Paeds session 3

Question 1

Describe the procedure for a pulpotomy

Answer 1

1. Select straight fissure bur and remove caries from extracted tooth
   
   2. Should be able to see the pulp orifices
   3. To arrest the haemorrhage - ferric sulphate is used. Placed on pulp chamber and check for haemostasis
   4. If it is still unsuccessful it may be that the pulp tissue is hyperaemic and pulpectomy or extraction may be indicated instead
   5. If haemostasis is achieved fill with zinc oxide paste - tooth should now be restored using preformed metal crown

Question 2

Describe the procedure for a pulpectomy

Answer 2

1. Caries has been removed and an access cavity cut
   
   2. Pulp canals cleaned out using a file with a stopper set 2mm short of our estimated working length
   3. Canals are irrigated between filing and given a final rinse before being dried with paper points
   4. Vitapex delivery system has a rubber point 2mm short of our working length and the material introduced into the canals
   5. As in the pulpotomy procedure the pulp chamber can be filled with zinc oxide euganaol and filled with a stainless steel crowns

Question 3

What are the disadvantages of unplanned primary tooth extractions

Answer 3

Loss of space causing increased risk of malocclusion

Decreased masticatory function

Impeded speech development

Psychological disturbance

Trauma from anesthesia surgery

Question 4

What are indications for pulp treatment

Answer 4

good cooperation

medical history precludes extraction

missing permanent successor

over-riding necessity to preserve the tooth

child under 9 years of age

Question 5

What may be seen in a medical history that means that pulp treatment is more beneficial than extraction

Answer 5

Bleeding disorders

Question 6

What may be seen in a medical history that means that extraction is more beneficial

Answer 6

if patient is immunocompromised - higher risk of infection

Question 7

What are contraindications for pulp treatment

Answer 7

poor cooperation
poor dental attendance
cardiac defect - ENDOCARDITIS RISK
multiple grossly carious teeth 
advanced root resorption 
severe/recurrent pain or infection

Question 8

What is the best treatment for a vital tooth in primary teeth

Answer 8

vital pulpotomy

Question 9

When is a vital pulpotomy done

Answer 9

when there is carious or traumatic exposure of a bleeding pulp

Question 10

What is the main principles of a pulpotomy

Answer 10

radicular pulp is preserved and bleeding controlled
ALWAYS USE LA
use rubber dam
remove caries prior to access 
remove entire roof of pulp chamber

Question 11

What is the technique for pulptomy

Answer 11

remove roof of pulp chamber

remove coronal pulp with

sterile excavator or slow

running large round steel bur

place a cotton pledget with ferric sulphate for 20 seconds

place zinc oxide/eugenol in the pulp chamber and restore with PMC

Question 12

Describe the access stage of a pulpotomy

Answer 12

caries removal

remove roof of pulp chamber using sterile diamond fissure bur

Question 13

Describe the amputation stage of a pulpotomy

Answer 13

remove coronal pulp (using sterile excavator/round steel bur)
hemorrhage control
evaluate pulp stumps
place ferric sulphate over root stumps for 20 seconds and evaluate - want to achieve minimal oozing

Question 14

Describe the restoration stage of a pulptomy

Answer 14

cover root stumps with reinforced ZOE paste/CaOH/MTA
GIC core
restore with PMC

Question 15

What does normal bleeding appear as

Answer 15

bright red colour

good hemostasis

Question 16

What does normal bleeding indicate

Answer 16

uninflammed pulp

Question 17

What does abnormal bleeding appear as

Answer 17

deep crimson colour

continued bleeding after pressure

Question 18

What does abnormal bleeding indicate

Answer 18

inflamed pulp

Question 19

When is a pulpectomy done

Answer 19

non vital or hyperemic pulp

irreversible pulpitis

Question 20

What are the signs of a non vital primary molar

Answer 20

hyperemic pulp - lots of bleeding

pulp necrosis and furcation involvement

Question 21

What are the symptoms of a non vital primary molar

Answer 21

irreversible pulpitis
periapical periodontitis
chronic sinus

Question 22

If you see a severe infection with facial swelling what should be done

Answer 22

EXTRACTION

Question 23

What is required from a patient for a primary molar pulpectomy

Answer 23

excellent patient cooperation

Question 24

What is the aim of a primary molar pulpecotmy

Answer 24

prevent control/infection by removal of radicular pulp followed by cleaning and obturation of canals

Question 25

How is the estimated working length assessed

Answer 25

on a radiograph

Question 26

How many mm short of EWL should the files be

Answer 26

2mm

Question 27

Why do you need to keep files 2mm short

Answer 27

open apex

don’t want to risk damaging permanent successor

Question 28

What are the shapes of the primary canals

Answer 28

wide ribbon shaped

Question 29

What are potential complications of a pulpectomy

Answer 29

early resorption leading to early exfoliation

over preparation

Question 30

How does a radiographic failure of pulpotomy and pulpectomy appear

Answer 30

increased radiolucency
external/internal resorption
furcation bone loss

Question 31

How does a clinical failure of pulpotomy and pulpecotmy appear

Answer 31

pathological mobility
fistula/chronic sinus
pain