Vital Pulp Therapy Primary Teeth

Question 1

Indirect Pulp Therapy (IPC)

Answer 1

Cover deepest w/ biocompatible material to create bio seal

Not reimbursed well w/ insurance tho

Question 2

DPC

Answer 2

pinpoint exposure during caries removal covered w/ biocompatible material
little success in primary teeth

Question 3

Pulpotomy

Answer 3

entire coronal pulp removed, hemostasis of radicular pulp obtained and it is treated with a medicament of choice, MOST FREQUENTLY used VPT for deep caries on primary teeth
Panel recommends use of MTA and formocresol for pulpotomies (Strong rec, mod evidence)
Panel recommends AGAINST use of calcium hydroxide for pulpotomies (Conditional rec, low quality evidence)

Question 4

Panel Summary Pts

Answer 4

Overall panel found:

1. moderate quality evidence for IPT, MTA and formo pulpotomies. For all other interventions, quality of evidence was low or very low.
2. The success of IPT and DPC independent of medicament.
3. For pulpotomies higher evidence for use of MTA and formo and evidence against the use of CaOH

Question 5

Restoration after VPT

Answer 5

1. Resin/amalgam or SSC suggested for occlusal surface restorations on primary tooth w/ <2yrs life-span
2. SSC are treatment of choice for multi-surface restorations

Question 6

Restoration after VPT

Answer 6

1. Resin/amalgam or SSC suggested for occlusal surface restorations on primary tooth w/ <2yrs life-span
2. SSC are treatment of choice for multi-surface restorations

Question 7

Adverse effects of Formo

Answer 7

Panel did not find any reports on toxicity related to use of formo for VPT in children, when used judiciously for pulpotomy it is unlikely to be genotoxic, immunotixic or carcinogenic

Question 8

MTA

Answer 8

1. Panel found reports of unintended grayish discoloration of teeth treated with MTA pulpotomy, which had no influence on success of VPT
2. new multi-use products marketed now which have lowered price

Question 9

Mycobacterial infection

Answer 9

1. Contaminated water used for pulpotomies, introducing M. abcessus into pulp chamber, prevalence rate of 1%. Report done by CDC investigated this.
2. Can become severely ill, but no deaths reported. M. abcessus found in the environment and poses a risk.
3. Monitor water quality, disinfect water lines as per manufacturer’s instructions, use point of use water filters and eliminate dead ends in plumbing where stagnant water can enable biofilm formation.