Pulp therapy

Question 1

Aims and indications fo pulp therapy?

Answer 1

Maintain a disease free primary tooth until exfoliation
Maintain intact arch
Avoid physiological and psychological trauma of extraction
If extraction Control-indicated
No permanent successor tooth
Space maintenance
Cooperative child/carer

Question 2

Contra-indications of pulp therapy

Answer 2

uncooperative
Child at risk f infection
Neglected dentition
Severe acute infection
Unrestorable crown
Root caries
>2/3 root resorption (near to exfoliation)

Question 3

3 approaches to pulpotomy

Answer 3

Preserving radical pulp in a healthy state
Rendering radical pulp inert
Encouraging tissue regeneration and healing of radicular pulp at site of amputation

Question 4

Describe the ideal pulp therapy

Answer 4

Doesn’t harm pulp or surrounding tissue
No interference with physiological root resporption
Promtote healing of radicular pulp

Question 5

Aetiology of pulp disease

Answer 5

Microbial infection - more rapid progression in primary

Marginal ridge collapse

Question 6

How can pulp therapy be characterised?

Answer 6

Vital vs non vital pulp

Non-vital pulp = pulpectomy only

Vital = indirect pulp therapy
pulpotomy
Desensiting pulpotomy
Pulpecotmy

Question 7

When is indirect pulp therapy used?

Answer 7

Deep dentinal caries, no symptoms/nocturnal pain (no irreversible inflammation), no pulp exposure, walls clean but stained cavity floor (if removed would expose pulp)

Question 8

What is pulpotomy?

Answer 8

Removing irreversibly inflamed pulp and leaving normal/reversible inflammation

Question 9

How do you know if the pulp is irreversibly inflamed?

Answer 9

Lots of bleeding that doesn’t stop in normal time after ferric sulphate adminsteraion

Question 10

Management if arrested bleeding in pulpotomy

Answer 10

Ferric sulphate for 15 seconds

Question 11

Management of copious bleeding in pulp?

Answer 11

2 applications fo ferric sulphate or pulpectomy

Question 12

Describe ferric sulphate pulpotomy?

Answer 12

Prepare cavity and remove caries into pulp
Apply ferric sulphate 15% for 15% to stop bleeding
GIc and pre-formed metal crown

Question 13

When to use desisting pulp therapy?

Answer 13

When no LA or LA not working

Question 14

Describe desensitising pulp therapy

Answer 14

expose pulp until sensitive = dress with ledermix

second visit = ferric sulphate pulpotomy

Question 15

When is non-vital pulp therapy used?

Answer 15

Pulp is necrotic = no blood

or irrveeribsle pulpitis - lots of blood, not stopping

Question 16

How to perform non-vital pulp therapy (pulpectmy)

Answer 16

Remove coronal pulp and extirpate radicular pulp
Clean but don’t shape - irrigate with chlorhex/saline
If bleeding = temporise
next visit fill