Restorative Dentistry and Pulp Therapy Flashcards by Shauniell Frazier Dearing

What ate the 2 primary objectives in pulp therapy for baby teeth?

1- eradicate infection

2-maintain the integrity and heath of the teeth and supporting tissures

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8 reasons why we don’t just pull baby teeth

1- prevent space loss and malocclusion
2- aid in mastication
3- preserve the primary tooth in case of hypodontia
4 - Prevent possible speech problems
5- Maintain esthetics
6- Prevent aberrant tongue habits
7- Prevent potentially damaging psychosocial effects
8-Maintain normal eruption patterns and timing

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If a primary tooth is removed, and space is not maintained, what can happen with the premolars?

1st premolar can come in ectopically and resorb roots of 2nd premolar

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what are the 5 pulpal therapies offered in pediatric dentistry?

1- protective liner
2- indirect pulp cap
3- direct pulp cap
4- pulpotomy
5- pulpectmy

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T/F In relation to crowns, the pulp in primary teeth are smaller than in the permanent dentition

False

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Which pulp horn is closest to the outer surface of the tooth?

Mesial pulp horns

**makes it more readily exposed to caries or trauma

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T/F Pulp horns under each cusp are longer than suggested by external anatomy?

true

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Which arch has molars with bigger pulp chambers?

Mandibular

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where do accessory canals in primary teeth lead?

directly to the intra radicular furcation

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Describe how roots compare to crown size in primary teeth

Longer and more slender than permanent teeth

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Describe primary tooth canals

long, ribbon like, tortuous

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T/F primary teeth are wider mesiodistally

False- they are narrower

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proper identification and diagnosis requires what 4 things?

1-History
2-symptoms
3- radiographic eval
4- clinical eval

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Do you need consent from parents?

yes. Duh.

*or Legal guardian
*Get documentation of concent
*answer all questions

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What pulpal therapy is indicated if you have normal pulp, all caries are removed for a restoration?

Protective Liner

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what are the 3 purposes of a protective liner?

1- minimize injury to pulp
2- promote pulp tissue healing
3- minimize post-op sensitivity

*Place in deep spots
- a good seal is more important than the actual material type that is placed

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What are the 4 objectives for a protective liner?

1- preserve tooth vitality
2- promote pulp tissue healing
3- promote tertiary dentin formation
4- minimize bacteria microleakage

**Should prevent post-op sensitivity, pain, swelling

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5 protective liner materials

1- GLUMA
2- calcium hydroxide
3- bonding agents
4- glass ionomers
5- RMGI

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What makes up gluma ?

5% glutaraldehyde

35% HEMA (hydroxyethyl methacrylate in water)

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What 4 things does GLUMA do?

1- Desensitizer
2- cavity disinfectant
3- rewetting agent
4- adhesion promoter

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what are 2 indications to use an indirect pulp cap?

1- no pulpitis or irriversible pulpitis

2- deepest caries are NOT removed to avoid pulp exposure

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The pulp is judged by what 2 things to determine if tooth is vital and able to heal from the carious insult?

1- radiograph

2- clinical criteria

7 Steps to indirect pulp cap

1- prep tooth for restoration
2-caries free margins
3- remove gross caries and infected dentin
4- don't hit the pulp
5- leave affected dentin
6- place radiopaque base
7- restore

5 objectives of indirect pulp cap

1-seal involved dentin
2- preserve tooth vitality
3- no post-op symptoms
4- no evidence of root resportpion or path. changes 
5- no harm to perm. tooth

5 indirect pulp cap materials

``` 1- Calcium hydroxide 2- ZOE 3- resin modified glass ionomer 4- mineral trioxide aggregate (MTA) 5- glass ionomer cement ```

what should be placed over CaOH?

glass ionomer or ZOE to provide seal

CaOH has high or low solubility?

high

CaOH has good or poor seal?

poor **one of the reasons it needs to be reinforced

CaOH has high or low compressive strength

low

2- indication for direct pulp cap

1- normal pulp following small exposure | 2-favorable conditions to heal

T/F direct pulp cap of carious pulp exposure is recommended

false

3 basic steps of direct pulp exposure

1-mechanical or traumatic pulp exposure 2- place radiopaque base 3- restore and seal

2 main objectives if direct pulp cap

1-mainain tooth vitality | 2- no post-op symptoms

what should result from direct pulp cap?

pulp healing and reparative dentin formation

2 materials for direct pulp cap

1- CaOH | 2- MTA

what should be placed as a seal in direct pulp cap to prevent microleakage?

Glass ionomer, RMGI or reinforced ZOE **CaOH have high solubility, poor seal, low compressive stregnth

2 indication for pulpotomy

1- pulp exposure from caries removal with normal pulp | 2- reversible pulpitis from traumatic pulp exposre

9 pulpotomy basic steps

``` 1- prep tooth for full coverage 2- remove caires 3- unroof pulp chamber 4- remove coronal pulp (#4, 6, spoon) 5- stop bleeding with pressure 6- apply medicaments 7- dry with cotton pellets 8- seal 9- place crown ```

3 objectives of pulpotomy

1- radicular pulp should remain asymptomatic 2- no post op root resorption 3- internal resorption should be stable and self limiting **might need to remove tooth in perf. causes loss of supportive bone

5 pulpotmy materials *material (purpose)

1- Formocresol - 1:5 dilution, bactericidal, 65-95% success *(devitalization/fixation) 2- Ferric sulfate- mask pulp signs (preservation) 3- Chlorhexidine (preservation) 4-MTA (regeneration) 5- ZOE (IRM) is the gold stanard for sealing and filling coronal pulp chamber

In class hint regarding pulpotmy materials

***it doesn't really matter what product you use as long as you SEAL THE TOOTH

3- pulpectomy indications

1- irreversible pulpitis or necrosis 2- planned for pulpotomy but you see radicular pulp is bad 3- roots have minimal or no resorptions **you'll know you need to go to pulpetomy if there is excessive bleeding

11 basic steps for pulpectomy **steps 5-9 are different from pulpotomy

1- prep tooth 2- remove caries 3- unroof pulp chamber 4- remove coronal pulp 5- extiprate radicular pulp with broaches 6- short fine for radiographic apex (<35) 7- instrument only to point of resistance 8-dry with paper points 9-obturate with ZOE or iodoform past 10- seal 11- place crown

3 pulpectomy objectives

1- radiographic infection should resolve 2- clinical signs should resolve 3- tx will allow for primary tooth resorption and allow perm. tooth to erupt

how long after pulpectomy will radiographic evidence go away?

6 month

how long after pulpectomy will clinical pre-tx go away?

few weeks

4 pulpectomy materials

1- ZOE 2-CaOH 3-MTA 4- Iodoform paste (bactericidal, resorbable)

4 keys to success of any pulp therapy?

1- diagnose 2- isolate 3- technique 4- seal

4- Contraindications to pulp therapy in primary teeth

``` 1-close to exfoliation 2-PA abscess with swelling and drainage 3- unrestorable 4- medically complex ```

Crown options for primary teeth

1- stainless steel crown 2- veneered stainless steal crowns 3- zirconium crowns

what three pulp therapies are the same for primary and perm. teeth?

1- protective liner 2- indirect pulp cap 3- direct pulp cap

How does a pulpotomy in a primary tooth differ in a permanent tooth?

more conservative pulp access. uses reparative materials like CaOH and MTA

How does a pulpectomy in a primary tooth differ in a permanent tooth?

endo referal same as pulupotomy: more conservative pulp access. uses reparative materials like CaOH and MTA