Primary tooth pulp therapy and restorative

Question 1

What interview questions should be asked to determine the subjective symptoms?

Answer 1

Chief Complaint
Which tooth
What are you doing when it starts hurting?
How badly does it hurt? 1-10?
Does it hurt for a long time?
Beware of questionable reliability in reporting

Question 2

What are the main components of an objective intra and extra oral examination?

Answer 2

Is it a tooth/which tooth?
Soft tissue infection/facial cellulitis or parulis, fistula, abscess
Pathologic mobility
Sensitivity to palpation/percussion
Pulp testing
Radiographic signs
Direct inspection of the pulp

Question 3

What is the value of cold/heat/EPT vitality testing in primary teeth?

Answer 3

NOT reliable in primary dentition
False-positive results
Not reliable reporting

Question 4

What is the best test for primary tooth pulps?

Answer 4

Percussion

Use with caution!

Question 5

What are the radiographic signs of necrotic pulps?

Answer 5

Furcation radiolucencies, apicies of anterior teeth

Root resorption

Question 6

What are the different presentations of damaged or necrotic pulps?

Answer 6

Presence of hemorrhage
Quality and quantity of hemorrhage
Dry chamber
Purulent exudate or malodor

Question 7

What are the options for vital pulp therapy in primary dentition?

Answer 7

Indirect pulp treatment
Direct pulp cap
Pulpotom

Question 8

What are the options for NON-vital pulp therapy in primary dentition?

Answer 8

Pulpectomy

Extraction is the other alternative

Question 9

What are the indications for VITAL pulp therapy?

Answer 9

Intermittent, short duration

thermal or chemical stimulation

Question 10

What are the indications for NON VITAL pulp therapy?

Answer 10

Spontaneous pain
Nocturnal pain
Prolonged pain
Soft tissue signs
Pathologic mobility
Furcation/apical radiolucency
Radiographic evidence of internal/external resorption

Question 11

What are the indications for indirect pulp treatment?

Answer 11

Selection criteria

• -Restorable tooth
• -Near pulp exposure radiographically
• -Vital pulp: no spontaneous pain, no clinical signs, no radiographic signs

Question 12

What is the procedure for indirect pulp treatment?

Answer 12

Excavate but leave the deepest caries behind to avoid a pulp exposure
Place protective liner such as RMGI
Restore: The SEAL is the deal

Question 13

What is the selection criteria for direct pulp capping?

Answer 13

Restorable tooth
Pulp exposed during carious dentin removal
Pulp exposure is 1mm or less
Vital pulp
--No spontaneous pain
--No clinical signs
--No radiographic signs
LOW quality evidence for success

Question 14

What is the procedure for direct pulp capping in primary teeth?

Answer 14

Caries removal leads to pulp exposure
Apply medicament (CaOH, dentin bonding agents, MTA, formocresol)
Place protective liner such as RMGI
Restore: the SEAL is the deal

Question 15

What is the selection criteria for pulpotomy?

Answer 15

Restorable tooth with carious pulp exposure
VITAL pulp
--No spontaneous pain
--No clinical signs
--No radiographic signs

Question 16

What is the procedure for a pulpotomy?

Answer 16

LA and rubber dam isolation
Occlusal reduction
Access and completely de-roof pulp chamber– use 6 or 8 round bur
Careful removal of all coronal pulp tissue and remaining caries
Irrigate pulp chamber with water and dry with cotton pellets
Direct inspection of pulp (uncontrolled bleeding is a contraindication for pulpotomy)
Apply medicament (ferric sulfate at OSU) to surface of radicular pulp
Seal with IRM
Break contacts
Place SSC

Question 17

What are the different types of intracanal medicaments?

Answer 17

Formocresol
Ferric sulfate
MTA

Question 18

What are the functions of formocresol?

Answer 18

Long history of clinical success
Contains formaldehyde, creates a zone of fixation at the surface of the radicular pulp
Safety concerns?

Question 19

What are the functions of ferric sulfate?

Answer 19

Ferric ions interact with blood proteins leading to agglutination (forms physical plugs to occlude canal orifices)
Potential to mask hyperemic appearance of pule (assess pulp status with cotton pellets first

Question 20

What are the functions of MTA?

Answer 20

High alkalinity is antibacterial
High biocompatibility
Excellent seal
Promotes hard tissue formation
More expensive

Question 21

What are the selection criteria for pulpectomies in primary teeth?

Answer 21

Restorable tooth
Irreversible pulpitis or necrotic pulp
Spontaneous pain
Clinical signs
Radiographic signs

Question 22

What is the procedure for primary tooth pulpectomies?

Answer 22

LA, isolation with RD, prep, de-roof chamber
Debride and shape root canals with files
Irrigate canals with CHX or sodium hypochlorite and dry
Fill with resorbable material: ZOE, iodoform based paste, iodoform+calcium hydroxide
Under-fill>overfill

Question 23

What the best restorations after pulp therapy?

Answer 23

SSCs

Composite or amalgam can be considered with sufficient tooth structure and a tooth that will exfoliate within 2 years