Pulp Therapy in Children
Pulp Therapy in Children
Pulp Therapy in Children
preserve the vital pulp preserve the space for the underlying permanent tooth, eradicate potential for infection.
Clinical Assessment and Diagnosis of Pulp Status Visual and tactile examination of carious dentin. History of spontaneous unprovoked pain. Constant pain. Pain from percussion. Pain during the night. Degree of mobility. Palpation of surrounding soft tissues. Radiographic. Thermal and electric testing unreliable in primary teeth and permanent teeth with open apices.
1.
(calcium hydroxide) on healthy pulp tissue that has been inadvertently exposed from caries excavation or traumatic injury. Treatment Objective: to seal the pulp against bacterial leakage, encourage the pulp to wall off the exposure site by initiating a dentin bridge, and maintain the vitality of the underlying pulp tissue regions.
Contraindications for the Direct Pulp Cap 1. carious exposure, 2. spontaneous and nocturnal toothaches, 3. excessive tooth mobility, 4. thickening of the periodontal ligament, 5. radiographic evidence of furcal or periradicular degeneration, 6. uncontrollable hemorrhage at the time of exposure, and 7. purulent or serous exudate from the exposure.
Steps in the Procedure
1. Remove caries and make a conventional cavity preparation (which has resulted in a pinpoint exposure) 2. Gently clean the preparation with H2O2 3. Evaluate quality of hemorrhage and make sure bleeding stops quickly 4. Place Calcium Hydroxide (Dycal) directly on exposure 5. Place appropriate base and final restoration
2.
(1) a necrotic, soft, brown dentin outer layer, teeming with bacteria; (2) a firmer, discolored dentin layer with fewer bacteria; and (3) a hard, discolored dentin deep layer with a minimal amount of bacterial invasion.
3. PULPOTOMY
a. Calcium Hydroxide Pulpotomy
Indications
1. Primary teeth - is not indicated 2. Permanent teeth Carious or traumatic exposure Young vital tooth with incomplete root formation Asymptomatic pulp No periapical or furcation pathology
b. Formocresol Pulpotomy
Indications
1. Permanent teeth - is not indicated
2. Primary teeth Carious or traumatic exposure Young vital tooth Asymptomatic pulp No periapical or furcation pathology
Formocresole Pulpotomy
Steps in the Procedure
1. Remove gross decay 2. Remove roof of pulp chamber 3. Remove coronal pulp tissue 4. Apply dry cotton pellet 5. Apply formocresole impregnated cotton pellets for 1 2 minutes 6. Place IRM and a final restoration
Formocresol Pulpotomy
Criteria for Success 1. Correct diagnosis 2. Isolated field of operation 3. Opening the cavity sufficiently so that the entire pulp chamber is clearly visible 4. Using a medicament of sufficient strength to destroy all forms of bacteria