Pulp Therapy in the Primary Dentition

what is different from GA and LA

LA can still feel pressure senses etc but GA means reflexes and all nerves are shut off

means it is dangerous

why do we not extract primary teeth

loss of space - malocclusion

mastication

speech

aesthetics

avoidance of GA

what is accessory root canals

common in furcation

why we need to vitality test as bacteria can cause pulpal death

are little channels across the root and into the PDL

what is the difference in pulp chamber in primary and secondary root

Increased number if accessory canals foramina and prosperity of pulpal floors

Primary root canals are more ribbon like

Fine, filamentous pulp system and difficult to debride

root canals do not open at the apex of the root in primary teeth

when do we do a pulpotomy

irreversible pulpitis without abscess infection

what caujses irreversible pulptitis

caries

trauma

wear

What is carious exposure

pulp chamber is exposed to the oral cavity and bacteria air etc due to decay

what is a pulp polyp

caries is so bad there is only a shell of tooth around pulp tissue that is very swollen

this is overgrown due to bacteria etc and is broken with excavator

what pulp therapy do we do on vital teeth

pulp capping

pulpotomy

desensitising pulp therapy

when do we extract instead of pulp therapy

tooth is unrstorebale long term

pt uncooperative

medically compromised eg bleeding disorder

ortho extractions

what is a pulpotomy

Removal of the coronal portion of an exposed vital pulp

when would be not do a pulpotomy

abcess

no bleeding - tooth is dead

too much bleeding - indicates radicular inflammation

what medicaments are used

formocresol

ferric sulphate

gluteraldehyde

calcium hydroxide

what is formocresol and how does it work

tricesol - antiseptic

formalin - tissue fixative

binds bacterial and pulp proteins together so they dont decompose

is bacteriacidial and devitalising

tissue is fixed and inert to bacterial enzymes

why do we not use formocresol

mutagenic and carcinogenic properties found in animal studies

absorbed quick and goes into kidneys and liver etc

can leach into apical foramen and bad cos tooth germ is behind

devitalises 80-90% radicular pulp

what is ferric sulphate and how does it work

haemostatic - stops bleeding into pulp chamber

15% ferric sulphate in the lulp for 15 seconds

what is gluteraldehyde

aqueous solution 2-4%

powerful fixative discovered to have toxic effects

innfecetive compared to formocresol

linked to asthma

what is calcium hydroxide

allows dentine bridge of tertiary dentine to form due to irritant which cuts off inaffected radicular pulp from diseased coronal portion

encourages new dentine formation and creates a barrier from bacterial invasion

what is the clinical technique for pulpotomy

LA always necessary

isolate with DAM

outline form to access caries

caries removal and ensure margins are clear

remove caries from the cavity overlying pulpal roof so u can see horns

remove entire roof of pulp chamber but not the floor

remove contents of diseased pulp with excavator or slow speed bur

irrigate with saline and then pressure

apply medicament and restore with calcium hydroxide pulp base - medicament is what stops the bleeding

add zinc oxide eugenol into cavity

then SSC

what is always necessary for a pulpotomy

LA cos the tooth is vital

if there is excess bleeding what do we do

means there is possible inflammed radicular pulp;

do desensitising pulp therapy

pulpectomy

extract

what is desensitising pulpotomy

reduce pulpal inflammation and/or symptoms in order to facilitate extraction or pulpectomy

indicates carious exposure but no signs or symptoms of loss of vitality

also indicates hyperaemic or hyperalgasic pulp

how do we do desensitising pulpotomy

open access to chamber

dont use medicament, put on ledermix - mix of abx and steroid on exposed site

then restore with a well sealed temp restoration and review 7-10 days