Flashcards in Lecture 6 Deck (36)
Lower permanent first molars tend to ___
Upper permanent firs molars tend to ___
Tip and drift mesially
Remain upright but drift mesial (around palatal root?)
What is the primary objective of pulp therapy in the primary dentition?
Prevent or eradicate infection and to maintain the integrity and health of the teeth and their supporting tissues
What are the other objectives of pulp therapy?
Prevent space loss and malocclusion
Aid in mastication
Preserve the primary tooth in the case of hypodontia
Prevent possible speech problems
Maintain esthetics (more important for parent)
Prevent aberrant tongue habits
Prevent potentially damaging psychosocial effects (getting bullied)
Primary molars can last ___ years if they are kept well
Which has a larger margin of error, second or first primary molars?
What are some materials used for protective liners?
GLUMA (5% gluteraldyhyde and 35% HEMA. Useful as desensitized, cavity disinfectant, a resetting agent and an adhesion promoter.
You can do an indirect pulp cap when the tooth has ___ or ___, when the deepest carious dentin is not removed to avoid a pulp exposure.
Or reversible pulpits
Success rate depends most significantly on the diagnosis
True or false.. it is ok to leave affected dentin and infected dentin.
False. You may leave affected denting but you must remove all infected dentin
True or false... you may do an indirect pulp cap when there is radiographic evidence of pathologic external or internal root resorption or other pathologic changes
True or false.. you can do indirect pulp caps on teeth with reversible pulpitis
True or false.. MTA or calcium hydroxide can stimulate dentin formation
Primary teeth heal up better than permanent teeth
When is a protective liner indicated?
In a tooth with normal pulp when all caries is removed for a restoration. Protective liner can be placed in the deep areas of prep to minimize injury to pulp and promote pulp tissue healing and minimize post op sensitivity
What are some materials used for an indirect pulp cap?
Calcium hydroxide (GI or reinforced ZOE should be placed over it)
Why must you place GI or ZOE over calcium hydroxide?
Calcium hydroxide has high solubility, making a poor seal and low compressive strength. ZOE/GI provides a better seal preventing microleakage
What materials are used in direct pulp caps?
(Remember that GI or ZOE should be placed over it)
If you are going to do a pulpotomy, what should you do before you excavate the careis?
Prepare the tooth for full coverage
What are some matierals used in a pulpotomy?
Formocresol - devitaliztion/fixation
Ferric sulfate and chlorhexidine - preservation
MTA - regeneration
Filling - ZOE(IRM)
*although the medicaments and materials may change, the access opening technique will remain the same
If you see that the coronal pulp doesn't bleed or doesn't stop bleeding, should you do a pulpotomy?
No, this means the inflammation has gone beyond coronal pulp, do a pulpectomy
What are the indications for a pulpectomy?
Primary tooth with irreversible pulpits or necrosis
Roots should exhibit minimal or no resorption
What materials are used in a pulpectomy?
Iodoform paste - bacteriocidal, resoorbable
Although eh medicaments and materials may change, the access opening teachniques will remain the same
What are some contraindication to pulp therapy in primary teeth?
Close to exfoliation
PA abscess formation with swelling and drainage unless the tooth deemed important
Cellulitis (just extract it)
Medically complex pedo pts (transplants, cancer, immunosuppression)
What are the most important primary teeth to save?
Second primary molar prior to eruption of primary first molar (spacing issue)
This is really the only tooth you'd do pulp therapy on
Especially in young permanent teeth with immature roots, the pulp is integral to continue ___
True or false... a tooth without a vital pulp cannot remain clinically functional
True or false... symptomatic or asymptomatic irreversible pulpitis is incapable of healing
In permanent teeth, ___ and ___ tests may be helpful in diagnosing the pulp etiology
Electric pulp tests and thermal tests
What are the signs and symptoms of irreversible pulpitis or necrosis?
Hx of spontaneous unprovoked toothache
Soft tissue inflammation not resulting from gingivitis or periodontitis
Excessive mobility not associated with trauma or exfoliation
Radiographic evidence of internal/external resorption
What are the signs and symptoms of reversible pulpitis?
Provoked pain of short duration relieved by OTC analgesics
Pain caused by brushing or upon the removal of the stimulus and without signs or symptoms of irreversible pulpitis
Any planned treatment should include consideration of what 4 things?
The patients medical history
The value of each involved tooth in relation to the child's overall development
Restorablility of the tooth