute face swelling

Question 12

Give an example of a social factor that may indicate tooth extraction over retention

Answer 12

Patient is an irregular attender with poor compliance and unfavourable parental attitudes

Question 13

Give some examples of treatment options we can use to restore teeth

Answer 13

1. Indirect pulp therapy
2. Pulpotomy
3. Pulpectomy

Question 14

What happens to the pulp at the end of indirect pulp therapy

Answer 14

Tooth is vital and pulp hasn’t been removed

Question 15

What happens to the pulp at the end of a pulpotomy

Answer 15

Tooth is vital but some of the pulp is removed

Question 16

What happens to the pulp at the end of pulpectomy

Answer 16

Tooth is non vital and pulp has been removed

Question 17

How do we decide which treatment option to carry out

Answer 17

Dependent on pulpal status

Question 18

What is contra indicated in inflamed primary teeth

Answer 18

Pulp capping

Question 19

What is the aim of indirect pulp therapy

Answer 19

1. To arrest the carious process and provide condition conducive to the formation of reactionary dentine an demineralisation of remaining carious dentine
2. To promote pulpal healing and preserve/ maintain the vitality of pulp tissue

Question 20

Give some indication for indirect pulp therapy

Answer 20

1. Tooth with a deep carious lesion

2. No signs or symptoms indicating pulpal pathosis

Question 21

How success is indirect pulp therapy

Answer 21

> 90% clinical success at 3 year follow up

Question 22

What do we do in indirect pulp therapy

Answer 22

1. Clear margins to create a coronal seal
   2 Remove soft dentine
2. Leave hard discoloured dentine

Question 23

What is the aim of a pulpotomy

Answer 23

To remove the coronal pulp, which has been clinically diagnosed as irreversibly inflamed
This leaves behind a possibly healthy or reversibly inflamed radicular pulp

Question 24

Give some indication of a pulpotomy

Answer 24

1. Asymptomatic tooth or only transient pain
2. A carious or mechanical exposure of vital coronal pulp
3. No mobility
4. No sinus/ abscess
5. No history of swelling
6. No intra radicular radiolucency on radiograph
7. Bleeding pulp that stops with pressure

Question 25

How successful are pulpotomy's

Answer 25

>90% succes

Question 26

Give some signs a pulp may be non vital

Answer 26

1. Mobile 2. Presence of sinus/ abscess 3. History of swelling 4. intra radicular radiolucency on radiograph 5. Spontaneous pain that doesn't resolve quickly 6. Necrotic pulp 7. Furcation pathology

Question 27

How do we carry out a pulpotomy

Answer 27

1. Take pre operative radiograph 2. LA+ rubber dam 3. Caries removal 4. Access cavity 5. Remove coronal pulp 6. Control haemorrhage 7. Apply chosen pulp medication 8. Restore pulp chamber 9. Place stainless steel crown and follow up

Question 28

give examples of pulp medication we can use when carrying out a pulpotmy

Answer 28

1, Ferric sulphate 2. MTA 3. Calcium hydroxide 4. Electrosurgery 5. Laser treatment 6. Ledermix 7. Formocresol

Question 29

Name our ho to pulp Medicaid for a pulpotomy.

Answer 29

Ferric sulphate

Question 30

How strong is the Ferric sulphate we use for a pulpotomy

Answer 30

15.5%

Question 31

What does Ferric sulphate do

Answer 31

It promotes pulpal haemostats

Question 32

How successful is Ferric sulphate

Answer 32

>90%

Question 33

Which alternative do we use to Ferric sulphate sometimes

Answer 33

MTA

Question 34

What is MTA

Answer 34

Mineral trioxide aggregate

Question 35

What does MTA do

Answer 35

It releases cytokines from fibroblasts | These cytokines stimulate hard tissue formation

Question 36

What is the main disadvantage for using MTA

Answer 36

Expensive

Question 37

What are we aiming to do when creating our abscess cavity for a pulpotomy

Answer 37

1. Remove caries 2. identify exposire 3. Remove roof of pulp chamber (NO DEEPER)

Question 38

What can we use to remove the coronal pulp in a pulpotomy

Answer 38

1. Round burr | 2. Sharp excavator

Question 39

How do we control the haemorrhage during a pulpotomy

Answer 39

Cotton wool soaked in saline

Question 40

when is pulp capping contra indicated

Answer 40

In inflamed primary teeth

Question 41

After placing Ferric sulphate what do we do

Answer 41

1. DONT wash pulp chamber 2. Restore with zinc oxide eugenol cement 3. Pack well 4. Place stainless steel crown

Question 42

What is the aim of a pulpectomy

Answer 42

1. To remove irreversibly inflamed or necrotic radicular pulp tissue and gently clean the root canal system 2. To obturate the root caries with a filling material that will resorb the same rate as the primary tooth

Question 43

List some of the indication for a pulpectomy

Answer 43

1. Tooth diagnosed as having irreversible pulpits 2. Non vital radicular pulp with/ without associated infections 3. Good patient compliance

Question 44

How successful are pulpectomys

Answer 44

80% clinical success at 3 years

Question 45

What are we aiming to do in a pulpectomy

Answer 45

1. Gain access to root canals 2. Remove as much infected material as possible 3. Fill canals with suitable material

Question 46

Talk through the steps of a pulpectomy

Answer 46

1. LA+ rubber dam 2. Access 3. Identify canals 4. Spin or inject ZnO cement into canals and then into pulp chamber 5. Place stainless steel crown