s10 - Deep caries / Pulp Flashcards
What are the two types of pain considered in diagnosing deep carious lesions?
Provoked pain and spontaneous pain.
Why is history of pain less reliable in children compared to adults?
Children’s perception and reporting of pain can be inconsistent.
What does provoked pain indicate in a primary tooth?
It suggests the pulp is vital and protected by a thin layer of dentin.
What does spontaneous pain typically indicate?
Advanced pulp damage and potential pulp necrosis.
Why is tooth mobility assessed during a clinical examination?
Abnormal mobility may indicate advanced pulp disease affecting periodontal ligaments.
What does a positive response to percussion imply?
Possible apical or pulpal inflammation.
What are signs of an irreversibly diseased pulp in the mucobuccal fold?
Swelling, sinus, draining fistula, or chronic abscess.
Why is the size of the exposure and amount of pulpal bleeding significant?
Small pinpoint exposure with controlled bleeding is favorable for vital pulp therapy.
Why can radiographic interpretation be challenging in children?
Incomplete root formation, normal root resorption, and superimposition of permanent teeth.
What are radiographs used to assess in deep carious lesions?
Periapical changes, rarefaction of bone, and presence of calcified masses.
Why are sensitivity tests considered unreliable in children?
Children’s responses can be inconsistent, and pulp vitality tests may not reflect disease severity accurately.
Why should systemic health be considered before pulp therapy?
Serious systemic conditions may compromise pulp healing or increase infection risk.
What is the purpose of indirect pulp capping?
To maintain pulp vitality by placing a protective material over the remaining carious dentin.
When is indirect pulp capping indicated?
In deep caries where complete caries removal may result in pulp exposure.
What material is typically used in indirect pulp capping?
Calcium hydroxide (Ca(OH)₂).
How is success of indirect pulp capping evaluated?
No pain, no sensitivity to percussion, no radiographic pathology, and intact restoration.
What is direct pulp capping?
Application of a protective material directly onto an exposed pulp to maintain vitality.
Why is direct pulp capping not recommended for primary teeth?
Primary pulp ages early, has fewer undifferentiated cells, and is prone to internal resorption.
What are the main indications for pulpotomy?
Vital exposed pulp with limited inflammation and no advanced radiographic changes.
What materials are used for pulpotomy in young permanent teeth?
Calcium hydroxide for apexogenesis and formocresol for primary teeth.
What is the difference between calcium hydroxide and formocresol pulpotomy?
Calcium hydroxide promotes reparative dentin formation, while formocresol fixates pulp tissue.
How is hemorrhage controlled during pulpotomy?
With a sterile cotton pellet for about 4 minutes.
Why is a stainless steel crown often placed after pulpotomy?
To protect the weakened, brittle tooth structure post-treatment.
What is a partial pulpectomy?
Removal of coronal pulp tissue and partial removal of radicular pulp.
When is partial pulpectomy indicated?
In vital primary molars with hyperemia but no advanced necrosis.
What is a pulpectomy in primary anterior teeth typically used for?
Devitalized primary anterior teeth due to caries or trauma.
What materials are used for filling in pulpectomy for primary teeth?
Resorbable materials like calcium hydroxide or zinc oxide-eugenol.
What are contraindications for performing pulpectomy in primary teeth?
Severe root resorption, extensive bone loss, or compromised patient cooperation.
Why should pulpectomy be done cautiously in young permanent teeth?
To avoid trauma to developing roots and permanent tooth buds.
What is the recommended filling material for pulpectomy in primary molars?
Zinc oxide-eugenol or oxypara.
How does zinc oxide-eugenol affect the pulp?
It can cause chronic inflammation, abscess formation, and liquefactive necrosis.
What is the effect of calcium hydroxide on the pulp?
It creates a superficial necrosis that stimulates a calcific barrier, promoting healing.
Why is calcium hydroxide considered effective for pulp capping?
Its high pH (alkalinity) stimulates odontoblastic activity and dentin bridge formation.
What is the initial pulp reaction to formocresol?
Surface fibrous fixation followed by inflammatory response deeper into the pulp.
Why is formocresol controversial in pediatric dentistry?
Its potential systemic toxicity and link to internal resorption have raised concerns.
What are the three zones observed under formocresol-treated pulp?
Fixation (acidophilic), atrophy (pale), and inflammation (deep layer).
What is the most common sign of failure after pulpotomy?
Internal resorption visible on radiographs.
What typically causes internal resorption after pulpotomy?
Osteoclastic activity stimulated by inflammation or irritation from capping materials.
How can alveolar abscesses occur after pulp therapy?
Due to undetected pulp necrosis or inadequate sealing of the pulp chamber.
Why is pulp therapy contraindicated in primary teeth near exfoliation?
The natural resorption of roots can lead to treatment failure.
What are general contraindications for pulp treatment in primary teeth?
Poor patient cooperation, severe decay, or significant systemic health issues.
What is the principle of electrosurgery pulpotomy?
Non-chemical devitalization through heat-induced pulp cauterization.
Why is laser pulpotomy preferred over electrosurgery?
It creates a superficial coagulative necrosis while preserving underlying pulp tissue.
What is a significant advantage of laser pulpotomy in children?
Minimal bleeding and reduced postoperative discomfort.
Why are advanced pulpotomy techniques not widely adopted in all settings?
They require specialized equipment and may have higher costs.
What is the goal of apexogenesis?
To maintain radicular pulp vitality and allow root development to completion.
Which material is commonly used for apexogenesis?
Calcium hydroxide.
Why is periodic radiographic evaluation important in apexogenesis?
To confirm root closure and absence of pathologic changes.
What is apexification?
Inducing calcific closure of the root apex in non-vital young permanent teeth.
What material is preferred for apexification?
Calcium hydroxide to stimulate calcific barrier formation.
Why is careful follow-up essential during apexification?
To replace the calcium hydroxide if it washes out before closure.
