Pulp therapy

Question 1

Describe the pulp in primary teeth

Answer 1

Relatively large pulp chamber compared to small tooth size

Question 2

Why is there early pulp involvement in primary teeth?

Answer 2

Thinner enamel and dentine and larger pulps

Question 3

Disadvantages of early tooth loss

Answer 3

Risk of space loss and centre line shifting 
Decreased masticatory function 
Impeded speech 
Psychological disturbance 
Trauma from anaesthesia/surgery

Question 4

What is at risk in primary endodontics?

Answer 4

Damage to permanent successor

Question 5

How to diagnose pulp status in children

Answer 5

History
Examination
Radiographs

Other special tests are unreliable

Question 6

What ix do we avoid in children?

Answer 6

TTP and electrical pulp tests, cold tests

Question 7

Irreversible pulpitis symptoms and signs

Answer 7

Spontaneous, unprovoked pain 
Sinus tract/ soft tissue inflammation 
Excessive PATHOLOGICAL mobility 
Furcation radiolucency 
Radiographic evidence of internal/external resorption

Question 8

Reversible pulpitis symptoms

Answer 8

Provoked pain of short duration that does not linger

Relieved with analgesics

Question 9

What are the tpes of pulp therapy in primary teeth

Answer 9

(Direct pulp cap)
Indirect pulp cap
Pulpotomy
Pulpectomy

Question 10

What is pulpotomy also called?

Answer 10

Vital pulp therapy

Question 11

Indications for pulp therapy

Answer 11

• Evidence of pulpal symptoms
• Regular attender
• Restorable
• Overriding need to retain tooth as space maintainer e.g. missing successor or long time until exfoliation
• No other teeth requiring pulp therapy
• Developmental state of tooth

Question 12

Contraindications for pulp therapy

Answer 12

• Poor coop/attendance
• Medical contraindications
• Unrestorable
• Multiple grossly carious teeth w pulp symptoms
• Advanced root resorption
• Severe or recurring pain
• Close to natural exfoliation
• Cellulitis
• Gross bone loss

Question 13

List medicaments used in pulp therapy

Answer 13

Ferric sulphate
Calcium hydroxide
MTA

Question 14

Is odontopaste used?

Answer 14

It can be if the pt in pain or the tooth will be extracted eventually
It causes pulpal necrosis

Question 15

Irrigants used in primary teeth

Answer 15

Saline
LA
CHX

Question 16

What irrigant is NOT used in children

Answer 16

SODIUM HYPOCHLORITE !!!!

Question 17

When is LA a useful irrigant

Answer 17

Hyperaemic pulp

Question 18

Indications for direct pulp cap

Answer 18

Asymptomatic tooth with small, traumatic pulpal exposure (non-carious)

Question 19

Rationale of direct pulp cap

Answer 19

Dentine bridge formation at the point of exposure to preserve vitality

Question 20

Success of direct pulp caps

Answer 20

VERY POOR - not done in children

Question 21

Indications for indirect pulp capping

Answer 21

Primary molars with deep caries

No signs/symptoms/history of pulpal pathology

Question 22

Rationale of indirect pulp cap

Answer 22

Arrest carious process and provide conditions conductive for the formation of reactionary dentine to remineralise retained caries

Question 23

Success of indirect pulp cap in primary teeth

Answer 23

VERY SUCCESSFUL

>90% clinical success observed

Question 24

What is a pulpotomy

Answer 24

Partial removal of the pulp

Question 25

Indications for pulpotomy

Answer 25

- Carious or traumatic exposure of a vital pulp | - Pulp minimally inflamed/reversible pulpitis

Question 26

Rationale of pulpotomy

Answer 26

Affected pulp removed and remaining pulp is preserved, thus maintaining vitality and allowing tooth to exfoliate naturally

Question 27

What type of bleeding is normal in pulpotomy

Answer 27

Bright red blood that achieves good haemostasis after gentle pressure with ferric sulphate

Question 28

What type of bleeding is abnormal in pulpotomy

Answer 28

Deep crimson colour which doesn't achieve haemostasis

Question 29

What does abnormal bleeding in pulpotomy indicate

Answer 29

Extensive inflammation - most likely irreversible pulpitis

Question 30

Indications for pulpectomy

Answer 30

- Irreversible pulpitis - Non-vital pulp or hyperaemic pulp - Profuse bleeding during pulpotomy

Question 31

Aims of pulpectomy

Answer 31

Control infection by removing non-vital or hyperaemic pulp and obtruate canals with resorbable material allowing the tooth to exfoliate naturally

Question 32

When is one stage pulpectomy done

Answer 32

In absence of infection bc the canals can be dried

Question 33

When is two stage pulpectomy done

Answer 33

When there is infection or profuse bleeding preventing drying of the canals

Question 34

When should the tooth be extracted

Answer 34

Signs of cellulitis or severe infection, especially if it is recurring or if MH indicates immunocomp

Question 35

When should the PMC be placed and why?

Answer 35

Ideally in the same appt as it improves overall prognosis

Question 36

When should the patient be reviewed after pulp therapy

Answer 36

Every 6 months until the tooth exfoliates

Question 37

When should radiographs be taken after pulp therapy

Answer 37

Every 12-18 months until exfoliated

Question 38

Clinical signs of failed pulp therapy

Answer 38

Pathological mobility Fistula or chronic sinus Pain

Question 39

Radiographic signs of failed pulp therapy

Answer 39

Increased or new radiolucency External/internal resorption Furcation bone loss