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PAEDS FLASHCARDS > RESTORATIVE MANAGEMENT AND PULP THERAPY OF THE PRIMARY DENTITION > Flashcards

RESTORATIVE MANAGEMENT AND PULP THERAPY OF THE PRIMARY DENTITION Flashcards

1
Q

name 7 ways as to why we would restore the primary dentition rather than XLA.

A
  • to restore FORM
  • to restore aesthetics
  • to restore function - eating and speech
  • maintain space for ortho reasons
  • acclimatisation
  • avoiding sepsis/infection to permanent successors
  • to avoid XLA - especially if GA is required as we want to minimise this
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2
Q

Name 5 important considerations when restoring a primary tooth (think of the DIFFERENCE in shape/morphology of the teeth)

A
  • teeth are much smaller
  • enamel is thinner
    -pulp is RELATIVELY larger
  • pulp horns are NEARER the surface i.e more towards the crown.
  • the contact points are flatter and wider
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3
Q

what does the anatomy and morphology of a primary tooth mean for caries progression

A

it will lead to more RAPID progression of caries and the identification of demineralisation is more difficult (this is because primary teeth enamel is less mineralised than that of secondary teeth)

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4
Q

can primary pulps have the same potential to produce secondary dentine as a permanent counterpart?

A

YES

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5
Q

How many canals are there in a primary molar?

A

there are 3 (usually) canals in upper and lower molars

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6
Q

Name the surfaces of the teeth at which the 3 canals run along on lower primary molars

A

LOWER - MESIOBUCCAL, MESIOLINGUAL, and DISTAL.

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7
Q

Name the surfaces of the teeth at which the 3 canals run along on upper primary molars

A

UPPER - MESIOBUCCAL DISTOBUCCAL and PALATAL.

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8
Q

list the stages of a typical paeds treatment plan. (7 stages)

A

RELIEF OF PAIN
PREVENTION AT HOME

THEN, PROFESSIONAL PREVENTION:
- stabilisation of caries present
- restorations
- pulp therapy
- extractions
- behaviour management
- reinforce prevention

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9
Q

name the common causes of oral pain in children (7)

A
  • abscesses
  • caries/irreversible/reversible pulpitis
  • trauma
  • tooth wear
  • infection
  • soft tissue lesions
  • exfoliation/eruption
    IMPORTANT TO GET THE CORRECT DIAGNOSIS
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10
Q

describe history, examination and radiographic appearence of a reversible pulpitis in a primary tooth

A

HISTORY - precipitated by sweet/hot/cold, pain stops when stimuli removed, short duration, mainly occurs when eating.
EXAMINATION - early carious lesion
RADIOGRAPHS - caries INTO dentine

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11
Q

describe history, examination and radiographic appearence of an irreversible pulpitis in a primary tooth.

A

HISTORY - constant, relieved only by analgesics, kept awake at night, symptoms of reversible but untreated
EXAMINATION - lymphadenopathy, raised temp, extensive marginal ridge destruction, sinus, intra-oral swelling.
RADIOGRAPHS - caries close to pulp, radiolucency

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12
Q

name 3 things to consider before deciding to either restore OR extract a primary tooth

A
  • depends on the type of pulpitis present
  • quality and quantity of remaining tooth tissue
  • previous extractions and edentulous spaces.
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13
Q

name the 4 reasons when we would RESTORE a primary tooth

A
  • when the majority of other carious teeth are restorable (no point in extracting one!)
  • compliance
  • patient keen to save
  • good reasons (space maintenance, hypodontia)
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14
Q

name the 4 reasons when we would EXTRACT a primary tooth

A
  • when balancing extractions
  • non compliance/non-cooperative
  • no parental support
    -no attendance beyond pain relief
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15
Q

what does temporisation involve within a primary tooth/what is the use of a temporary filling

A
  • it involves the placement of a temp dressing which is effective in relieving pain until a restoration can be completed/ xla arranged, or if the tooth needs to be KUO for some time. the material should not be detrimental to the pulp, produce a good seal and not conflict with the proposed final restoration.
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16
Q

what does stabilisation involve when managing the primary dentition.

A
  • managing a child with constant poor OH and high risk caries needs to be thought of and should be stabilised first before any restorations are considered.
  • the procedure involves removing caries from cavity margins, dressing it which in turn means there is time bough for cooperation of the child to improve and treatment of other RESTORABLE teeth.
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17
Q

what are the VALUES of stabilisation

A
  • for the pre-cooperative patient, it prevents lesion progression!
  • if there are multiple carious lesions, we are arresting the caries in a long plan - better in the long run….
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18
Q

describe the sequence of operative care

A
  • where possible, start in the maxillary buccal segment as painless LA can be achieved here
  • DELAY IDBs until pt confidence and understanding has been achieved
    -operative care must be integrated with preventive therapy or new lesions will develop during the course of treatment.
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19
Q

describe the TYPICAL SEQUENCE of treatment for a child . (6)

A

PERIOD OF ACCLIMATISATION IS NECESSARY BEFORE EMBARKING ON RESTORATIVE APPROACH

  • temp dressing
  • ohi/prevention, placement of FS
  • simple, minimal restorations
  • restorations, pulp therapy, extractions (maxilla first!)
  • operative treatment in mandible IDB treat whole quadrant if and when possible
  • anterior restorations last.
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20
Q

describe the CROWN MORPHOLOGY of a primary tooth (9)

A
  • cervical BULGE with gingival constriction
  • tendency to make the floor of the box too deep when doing a restoration
  • exposure risk as pulp horns are nearer crown of tooth
  • narrow occlusal table
  • broad contact areas located gingivally
  • difficulties clearing buccal/lingual walls of box to clear contact when doing a restoration
  • large pulp horns sited below cusps
  • isthmus must be narrow to avoid pulp exposure…
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21
Q

6 REASONS WHY DECIDUOUS TEETH ARE RESTORED:

A
  • prevents pain, irreversible pulpitis and infection
  • avoids xla esp in medically compromised and anxiety pts
  • preserves function
  • maintenance of arch
  • space maintenance for permanent successors
  • anterior aesthetics - confidence etc
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22
Q

What are the two main factors affecting the CHOICE OF MATERIAL to restore

A
  1. Those relating to the tooth
  2. Factors relating to the patient
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23
Q

Explain the TOOTH FACTORS to consider when restoring a primary tooth.

A

-extent of carious lesion/how grossly carious is the tooth
-cavity shape after caries removal ie composite or amalgam

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24
Q

explain the PATIENT FACTORS to consider when restoring a tooth.

A
  • efficacy (how well are you able to…) of isolation and moisture control
  • caries rate (stabilise with temp material to obtain control eg GI FUJI)
  • aesthetic expectations of the patient
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25
Q

why is it a bad idea to remove as much caries as possible and replace with a GIC (do a pulpotomy)..

A
  • due to a large proportion of the teeth going into an abscess (infection)
  • this is due to the caries in primary teeth compromising the pulp VERY EARLY ON - due to the pulp being RELATIVELY larger in primary teeth (spreads to the pulp quicker)
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26
Q

why would we place a preformed metal crown if the restoration is large

A

it will strengthen the compromised remains (of the tooth) - maintaining function

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27
Q

describe what a pulpotomy is.

A

removing the CORONAL part of the pulp tissue, inflamed or infected as a result of deep caries and the MAINTENANCE of VITAL RADICULAR pulp tissue.

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28
Q

what is considered the definitive restoration for class II cavities in primary molars & why

A

STAINLESS STEEL CROWNS
this is because deciduous tooth morphology holds the key to the retention of the stainless steel crown. it is held by the CERVICAL CONSTRICTION
it is now seen as the optimum restoration in primary molars for strength, durability, wear characteristics.

29
Q

describe 4 signs in the primary dentition that would mean placing a sscrwn (indications for placing a SSCR)

A
  • large class 2 cavities
  • badly broken down teeth
  • following a pulpotomy
  • hard tissue anomaly (amelo imperfecta)
30
Q

2 considerations when selecting the correct fit of stainless steel crown.

A
  • each crown is marked with size and position
  • measure the mesiodistal width of the crown in the mouth or trial and error! - usually trial and error.
31
Q

describe the slice prep/conventional technique for placing a sscrwn(7)

A
  • remove caries
  • prepare the tooth - occlusal and approximal
  • select crown and try into mesial and distal areas - do not seat fully YET - will be hard to remove if seated fully
  • make sure there are no shoulders to prevent correct seating of crown.
  • cement crown
  • remove excess cement
  • check occlusion
32
Q

signs of a badly placed crown

A
  • over - extended on one side of the tooth ie mesially or distally
  • rocking - meaning its too wide for the crown of the tooth
33
Q

describe the hall technique

A

the hall technique is a method of managing carious primary molars using PMCs (preformed metal crown), but WITHOUT any tooth preparation, caries removal, or the use of LA as no tooth prep.

34
Q

describe the process/what you do when doing the hall technique.

A
  • the child sits UPRIGHT (usually) in dental chair
  • find the correct size of CROWN
  • fill the crown with GIC
  • ask the child to bite on the crown into place and encourage them to do so boldly and with commitment!
  • quickly wipe away excess cement!!
35
Q

what does carrying out an ANTERIOR restoration depend on…

A
  • dependant on age and co-operation of patient
  • preschool - indicates - bottle mouth caries…
  • if more than 3 years (non pacifier related) - this indicates HIGH CARIES ACTIVITY as no other relation/reason
  • traumatic fractures (trauma)
36
Q

describe the technique used to restore approximal anterior caries and describe the reason/use behind it.

A

a technique called DISCING can be used to create a self cleansing cavity but preventitive measures MUST be adhered to.

37
Q

Describe the minamata convention

A

was developed in July 2018, its a global treaty that aims to reduce the negative impact that mercury has on the environment - stopping the use of amalgam on primary teeth

38
Q

why is amalgam not a suitable choice for restoration in primary teeth

A

it requires destructive retention in cavity preps ie the depth requirement vs exposure and chance on material failing if cavity not deep enough as amalgam isnt bonded to anything apart from the cavity prep,

39
Q

what is a sign on a primary tooth of high caries activity?

A

OCCLUSAL SURFACE CARIES

40
Q

is composite resin/compomer widely used in the restoration of primary teeth

A

yes, it is, and has acceptable results
moisture control and expense are the cons of this material so needs to be used on a cooperative child so it is worthwhile doing.

41
Q

describe the use of rubber dam in paediatric dentistry as a method of moisture control (5)

A
  • it should be ENCOURAGED
  • children prefer it to cotton wool roll and bits falling into mouth
  • has safety benefits - inhalation, protection from caustic medicaments
  • great isolation/moisture control
  • it is a MUST for resin composites and pulp therapy procedures!!!!
42
Q

what teeth must we use an IDB on when restoring the primary dentition

A

the LOWER D,s and E,s. - IDBs must be used for all procedures on lower second deciduous molars A SHORT NEEDLE FOR AN IDB CAN BE USED FOR CHILDREN UNDER THE AGE OF 7!!!

43
Q

describe the dose limitation when administring LA

A

1/10th of a cartridge per KG of body weight
average child weights :
- 2 y/o - 10kg
-5y/o - 20kgs
- 10y/o - 40kgs

44
Q

what technique adjustment would we have to consider when administring LA to a CHILD patient.

A
  • the angle of the mandible of a child is more obtuse than that of an adult for the ID foramen is found lower
  • the adjustment is that the position from the opposing arch is over the deciduous molars rather than the adult 45 area.
45
Q

what is the rule of thumb for LA in mandibular molar area for paeds ….

A
  • CHILDS AGE + number of tooth eg D=4, E=5
  • IF THE TOTAL number is under 10we would carry out infiltrations, if over use IDB
  • for example, D(4) in a 5 y/o = 9 as this is under 10 we would carry out an LIA.
  • or an E in a 7y/o (5 plus 7 is 12), therefore we would carry out an IDB as its over 10!
46
Q

why wouldn’t we extract in the primary dentition (5)

A
  • loss of space - maybe develop a malocclusion
  • mastication (chewing)
  • speech difficulties/complications
  • aesthetics
  • avoidance of GA as much as possible
47
Q

Describe the primary pulp morphology ie the root canals etc.

A
  • primary root canals are more ribbon like whereas permanent teeth root canals are more conical shaped (rounded).
  • it has a fine filamentous pulp system which means that it is very easily broken down & not very well structured unlike secondary teeth.
  • the roots are much more splayed in primary teeth eg if we were to put a file down a primary tooth root canal it would be harder to access as it is not straight down.
  • the roots start to exfoliate in primary teeth
  • due to the softer enamel and dentine in primary teeth, it is much a higher risk of perferating through the tooth.
48
Q

When would we carry out a PULPOTOMY

A

we would mostly be carrying out a pulpotomy procedure on IRREVERSIBLE PULPITIS teeth OR where a third of the marginal ridge has broken down.

49
Q

when should the hall crown technique be used

A

should be used for teeth that are NOT involved with irreversible pulpitis to AVOID EXPOSING THE PULP - we want to arrest carious lesions in these teeth!

50
Q

how can we identify whether a tooth has irreversible pulpitis in a primary tooth or not

A

it is where a third or more of the marginal ridge has broken down, likely to be IP. - EVEN IF THE PULP LOOKS RELATIVELY UNAFFECTED ON A RADIOGRAPH. - in these cases a pulpotomy should be carried out.

51
Q

what is a pulp polyp

A
  • almost like a shell of tooth left over, usually from a pulp exposure but the pulp has then grown out of the chamber after (called hyperinflammation).
  • pulp polyps are VERY weak + as soon as we touch them they will break down. very painful!
52
Q

when should we not carry out pulp therapy (NOT JUST A PULPOTOMY) in primary teeth (contraindications)

A
  • tooth is unrestorable in the long term - VERY IMPORTANT (not enough hard tissue left for restoration)
  • if the pt is unco-operative
  • medically compromised eg cancer, leukeimia
  • ortho extractions? - worth speaking to an orthodontist if the child needs ortho treatment in the long run ie spacing for movement of teeth etc.
53
Q

list the 3 things we do for pulp therapy in VITAL primary teeth

A
  • pulp capping - DIRECT (if there is a micro-exposure, has to be caries free) AND INDIRECT (0.5mm within the pulp (a very deep restoration)
  • pulpotomy (pulp amputation) - SHOULD ONLY BE CARRIED OUT IF THE TOOTH IS VITAL
  • densensitising pulp therapy
54
Q

is a direct pulp cap suitable for primary teeth

A

NO - rare expectations

55
Q

describe what happens during a pulpotomy

A
  • involves removing the DISEASED CORONAL PORTION OF THE PULP only - WE NEVER GO INTO THE RADICULAR PULP - if we have to do this then we assume it is radicular pulpitis (death of pulp) and applying medicaments (soothes pulp/heals it) to the remaining pulp tissue, thus allowing the tooth to continue functioning
  • pulpotomy has a much greater success rate than pulp capping in primary molars
56
Q

when should we NOT carry out a PULPOTOMY

A
  • abscess (we know there is inflamed radicular pulp) - IMPORTANT
  • excessive bleeding upon access to pulp chamber - indicates inflamed radicular pulp
  • no bleeding upon access to pulp chamber (necrotic?)
57
Q

list the medicaments used in pulp therapy/pulpotomy in primary teeth - EXAM QUESTION SO KNOW THIS WELL

A

we should see pulp stumps after clearing the affected tooth:
formocresol
ferric sulfate
gluteraldehyde (v carcinogenic)
calcium hydroxide

58
Q

describe properties of ferric sulphate

A
  • excellent haemostatic agent - stops bleeding
  • emerging as an alternative to formocresol
  • not a fixative agent
  • applied to the pulp stumps for 15 seconds
59
Q

describe properties of calcium hydroxide

A
  • previously ruled out as a medicament for pulp therapy of primary teeth due to the effect of internal resorption
  • encourages new dentine formation, often dentine bridge is formed
  • calcium hydroxide works by allowing healing within the pulp, rather than fixing the tissue
60
Q

briefly explain the main points of each medicament used for a pulpotomy

A

formocresol - v efficient tissue fixative (makes it biologically intert), carcingogenic, recent concerns regarding safety, seeking an alternative
ferric sulphate - a promising substitute, although not as effective - works only as a haemostatic agent, although may have bactericidal properties - most commonly used in primary pulp therapy.
gluteraldehyde - works in same was as formocresol, but not as effective, some toxicity reported, research needed, probs not a contender
calcium hydroxide - works by promoting new dentine formation, thus protecting the pulp and allowing to heal, promising.

61
Q

what is the medicament of choice when carrying out a pulpotomy / why

A

ferric sulphate for 15 seconds on cotton wool pledget to control bleeding (haemostasis)

62
Q

what happens if the bleeding is still uncontrolled after carrying out a pulpotomy

A

if more bleeding is involved, this means that we have inflamed RADICULAR pulp - either dress/calm the tooth down and get the pt back in for XLA or XLA immediately. need to have this conversation with pt beforehand about the risks of pulpotomy tx as this is exactly what can go wrong .

63
Q

why do we carry out desensitising pulpotomies

A

used in order to REDUCE pulpal inflammation and/or symptoms in order to FACILITATE subsequent extraction or PULPECTOMY (we wouldnt necessarily carry out rct on a primary tooth - but we could XLA the tooth)

64
Q

list the 3 reasons why we would carry out desensitising pulp therapy:

A
  • carious pulp exposure but no signs or symptoms or loss of vitality
  • hyperaemic pulp during attempted pulpotomy (excessive bleeding)
  • hyperalgesic pulp - this is when adequate analgesia is not obtained. - pt is in a lot of pain
65
Q

describe the clinical technique for densensitising pulp therapy

A
  • open and gain access to pulp chamber (same for pulpotomy)
  • place a cotton wool pledget with ledermix directly over the exposure site
  • place a well sealed temp dressing ie kalzinol
  • review in 2 weeks, proceed with xla or pulpectomy (we dont do - so ref to dentist)
66
Q

what is ledermix

A

this is used when de-sensitising pulp and is a steroid/antibtiotic in one.

67
Q

pulp therapy for NON-VITAL primary teeth is as follows….

A

a pulpectomy
differs to pulp amputation as the aim is not to preserve the viable tissue, but it is to remove necrotic tissue and obturate canals - OUTWITH OUR REMIT ANYWAY

68
Q

What are the signs of irreversible pulpitis

A

signs/causes of irreversible pulpitis are caries (most common), trauma, and wear (often we see worn down cusps on baby teeth due to the softer enamel

PAEDS FLASHCARDS (10 decks)

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