CSL 10 pulpotomy ( easy)

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Questions and Answers

What clinical assessment indicates that a tooth might be affected by pulpal disease?

Significant marginal ridge breakdown

Missing restorations

Abscess present

Excessive mobility compared to the contralateral tooth (correct)

Sensitivity to percussion can reveal a tooth that may have inflammation affecting the periodontal ligament.

True

What might be felt by palpating a swollen mucobuccal fold that indicates an acute dentoalveolar abscess?

Fluctuation

A significant difference in mobility when comparing a tooth to its contralateral tooth might suggest ________ disease.

pulpal Signup and view all the answers

Match the dental assessments with their purposes:

Palpation = Detecting fluctuation or bone destruction Mobility = Comparing to assess pulpal disease Percussion test = Identifying sensitivity to pressure Clinical assessment = Evaluating tooth restorability and caries site Signup and view all the answers

Which condition indicates that the pulp is capable of healing?

Reversible pulpitis Signup and view all the answers

A necrotic pulp is considered vital.

False Signup and view all the answers

What type of pain is typically associated with reversible pulp inflammation?

pain while eating that subsides after a few minutes Signup and view all the answers

Clinical diagnosis of pulp conditions includes assessing the patient's medical and dental ______.

history Signup and view all the answers

Match the types of pulp diagnosis with their characteristics:

Normal pulp = Symptom free and responsive to vitality testing Reversible pulpitis = Pulp is capable of healing Symptomatic irreversible pulpitis = Vital inflamed pulp is incapable of healing Necrotic pulp = Nonvital and cannot heal Signup and view all the answers

What type of clinical examination is necessary to assess pulp conditions?

Comprehensive clinical tests including palpation and mobility Signup and view all the answers

Spontaneous, throbbing pain can indicate a reversible pulp condition.

False Signup and view all the answers

What examination can help diagnose pulpitis or necrosis besides clinical tests?

Radiograph(s) Signup and view all the answers

What is a common limitation of electrical and thermal tests in clinical assessment?

They can result in false positive results Signup and view all the answers

A high-quality bitewing radiograph is primarily used to assess root length, perifurcational pathology, and internal resorption.

True Signup and view all the answers

What condition is indicated when pulp tissue is exposed during a pulpotomy?

Acute inflammation Signup and view all the answers

A patient with a history of ________ pulpitis may undergo a vital pulpotomy.

reversible Signup and view all the answers

Match the following conditions with their appropriate treatment options:

No history of pain or symptoms = Indirect pulp treatment History of reversible pulpitis = Vital pulpotomy History of irreversible pulpitis = Extraction Unrestorable tooth = No treatment Signup and view all the answers

Which treatment option is indicated for a tooth with root length greater than 1/3rd?

Indirect pulp treatment Signup and view all the answers

Persistence of bleeding is a sign for pulpotomy.

True Signup and view all the answers

If a tooth is termed _________, it indicates that it is not treatable regardless of symptoms.

unrestorable Signup and view all the answers

Study Notes

Chief Complaint

Pain while eating, subsiding after a few minutes without analgesics.

Examination

Extra-oral and intra-oral soft and hard tissues examined.

Investigations

Periapical radiograph taken.
Bitewing radiograph taken to visualize the involved tooth, furcation, periapical area, and surrounding bone.

Diagnosis

Reversible pulp inflammation.

Pulp Therapy

Pulpal therapy determined by pulp vitality (vital or non-vital). Normal pulp is symptom-free and responsive to vitality testing.
Reversible pulpitis means the pulp can heal, and symptomatic or asymptomatic pulpitis involves a vital inflamed pulp that cannot heal, or a necrotic pulp.

Clinical Diagnosis

Comprehensive medical history taken.
Past and present dental history reviewed, including current symptoms and chief complaint.
Subjective evaluation of the area associated with pain in terms of location, intensity, duration, stimulus, relief, and spontaneity.
Objective extraoral and intraoral examination of soft and hard tissues performed.
Radiographs taken when possible to diagnose pulpitis or necrosis of the involved tooth.
Clinical tests conducted, including palpation, percussion, and mobility testing.
The combination of history, clinical examination and radiographs together gives an approximate diagnosis.

Diagnosis and Pulpal Treatment Planning

Clinical history includes history of pain and symptoms of pain.
Spontaneous, throbbing pain simulating irreversible pulp condition occurs when food impaction affects the inflamed inter-dental gingiva.

Clinical Assessment

Assessment of tooth includes checking for abscess, excessive mobility, swelling or if there is tenderness to percussion.
Examination of the extent of marginal ridge breakdown and the site of caries (occlusal or proximal). Also an assessment for missing or fractured restorations.

Mobility

Comparison of mobility of the tooth with its contralateral tooth is important. Significant differences may indicate pulpal disease and abnormal mobility in the normal time of exfoliation is not usually problematic.

Percussion Test

Sensitivity to percussion may reveal a painful tooth in which inflammation of the periodontal ligament has progressed to involve the apical periodontitis.
Percussion should be done very gently.

Electrical and Thermal Tests

Electrical and thermal tests are not helpful clinically when diagnosing a painful tooth and can produce false positive results due to apprehension.

Radiographic Assessment

High-quality bitewing radiograph taken.
Perifurcational pathology and internal resorption in the root canal are noted in the radiograph.

Operative Diagnosis

Acute inflammation and pain, with exposed pulp tissue in the pulpotomy, persistent bleeding.

Treatment Options (Table)

Table shows various treatment options (caries removal, pulpotomy, vital pulpotomy, non-vital pulpotomy, extraction) based on different clinical scenarios. Options are listed depending upon the extent of root breakdown.

Pulpotomy Treatment Objectives

Eradication of infection.
Maintenance of tooth in a quiescent state.
Preservation of space for underlying permanent teeth.
Retention of primary tooth in case the permanent tooth is congenitally absent.

Indications for Pulpotomy

Deep caries without pulp exposure is an indication.
Carious or traumatic pulp exposures with transitory thermal and/or chemical stimulated pain.
Physiologically mobile teeth with normal soft tissues, no percussion sensitivity (except in cases of food impaction) that show an intact continuous ligament space and intact periapical and/or furcation bone.

Confours in Pulp Status Diagnosis

Color of pulpal hemorrhage is not a reliable indicator of pulp histological status.
Excessive bleeding is strongly correlated with degenerative changes.
Different types of carious pulp exposure have varying aspects of normal and abnormal pulps.

Must for Successful Pulp Therapy

Co-operation
Local anesthetic
Rubber dam placement
Post-operative restoration
Follow-up

Steps of Pulpotomy

Local anesthetic administration and isolation.
Caries removal, and identification of pulp exposure or access to the pulp chamber.
Complete removal of the roof of the pulp chamber, but not deeper.
Removal of the coronal pulp using a large spoon excavator or round bur.
Application of saline cotton pellet for one minute.
Application of medication.
Pulp chamber filling with ZOE cement, condensed with damp cotton pledget.
Placing a coronal restoration using SSC.

Materials for Pulpotomy

Ferric sulphate.
MTA.

Ferric Sulphate

Current gold standard, applied to radicular pulp, for 15 seconds.
Creates ferric ion protein complex sealing cut vessels.
Astringent to stop hemorrhage.

Problems

Perforating the pulpal floor.
Approximately at the gingival margin.

Safe Ended Burs

Tungsten carbide (Endo-Z bur).
Diamond abrasive bur.

Additional Considerations

Additional images and notes provide details of dental procedures, highlighting important aspects such as locating the canal orifices.

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Description

Test your knowledge on diagnosing reversible pulp inflammation and understanding pulp therapies. This quiz covers chief complaints, examination, investigations, and clinical diagnosis related to dental pulp health. Brush up on your skills in dental diagnostics!