Pulp Therapy

Question 1

Morphology of tooth and pulp?

Answer 1

1. Increased number of accessory canals
2. Root canals more ribbon like
3. Filamentous pulp system
4. More difficult canal debridement
5. Increased potential of root perforation

Question 2

If tooth has a third or more of the marginal ridge broken down most likely what?

Answer 2

Irreversible pulpitis

Question 3

What would be carried out for irreversible pulpitis?

Answer 3

Pulpotomy however more commonly now is the hall technique

Question 4

Symptoms of varies exposure?

Answer 4

Similar to irreversible pulpitis

Question 5

What can exposed caries lead to?

Answer 5

Pulp polyp

Question 6

What is a pulp polyp?

Answer 6

Chronic hyperplastic pulpitis - inflammatory hyperplasia

Question 7

Pulp therapy contraindications?

Answer 7

1. Tooth is unrestorable
2. No patient cooperation
3. Medically compromised
4. Orthodontic extractions

Question 8

Pulp therapy got VITAL teeth?

Answer 8

1. Pulp capping
2. Pulpotomy
3. Desensitising pulp therapy

Question 9

Is indirect pulp capping an option for primary teeth?

Answer 9

Yes

Question 10

Is direct pulp capping suitable for primary teeth?

Answer 10

No

Question 11

What happens during direct pulp capping?

Answer 11

Dressing is placed directly over exposed pulp

Question 12

What happens during indirect pulp capping?

Answer 12

A thin layer of dentine is left over the pulp and dressing placed on top (not directly on pulp)

Question 13

What is a pulpotomy?

Answer 13

Removing the diseased coronal portion of pulp only and applying medicaments to the remaining pulp tissue - allows tooth to keep functioning

Question 14

Pulpotomy contraindications?

Answer 14

1. Abccess (inflamed RADICULAR pulp)
2. Excessive bleeding (inflamed RADICULAR pulp)
3. No bleeding

Question 15

What is formocresol?

Answer 15

1. Very effective medicament
2. Guidelines advice that it is no longer used in conjunction with pulp therapy (2004)

Question 16

Properties within formocresol?

Answer 16

1. Tricesol - antiseptic
2. Formalin - tissue fixative
3. Acts by binding with bacterial and pulp tissue proteins

Question 17

Formocresol side effects?

Answer 17

1. Carcinogenic properties
2. If extruded via apical foramen results in damage to permanent tooth germ

Question 18

Using formocresol?

Answer 18

1. Use small amount
2. Blot
3. Isolation important
4. We’ll sealed margins to prevent leakage

Question 19

What is ferric sulphate?

Answer 19

1. Great haemostatic agent
2. Alternative to formocresol
3. NOT a fixative agent
4. Applied to pulp stump for 15 seconds

Question 20

What is Gluteraldehyde?

Answer 20

1. Aqueous solution
2. Fixative agent
3. Toxic effects discovered
4. Ineffective compared to formocresol
5. Unlikely to be used

Question 21

What is calcium hydroxide?

Answer 21

1.Ruled out for primary teeth due to the effect of internal resorption
2. Equal efficiency with formocresol
3. No toxic side affects known

Question 22

Properties of calcium hydroxide?

Answer 22

1. Encourages new dentine
2. Dentine bridge is formed
3. Pulp now has effective barrier against bacterial invasion
4. Heals the pulp

Question 23

How to carry out pulpotomy?

Answer 23

1. LA + isolate
2. Outline form + remove caries
3. Large access cavity to access pulp horns
4. Remove entire roof of pulp chamber
5. Remove contents with excavator
6. Once pulp tissue exposed do not use 3 in 1 (emphysema)
7. Irrigation
8. Apply medicament 15 seconds
9. Restore

Question 24

What is desensitising pulpotomy?

Answer 24

Reduces pulpal inflammation

Question 25

Desensitising pulpotomy technique?

Answer 25

1. Open and gain access to pulp chamber 2. Cotton pledger with ledermix directly over exposed site 3. Place a well sealed temp dressing 4. Review in 2 weeks

Question 26

After desensitising?

Answer 26

Extraction or pulpectomy