Questions and Answers
Which of the following are indications for pulpectomy? (Select all that apply)
Over-instrumentation can potentially damage the underlying permanent tooth.
True
What is the primary purpose of behavior management in pediatric dentistry?
To reduce the child's fear and provide quality dental service.
Match the following materials with their usage.
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The __________ is the clinical indication criteria involving the presence of abscess or fistula.
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Behavior management techniques can include the use of sedation.
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What is the pediatric treatment triangle in behavior management?
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What can be a consequence of root resorption in primary teeth?
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What is the width of the enamel layer in primary teeth compared to permanent teeth?
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What is the cavity depth from enamel to pulp according to Class 1 cavity principles?
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What is the internal angle recommendation for cavities in amalgam restorations?
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Which types of GIC are classified according to hardening reactions?
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What are the indications for fissure sealants?
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Which factors affect the decision for pulp treatment in primary teeth?
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Indirect pulp capping is applied to infected pulp.
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What is the recommended working time of resin-modified GIC?
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The clinical indications for vital pulp treatment include _____ pulp.
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What type of material is often used in direct pulp capping?
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What is the primary aim of a pulpotomy?
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What are the contraindications for tooth extraction?
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It is safe to extract a tooth if malignancy is suspected.
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What should be assessed before tooth extraction in children?
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Fluoride is released in a steady manner from ____________ materials.
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Match the procedure with its principle:
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What are the indications for using stainless steel crowns?
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Primary teeth are narrower in the cervical area compared to permanent teeth.
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What is the advantage of using glass ionomer cement?
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The __________ of 1 tooth is often severely destroyed due to caries.
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Study Notes
Indications and Contraindications of Tooth Extraction
- Extraction indications:
- Ideal restoration cannot be provided in a tooth with substance loss
- A tooth's roots are completely resorbed and attached to mucosa with very little contact
- Permanent tooth germ has completed formation, and roots have not been resorbed
- Int or ext resorption
- Failed endo treatment
- Extensive bone destruction
- Granuloma or follicular cyst
- Crown of a tooth is severely destroyed by caries, extending to the bifurcation area
- Ankylosed teeth
- Primary teeth causing cervical adenopathy
- Contraindications of Extraction:
- Malignancy is suspected
- Radiotherapy will be applied to the jaw with suspected malignancy
- Teeth that will cause infection are indicated for extraction
- Precautions taken with patients who have blood disorders like Hemophilia:
- Consult a hematologist before extraction due to coagulation time and prone to hemorrhage
- Precautions taken with patients who have acute systemic infections:
- Prophylaxis done to prevent infection
- Diseases that need to be controlled before extraction:
- Acute oral diseases
- Acute necrotizing ulcerative gingivitis
- Acute herpetic stomatitis
- Acute dentoalveolar abscess
General Principles of Tooth Extraction in Children
- Preoperative assessment:
- Thorough medical history and informed consent
- Evaluate the tooth to be extracted both clinically and radiographically
- Identify potentially difficult root anatomy and proximity of other important structures
- Be aware of implications for the permanent successor
- Important considerations:
- Profound local anesthesia is vital
- Explain the feeling of 'numbness' and the sensation associated with luxation of the tooth
- Consider sedation or general anesthesia if the child will be unable to cope with the extraction
Stainless Steel Crowns
- Indications:
- Teeth with large 2 or 3-sided carious lesions that can't be restored with other restorative materials
- Grossly broken-down teeth
- Bruxism
- When functional cusps are lost
- To restore teeth after pulp treatments that would weaken the tooth
- When carious lesions extend to the approximal surface and C/A is lost
- Steps of tooth prep:
- Minimal preparation indicated
- Occlusal surface reduced by 1.1-1.5mm with a flame-shaped diamond bur
- Anatomical lines of tubercles preserved as much as possible
- Interproximal reduction tapered and fine diamond bur held slightly convex to the long axis of the tooth
- Shaping SSC:
- SSC is shaped with forceps according to the anatomy of the tooth
- Retention is gained by alignment of SSC to the cervical area of the tooth
- Luting SSC:
- With GIC or polycarboxylate cement
- If tooth is restored with GIC before SSC placement, then the crown must also be bonded with GIC
Glass Ionomer Cement
- Composition:
- Fluoro-alumino silicate glass powder dissolved in polyacrylic acid liquid
- Advantages:
- Therapeutic material due to fluoride content
- Anticariogenic properties
- Serves as fluoride reservoirs
- Long-term fluoride release
- Fluoride recharging ability from external resources
- Directly binds to tooth
- Expansion coefficient is close to that of dentin
- Biocompatible
- Easy to apply
- Contraindications:
- In class 4 cavity prep
- In restorations that require 99% placement on the labial surface
- In teeth with large tubercle losses### Mesial Horns and Cavity Preparation
- Mesial horns are easily perforated, and the width of the enamel layer is narrower than in permanent teeth.
- The enamel layer becomes gradually thinner towards the cervix, similar to permanent teeth.
Class 1 Cavity Principles for Amalgam Restorations
- Cavity boundaries cover all carious lesions and retentive fissures.
- Intact tooth tissue is not removed.
- Cavity depth is 1.5 mm from the enamel to the pulp, with 0.5 mm removed from the dentin.
- Labio-lingual width of the cavity is ⅓ - ¼ of the distance between the tubercles.
- Internal angles of the cavity and curvatures are slightly rounded to reduce amalgam pressure.
Class 2 Cavity Principles for Amalgam Restorations
- Occlusal cavity preparation follows Class 1 rules.
- Buccal and lingual margins of the proximal box cavity are in easily cleaned areas.
- Proximal surfaces do not touch adjacent teeth, checked with a sond test probe.
- Width of the isthmus is ⅓ of the distance between the tubercles.
- Narrow isthmus provides fracture resistance to the tooth and preserves marginal integrity of the restoration.
Classification of Glass Ionomer Cements (GICs)
- Type 1: Luting cement and space maintainer.
- Type 2: As a restorative material, including aesthetic-enhanced restorative cements.
- Type 3: Cavity and base materials, including fast-setting base material and fissure sealant.
Classification of GICs according to Hardening Reactions
- Conventional GIC.
- Resin-modified GIC.
- Polyacid modified composite resins (compomers).
Usage Areas of GICs
- As a fissure sealant in occlusal pits and fissures.
- To close occlusal fissures with initial lesions.
- In permanent restorations of primary teeth.
- As a fissure sealant when isolation is not possible.
- In erosion lesions.
- In temporary restorations.
- In pediatric dental care, especially for patients who cannot cooperate.
Contradictions of GICs
- Class IV (4) cavity restorations.
- Restorations involving large tubercle losses.
- Restorations with large placement in the labial area.
Successful Treatment with GICs
- A suitable tooth surface must be created.
- Manipulation according to setting time.
Resin-Modified GIC
- Combination of HEMA and BIS-GMA.
- ↑ Resistance to breakage and wear.
- ↑ Working time.
- ↓ Early moisture sensitivities.
- Fluoride-releasing.
Fissure Sealants
- Prevent caries formation by bonding and covering pits and fissures with organic material.
- Most accepted pit and fissure sealants are resin-based sealants.
- GI sealants are used on partially-erupted molars.
Indications for Fissure Sealants
- Dental indications: 1° molars, permanent molars, and PM with deep and narrow pits and fissures.
- Incisors with lingual pits and fissures.
- Caries-free teeth clinically and radiographically.
- Post-teeth with initial caries, discoloration, or non-cavitated lesions.
Ideal Ages for Applying Fissure Sealants
- 3-4 years for primary molars.
- 6-7 years for permanent 1st molars.
- 10-11 years for premolars.
- 12-13 years for permanent 2nd molars.
Application Steps of Resin-Based Fissure Sealants
- Isolation and cleaning the surface.
- Etching, washing, and drying.
- Applying sealant agent and polymerization.
- Re-evaluation.
Pulp Treatments in Primary Teeth
- Vital pulp therapies aim to preserve vital pulp and eliminate pulp-irritating factors.
- In primary teeth, pulp treatments are done to retain teeth until they fall out or until they are needed for occlusal development.
Indications for Vital Pulp Treatments
- Normal pulp with asymptomatic and positive results to viability tests.
- Reversible pulpitis with pulp that can heal.
- Symptomatic and asymptomatic irreversible pulpitis.
Factors Affecting Pulp Treatment Decision for Primary Teeth
- Patient and parent cooperation and motivation level to maintain oral health and hygiene.
- Patient's caries activity, stage of tooth development, and comprehensive prognosis of treatment.
Remaining Dentin Thickness
- Minimum distance of healthy dentin that separates the pulp from the carious lesion.
- Best barrier against pathological and iatrogenic damage.
Pulp Treatments in Primary Teeth
- Vital pulp therapy:
- Pulp capping (direct and indirect).
- Pulpotomy (partial pulp amputation).
- RCT/Pulpectomy for irreversible pulpitis or necrosis.
Indirect Pulp Capping
- Covering the decalcified/demineralized affected dentin layer with a biocompatible restorative material.
- Objectives: stop caries development, allow remineralization, and promote reparative dentin formation.
Direct Pulp Capping
-
Applied to a pulp that is mechanically opened after removing carious dentin or perforated due to iatrogenic reasons.
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Indications: very limited in primary teeth, with a normal pulp after mechanical or traumatic opening.
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Factors affecting success: correct diagnosis, isolation, size and location of pulp perforation, formation of a thick clot layer, and restoration.### Formaldehyde in Foods
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Amount of formaldehyde used is less than the amount naturally present in many foods (Milk, pears)
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No dentinal bridging occurs, but calcific changes do occur
Histologic Zones in FC Treated Radicular Pulp
- Acidophilic zone: Fixation = Coronal
- Pale-staining zone: Atrophy = Middle
- Broad zone of inflammatory cells = Apical
Pulpectomy
- Complete removal of all pulpal tissue
- For primary teeth with intact roots
- Exceptions:
- If evidence of root resorption = Extraction
- If severe infections (e.g. Acute facial cellulitis) associated with primary teeth = Extraction
Morphological Differences of Primary Roots from Permanent Roots
- Multi-rooted primary teeth have more complex roots
- They have fins, ramifications, and inter-canal connections
- These factors inhibit chemo-mechanical debridement of RC
- Anatomical apex may be up to 3 mm from radiographic apex
- Frequently on lateral surface of root
- Difficult to determine true working length
- Electronic measurements used to help locate anatomical apex
Over-Instrumentation and Obturation
- Over-instrumentation = Potential damage to underlying permanent tooth
- Obturation must not interfere with normal exfoliation of permanent successor
- Use resorbable paste root filling (e.g. ZOE, CaOH, Iodoform paste)
- Exception: Where there's no permanent successor present = RCT to keep it in mouth
- Use Gutta percha + Pat or Calcium silicate cements (MTA, Biodentine, Bioaggregate)
Indications for Pulpectomy
- Irreversible pulpitis: Acute or Chronic
- Necrotic pulp: Partial or Total
- Carious exposure of Vital incisor (primary)
- Dark bleeding that doesn't stop after 5 min after coronal pulp removal
- Preoperative radiograph = Intact non-resorbed root
- Or bone loss between roots does NOT exceed coronal ⅓
- Cuz Retention is needed
- If very little mobility
- Restorable tooth
Pulpectomy Indication Criteria
- Clinical indication criteria:
- Persisting, Spontaneous, or Pulsating pain
- Presence of abscess or fistula
- Sensitivity in vertical percussion
- Radiographic indication criteria:
- Deep dentin caries
- Widening of PDL space + Loss of lamina dura
- Lesion is limited to ⅓ coronal of interroot region
- When bone loss between roots does NOT exceed ⅓ — Retention is needed
- Operative indication criteria:
- Bleeding outside physiological limits at Canal mouths
Contraindications of Pulpectomy
- Presence of bone lesion exceeding coronal ⅓ of bifurcation
- Advance bone loss in tissues
- Uncontrolled bleeding even after removing Root pulp
- Int or Ext resorption
- Advanced physiological resorption
- Cystic or tumoral lesions
- Pulp chamber floor perforation
Primary Teeth Differences in RCT
- Physiological root resorption + enlarged apical opening with time
- Tissues = Small in volume + Short crown length
- Presence of permanent teeth germs
- Narrow + curved RC
- Complex morphology, anatomical variations, lateral branching
- Presence of Paramolar canals in furcation area = Pulp-periodontal canals
Behavior Management in Dentistry
- Why are kids afraid? They're afraid of a new foreign environment with new people
- Why are kids afraid? It's a new experience that might cause them pain
Purpose of Behavior Management
- Reduce the child’s fear
- Provide quality dental service
- Emphasize good oral health
- Provide lasting behavioral change
- Receive positive feedback
Techniques of Behavior Management
- Coordinated team
- Child-friendly environment
- Behavior management techniques + Experience
- Proper treatment plan
- General anesthesia or Conscious sedation
Basic Behavior Guidance Techniques
- Tell-show-do (most used)
- Ask-tell-ask
- Positive reinforcement by explaining and praising their bravery
- Modeling = let them reenact the role of a doctor
- Showing positive images before appointment
- Voice control = by using a different tone
- Distracting = don't let them see blood gauzes
Advanced Behavior Guidance Techniques
- Protective stabilization
- Sedation
- General anesthesia
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Description
This quiz covers dental material sciences, including fissure sealants, fluoride gel, and glass ionomer cements (GIC). It also touches on pulpotomy criteria, behavior techniques, and extraction indications.
