CSL 10 pulpotomy (hard)

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Questions and Answers

Which of the following is a key factor in clinical assessment during a dental examination?

  • Number of teeth present
  • Presence of orthodontic appliances
  • Tooth restorable (correct)
  • Patient's age

Fluctuation felt by palpating a swollen mucobuccal fold indicates a chronic dentoalveolar abscess.

False (B)

What is the purpose of the percussion test in dental assessments?

To reveal sensitivity in teeth and detect inflammation in the periodontal ligament.

A significant difference in mobility compared to the contralateral tooth might indicate __________ disease.

<p>pulpal</p> Signup and view all the answers

Match the following dental assessment techniques with their significance:

<p>Palpation = Detects bone destruction from chronic abscess Mobility comparison = Indicates potential pulpal disease Percussion test = Reveals inflammation in periodontal ligament Assessment of restorations = Checks for missing or fractured treatments</p> Signup and view all the answers

Reversible pulp inflammation indicates that the pulp is incapable of healing.

<p>False (B)</p> Signup and view all the answers

What type of radiographs are typically taken to diagnose pulpitis?

<p>Periapical radiograph and Bitewing radiograph</p> Signup and view all the answers

In the case of reversible pulpitis, the pulp is capable of __________.

<p>healing</p> Signup and view all the answers

Match the following terms with their definitions:

<p>Normal Pulp = Symptom free and normally responsive to vitality testing Symptomatic Irreversible Pulpitis = Vital inflamed pulp is incapable of healing Reversible Pulpitis = Pulp is capable of healing Necrotic Pulp = Nonvital pulp tissue that has died</p> Signup and view all the answers

Which symptom is NOT typically associated with reversible pulpitis?

<p>Spontaneous continuous pain (B)</p> Signup and view all the answers

What kind of examination should be performed on a child with a dental complaint?

<p>Objective extra-oral and intraoral examination, along with radiographs if obtainable.</p> Signup and view all the answers

The symptom of __________ pain can occur when the inter dental gingiva is inflamed due to food impaction.

<p>throbbing</p> Signup and view all the answers

What type of radiograph is recommended for assessing root length and pathology in paedodontics?

<p>High-quality bitewing radiograph (A)</p> Signup and view all the answers

Thermal testing is always conclusive in diagnosing dental conditions.

<p>False (B)</p> Signup and view all the answers

What is the primary indicator for performing a pulpotomy?

<p>Pulp tissue is exposed with persistent bleeding.</p> Signup and view all the answers

In cases of irreversible pulpitis, the recommended procedure is _________.

<p>extraction</p> Signup and view all the answers

Match the following dental conditions with the appropriate management options:

<p>No caries = Direct restoration Hx of reversible pulpitis = Vital pulpotomy Hx of irreversible pulpitis = Extraction MR breakdown 2/3rd = Indirect restoration</p> Signup and view all the answers

Which of the following is a symptom of a tooth requiring extraction?

<p>Persistent swelling and mobility (A)</p> Signup and view all the answers

An unrestorable tooth with symptomatic sepsis can still be treated with a vital pulpotomy.

<p>False (B)</p> Signup and view all the answers

For a tooth with occlusal caries and symptoms, the appropriate treatment choice is ________.

<p>pulpotomy</p> Signup and view all the answers

Flashcards

Clinical assessment for paedodontics

Checking for abscesses, mobility, swelling, tenderness, restorable teeth, extent of gum damage, and sites of cavities.

Palpation in dental assessment

Feeling for swelling (fluctuation) or bony changes by touching the affected area in a childs mouth to detect abscesses.

Mobility test in dentistry

Comparing a suspected tooth's movement with its opposite tooth to identify potential pulpal problems.

Percussion test in dentistry

Gently tapping a suspicious tooth to find tenderness, indicating inflammation that has reached the ligament.

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Importance of gentle percussion

To avoid causing unnecessary discomfort and distress to a child during a dental examination.

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Reversible Pulp Inflammation

A type of pulp inflammation that can heal without treatment.

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Vital Pulp

A healthy pulp that responds to stimuli.

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Irreversible Pulpitis

Inflamed pulp that cannot heal on its own.

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Necrotic Pulp

Dead pulp.

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Clinical Diagnosis

Diagnosis based on observing and examining a patient.

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Chief Complaint

Patient's main concern.

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Pulp Therapy Indications

Reason for choosing pulpal treatment; depends on vital/non-vital status.

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Pain Simulation - Food Impaction

Spontaneous, throbbing pain that mimics irreversible pulpitis, but actually caused by food lodged between teeth.

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Radiographic Assessment in Paedodontics

Using high-quality bitewing x-rays to assess root length, perifurcational pathology (problems around the roots), and internal resorption (damage inside the root canal).

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Operative Diagnosis (Pulp)

Pulp assessment for acute inflammation (redness, pain) with exposed pulp tissue. Pulp inflammation can be reversible or irreversible.

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Pulpotomy

A dental procedure for treating an inflamed pulp of a tooth. It involves removing the inflamed pulp tissue to save the tooth.

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Vital Pulpotomy

A pulpotomy procedure done on a tooth with an inflamed pulp, where the pulp tissue isn't entirely dead (vital).

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Non-vital Pulpotomy

A pulpotomy on a tooth with already dead or non-living pulp.

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Caries Removal (Indirect)

Treatment for cavities that removes decay without removing fillings or directly accessing the pulp.

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Occlusal Caries

Cavities on the chewing surface (top) of a tooth.

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Proximal Caries

Cavities on the sides of teeth (between teeth).

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Study Notes

Chief Complaint

  • Patients experience pain while eating, but the pain subsides after a few minutes without taking pain relievers.

Examination

  • A physical examination of the patient's mouth is performed.

Investigations

  • Periapical radiograph: X-ray image taken focused on the area around the tooth's root.
  • Bitewing radiograph: X-ray image taken from the side of the upper and lower teeth.

Diagnosis

  • Reversible pulp inflammation: Inflammation of the dental pulp, which can resolve.

Pulpal Therapy

  • The treatment plan depends on whether the pulp is vital or nonvital.
    • Normal pulp: Symptom-free and responsive to vitality tests, and is capable of healing.
    • Reversible pulpitis: Pulp can heal.
    • Symptomatic or asymptomatic irreversible pulpitis: Vital inflamed pulp is incapable of healing, or necrotic pulp.

Clinical Diagnosis

  • Comprehensive medical history: Reviewing the patient's past and present medical history, including dental history.
  • Current symptoms and chief complaint: Including symptoms related to the mouth.
  • Subjective evaluation of the area associated with current symptoms: Involves questioning the child and parent on location, intensity, duration, stimulus, relief, and spontaneity of the symptoms.

Clinical assessment

  • Assessing for abscess, abnormal mobility, swelling, and tenderness to percussion.
  • Assessing the extent of marginal ridge breakdown from caries.
  • Reviewing missing or fractured restorations.

Palpation

  • Detecting fluctuation (swelling) and bone destruction, which may result from a dentoalveolar abscess.

Mobility

  • Comparing the suspicious tooth's mobility with its counterpart. A significant difference might indicate pulp disease.

Percussion Test

  • Sensitivity to percussion may indicate inflamed periodontal ligament (acute apical periodontitis).
  • Percussion should be gentle to prevent discomfort for the patient.

Electrical and Thermal Assessments

  • These are not typically definitive indicators for pulp issues.

Radiographic Assessment

  • High-quality bitewing radiographs are used to determine root length, perifurcational pathology, and internal resorption.

Operative Diagnosis

  • Acute inflammation and pain.
  • Exposed pulp tissue, with continuous bleeding.

Pulpotomy in Primary Teeth Treatment Objectives

  • Eliminating potential infections.
  • Keeping the tooth stable.
  • Maintaining space for the permanent tooth.
  • Retaining primary teeth if permanent ones are congenitally absent.

Indications for Pulpotomy

  • Deep caries without pulp exposure.
  • Carious or traumatic pulp exposure with temporary thermal/chemical stimulated pain.
  • Physiological tooth mobility.
  • Normal soft tissues; no percussion sensitivity (excluding food impaction cases).
  • Intact continuous ligament space; intact periapical and/or furcation bone.

Conflicting Factors in Diagnosis of Pulp Status

  • Pulp hemorrhage color is not a definitive indicator for pulp histological status.
  • Excessive bleeding may indicate degenerative changes.
  • A significant portion of teeth with carious pulp exposures have normal pulps while a significant portion of teeth with deep caries and no pulp exposure have abnormal pulps.

Successful Pulp Therapy Requirements

  • Patient cooperation.
  • Using LA (local anesthesia).
  • Employing rubber dams.
  • Implementing postoperative restoration.
  • Conducting follow-ups.

Steps in Pulpotomy

  1. Local anesthesia and isolation.
  2. Caries removal, exposing the pulp chamber/cavity.
  3. Removing the roof of the pulp chamber, but avoiding deeper penetration, only laterally.
  4. Removing the coronal pulp using a large spoon excavator or bur.
  5. Applying saline solution on the cotton pellet for 1 minute.
  6. Applying medicine to the radicular pulp on a cotton pledget for 15 seconds.
  7. Checking for bleeding and removing the cotton pledget.
  8. Filling the pulp chamber (using ZOE cement), condensing it with a damp cotton pledget.
  9. Applying a coronal restoration using a SSC material.

Materials for Pulpotomy

  • Ferric sulfate.
  • MTA.

Ferric Sulfate

  • Current gold standard.
  • Applied to the radicular pulp.

Safe Burs

  • Tungsten carbide endodontic burs and diamond burs are used.

Additional Issues to be Aware of

  • Perforating the floor of the pulp chamber.
  • Problems with the pulp floor (approximately at the gingival margin).

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Pulpotomy In Primary Teeth Treatment Objectives PDF

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