Non-vital primary tooth tx

Question 1

Pulpectomy

Answer 1

High success rate, viable long term tx option
Monitor closely in first year
Use for dead/dying/abscessed w/ NO ROOT RESORPTION
Pulpectomy > LSTR when no root resorp
F/U x-rays every 12 months
ZO/iodoform/CaOH and ZOE may be better choice for obturation material compared to iodoform
Adverse effects:
Retained ZOE after exfoliation COMMON due to slow resorption of ZOE → can affect perm tooth path of eruption → ant crossbite for incisors possibility,
If pain after 48 hrs means therapy failed)

Question 2

LSTR

Answer 2

Better than pulpectomy when have sig root resorption (>1mm or internal resorp) or if you just need to retain tooth for up to 12 months and otherwise would need to be extracted
Perhaps ONLY use LSTR to save for up to 12 months to maintain space and monitor periodically
If LSTR tooth retained for longer than 12 months monitor closely
NO TETRACYCLINE
Alternate 3Mix w/o tetracycline better over traditional 3Mix
NOT COVERED by insurance → reduces conservative options for dentists

Question 3

Extraction indications

Answer 3

extensive root or crown resorp → non-restorable
parent preference, age, cost
Childs inability to cooperate
Complex med hx
Inability to achieve anesthesia
Limited opening
Severe gagger
Facial swelling
Oral pain w/ unclear diagnosis, complication from prior pulp therapies

Question 4

Reversible pulpitis

Answer 4

Provoked pain from eating for short duration (5-10min)

Question 5

Irreversible pulpitis/Necrosis

Answer 5

spontaneous unprovoked toothache, sinus tract, soft tissue pathology and gingival swelling, abnormal tooth mobility, furcation/apical RL, internal/external resorp