What are 5 characteristics of primary teeth to consider when treatment planning?
- progresses rapidly
- the teeth are smaller with larger pulp chambers
- the contact areas are broad
- irreversible pathological changes can occur prior to pulpal exposure
- the involvement of radicular pulp is earlier than in permanent dentition
What are 6 signs and symptoms associated with pulpal inflammation in primary teeth?
- any history of spontaneous pain, especially at night
- reported pain on biting
- the necessity for analgesics
- the clinical extent of caries, notably the presence of marginal ridge breakdown
- the presence of any intra-oral swelling or sinus
- a history of intra-oral or facial swelling
What 2 special investigations can be done on a paeds patient?
- gentle finger pressure to determine if mobile/tender
- radiographs: provide info on extent of caries, check for permanent successor, proximity of pulp horn
- no pulp testing as not appropriate
What are 3 indications for tooth retention?
- medical factors: patients at risk if a GA is required
- dental factors: minimal number of extensively carious primary molars likely to require pulp therapy, hypodontia, prevention of mesial migration, crowding
- social factors: regular attender with good compliance
What are 3 indications for tooth removal?
- medical factors: patient at risk from residual infection
- dental factors: tooth unrestorable after pulp therapy, extensive internal root resorption, extensive pathology or acute facial swelling
- social factors: irregular attender with poor compliance and unfavourable parental attitudes
What are 4 treatment options for caries in primary teeth?
- hall crowns cemented with GI provide an effective seal and a fluoride reservoir
- site specific prevention
- none restorable cavity control
- caries removal and restoration
What are 3 treatment options for caries in primary teeth with pulpal involvement?
- indirect pulp capping: arrest the carious process and arrest decay, stimulate remineralisation of remaining carious dentine to promote pulpal healing
- direct pulp capping: to encourage the formation of a dentine bridge at the point of pulpal exposure with preservation of pulpal health
- pulpotomy: a pulpotomy entails the removal of the coronal pulp and maintenance of the radicular pulp
What are the symptoms of reversible pulpitis?
- pain to cold/sweet
- tooth not ttp
- resolves on removal of stimulus
- tooth difficult to localise
- eases with pain relief
What are the symptoms of irreversible pulpitis?
- spontaneous pain wakens child at night
- does not resolve on removal of stimulus
- pain to hot/cold
- does not resolve with placement of a temp dressing
What are the symptoms of a dental abscess/periradicular periodontitis?
- spontaneous pain wakens child at night
- tooth mobile and ttp
- swelling
- malaise
What is the treatment option for a child with reversible pulpitis symptoms?
restore or place a dressing and restore later
What is the treatment for an uncooperative child patient with irreversible pulpitis?
- try to dress with sub lining of corticosteroid abx paste
- refer for treatment/XLA with sedation or GA
What is the treatment for a cooperative child with irreversible pulpitis symptoms?
- XLA or appropriate pulp therapy
What is the treatment for a child with multiple abscessed teeth?
refer for XLA with sedation or GA
What is the management for a child with symptoms of abscess or infection?
- XLA or pulpectomy
What is the management for caries when the tooth is close to exfoliation?
- non-restorative cavity control or site specific prevention
What is the treatment options for arrested caries in primary tooth?
- non-restorative cavity control or site specific prevention
What is the treatment for caries in a primary tooth that is not restorable?
XLA or non-restorative cavity control and review
What is the treatment for caries where on the radiograph, there is no clear separation between caries and the pulp?
explain uncertain prognosis and consider management options e.g. hall technique or pulpotomy
What is the treatment options for an initial lesion in a primary anterior tooth?
site specific prevention
What is the treatment options for an advanced lesion in a primary anterior tooth?
- selective caries removal
- complete caries removal
- non-restorative cavity control
What is the treatment options for initial occlusal caries on a primary molar?
- fissure sealant or site specific prevention
What is the treatment options for advanced occlusal caries on a primary molar?
- selective caries removal
- hall technique
What is the treatment options for advanced proximal caries on a primary molar?
- hall technique
- selective caries removal
