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3RD yr- CCD1- Clinical > Pulp treatment in primary teeth > Flashcards

Pulp treatment in primary teeth Flashcards

1
Q

Describe primary molars

A
  1. Large pulp chamber
  2. Large pulp horns
  3. Wide dentinal tubules
  4. Porous pulp floor with accessory canals
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2
Q

The fact that primary molars have a large pulp chamber means what

A

That there is easy pulpal involvement when a tooth gets caries

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3
Q

What happens before a carious lesion reaches the pulp in a primary molar

A

Marginal ridge breakdown leading to pulp inflammation

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4
Q

Is pulpal inflammation reversible

A

It is but it can quickly become irreversible if the tooth isn’t treated appropriately

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5
Q

Why do we restore some primary teeth

A
  1. Allieviate tooth ache
  2. Abscesses
  3. Early tooth loss can lead to future orthodontic problems
  4. Damage to permanent successor
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6
Q

How can carious or infected teeth damage permanent successor teeth

A

Local hypoplasia can arise due to chronic infection of a primary tooth
This can lead to ‘turner’ tooth

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7
Q

List some factors that influence our decision to carry out pup treatment rather than extract a tooth

A
  1. Quality of tooth
  2. Presence of successor
  3. Age of patient
  4. Behaviour
  5. Presence of infection
  6. Medical history
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8
Q

List some contraindication that may arise in a Childs medical history that may prompt us to extract rather than restore

A
  1. Patients with cardiac disease are at an increased risk of infective endocarditis
  2. Immunocompromised children
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9
Q

List some dental factors that indicate tooth retention over extraction

A
  1. Minimal number of carious primary teeth is less than 3
  2. Hypodontia of permanent dentition
  3. Where prevention of medial migration of 6s is desirable
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10
Q

Give an example of a social factor that may indicate tooth retention over extraction

A

Patient is a regular attender with good compliance and positive parental attitude

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11
Q

List some dental factors that indicate tooth extraction over retention

A
  1. Tooth is unreotoabel after pulp therapy
  2. Extensive internal root absorption
  3. Large number of carious teeth with pulpal involvement
  4. Tooth is close to exfoliation
  5. Contralateral tooth is already lost
  6. Extensive pathology or acute face swelling
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12
Q

Give an example of a social factor that may indicate tooth extraction over retention

A

Patient is an irregular attender with poor compliance and unfavourable parental attitudes

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13
Q

Give some examples of treatment options we can use to restore teeth

A
  1. Indirect pulp therapy
  2. Pulpotomy
  3. Pulpectomy
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14
Q

What happens to the pulp at the end of indirect pulp therapy

A

Tooth is vital and pulp hasn’t been removed

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15
Q

What happens to the pulp at the end of a pulpotomy

A

Tooth is vital but some of the pulp is removed

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16
Q

What happens to the pulp at the end of pulpectomy

A

Tooth is non vital and pulp has been removed

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17
Q

How do we decide which treatment option to carry out

A

Dependent on pulpal status

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18
Q

What is contra indicated in inflamed primary teeth

A

Pulp capping

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19
Q

What is the aim of indirect pulp therapy

A
  1. To arrest the carious process and provide condition conducive to the formation of reactionary dentine an demineralisation of remaining carious dentine
  2. To promote pulpal healing and preserve/ maintain the vitality of pulp tissue
20
Q

Give some indication for indirect pulp therapy

A
  1. Tooth with a deep carious lesion

2. No signs or symptoms indicating pulpal pathosis

21
Q

How success is indirect pulp therapy

A

> 90% clinical success at 3 year follow up

22
Q

What do we do in indirect pulp therapy

A
  1. Clear margins to create a coronal seal
    2 Remove soft dentine
  2. Leave hard discoloured dentine
23
Q

What is the aim of a pulpotomy

A

To remove the coronal pulp, which has been clinically diagnosed as irreversibly inflamed
This leaves behind a possibly healthy or reversibly inflamed radicular pulp

24
Q

Give some indication of a pulpotomy

A
  1. Asymptomatic tooth or only transient pain
  2. A carious or mechanical exposure of vital coronal pulp
  3. No mobility
  4. No sinus/ abscess
  5. No history of swelling
  6. No intra radicular radiolucency on radiograph
  7. Bleeding pulp that stops with pressure
25
Q

How successful are pulpotomy’s

A

> 90% succes

26
Q

Give some signs a pulp may be non vital

A
  1. Mobile
  2. Presence of sinus/ abscess
  3. History of swelling
  4. intra radicular radiolucency on radiograph
  5. Spontaneous pain that doesn’t resolve quickly
  6. Necrotic pulp
  7. Furcation pathology
27
Q

How do we carry out a pulpotomy

A
  1. Take pre operative radiograph
  2. LA+ rubber dam
  3. Caries removal
  4. Access cavity
  5. Remove coronal pulp
  6. Control haemorrhage
  7. Apply chosen pulp medication
  8. Restore pulp chamber
  9. Place stainless steel crown and follow up
28
Q

give examples of pulp medication we can use when carrying out a pulpotmy

A

1, Ferric sulphate

  1. MTA
  2. Calcium hydroxide
  3. Electrosurgery
  4. Laser treatment
  5. Ledermix
  6. Formocresol
29
Q

Name our ho to pulp Medicaid for a pulpotomy.

A

Ferric sulphate

30
Q

How strong is the Ferric sulphate we use for a pulpotomy

A

15.5%

31
Q

What does Ferric sulphate do

A

It promotes pulpal haemostats

32
Q

How successful is Ferric sulphate

A

> 90%

33
Q

Which alternative do we use to Ferric sulphate sometimes

A

MTA

34
Q

What is MTA

A

Mineral trioxide aggregate

35
Q

What does MTA do

A

It releases cytokines from fibroblasts

These cytokines stimulate hard tissue formation

36
Q

What is the main disadvantage for using MTA

A

Expensive

37
Q

What are we aiming to do when creating our abscess cavity for a pulpotomy

A
  1. Remove caries
  2. identify exposire
  3. Remove roof of pulp chamber (NO DEEPER)
38
Q

What can we use to remove the coronal pulp in a pulpotomy

A
  1. Round burr

2. Sharp excavator

39
Q

How do we control the haemorrhage during a pulpotomy

A

Cotton wool soaked in saline

40
Q

when is pulp capping contra indicated

A

In inflamed primary teeth

41
Q

After placing Ferric sulphate what do we do

A
  1. DONT wash pulp chamber
  2. Restore with zinc oxide eugenol cement
  3. Pack well
  4. Place stainless steel crown
42
Q

What is the aim of a pulpectomy

A
  1. To remove irreversibly inflamed or necrotic radicular pulp tissue and gently clean the root canal system
  2. To obturate the root caries with a filling material that will resorb the same rate as the primary tooth
43
Q

List some of the indication for a pulpectomy

A
  1. Tooth diagnosed as having irreversible pulpits
  2. Non vital radicular pulp with/ without associated infections
  3. Good patient compliance
44
Q

How successful are pulpectomys

A

80% clinical success at 3 years

45
Q

What are we aiming to do in a pulpectomy

A
  1. Gain access to root canals
  2. Remove as much infected material as possible
  3. Fill canals with suitable material
46
Q

Talk through the steps of a pulpectomy

A
  1. LA+ rubber dam
  2. Access
  3. Identify canals
  4. Spin or inject ZnO cement into canals and then into pulp chamber
  5. Place stainless steel crown

3RD yr- CCD1- Clinical (7 decks)

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