CSL 10 pulpotomy (medium)

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Questions and Answers

Which clinical assessment indicates that a tooth may not be restorable?

Abscess presence

Tooth tenderness to percussion

Surface caries on the occlusion

Significant marginal ridge breakdown (correct)

What can a fluctuation felt during palpation indicate?

Acute dentoalveolar abscess (correct)

Reactive hyperplasia

Chronic pulpitis

Normal bone density

Why is comparing the mobility of a suspicious tooth to its contralateral tooth important?

To evaluate the need for orthodontic treatment

To identify systemic diseases

To determine the age of the patient

To assess if there is significant pulpal disease (correct)

What does sensitivity to percussion suggest during a dental examination?

Possible acute apical periodontitis Signup and view all the answers

Which technique should NOT be used when performing a percussion test?

Using the end of a dental mirror Signup and view all the answers

What type of radiographic assessment is essential for evaluating a child's dental health?

High-quality bitewing radiograph Signup and view all the answers

Which condition would NOT lead to a diagnosis of irreversible pulpitis?

Symptoms of reversible pulpitis Signup and view all the answers

In what circumstance is a pulp tissue considered exposed during a pulpotomy?

During acute inflammation with persistent bleeding Signup and view all the answers

Which assessment is NOT typically involved in determining pulp vitality?

Bitewing radiography Signup and view all the answers

What would be an appropriate treatment for a child with irreversible pulpitis?

Extraction Signup and view all the answers

For a diagnosis of unrestorable decay, which factor is NOT considered?

Current orthodontic treatment Signup and view all the answers

Which factor may indicate a need for extraction despite the presence of caries?

Symptomatic condition Signup and view all the answers

What is a false positive result likely associated with?

Thermal testing Signup and view all the answers

What is indicated by pain while eating that subsides without analgesics?

Reversible pulp inflammation Signup and view all the answers

Which clinical diagnosis describes a pulp that is inflamed but capable of healing?

Reversible pulpitis Signup and view all the answers

What type of pulp therapy may be required for a diagnosis of irreversible pulpitis?

Root canal therapy Signup and view all the answers

Which examination method is NOT typically included in diagnosing pulp conditions?

Placing fillings Signup and view all the answers

What could simulate an irreversible pulp condition in a patient?

Inflamed interdental gingiva due to food impaction Signup and view all the answers

Which of the following is true regarding the classification of pulp conditions?

Reversible pulpitis indicates the pulp is capable of healing Signup and view all the answers

Which of the following is a component of a comprehensive clinical diagnosis?

Detailed exploration of past dental treatments Signup and view all the answers

What is a key symptom indicating a possible case of pulpitis?

Pain that occurs spontaneously Signup and view all the answers

Study Notes

Chief Complaint

Pain while eating, subsiding after a few minutes without analgesics

Examination

No details provided

Investigations

Periapical radiograph
Bitewing radiograph

Diagnosis

Reversible pulp inflammation

Pulpal Therapy

Indications, objectives, and type of therapy depend on pulp health
Normal pulp: asymptomatic, responsive to vitality tests
Reversible pulpitis: pulp capable of healing
Symptomatic/asymptomatic irreversible pulpitis: vital, inflamed pulp unable to heal
Necrotic pulp: dead pulp

Clinical Diagnosis

Comprehensive medical history
Review of past and present dental history, including symptoms and chief complaint
Subjective evaluation of the affected area by questioning, focusing on location, intensity, duration, stimulus, and relief

Extraoral/Intraoral Examination

Extraoral and intraoral soft and hard tissues examination
Radiographs: to diagnose pulpitis or necrosis, focusing on involved tooth, furcation, periapical area, and surrounding bone
Clinical tests: palpation, percussion, mobility

Operative Diagnosis

Dependent on history, clinical examination, and radiographic evaluations
Only an approximate diagnosis

Diagnosis and Pulpal Treatment Planning

Clinical history, including tooth pain history and symptoms
Image of a carious tooth with highlighted cavity

Spontaneous, Throbbing Pain

Spontaneous, throbbing pain simulating irreversible pulp inflammation can be observed if food is impacted in the interdental gingiva

Clinical Assessment

Abscess, excessive mobility, swelling, or tenderness to percussion
Restorable tooth assessment
Extent of marginal ridge breakdown
Site of caries (occlusal or proximal)
Evaluation of missing or fractured restorations

Mobility

Comparing mobility of suspicious tooth with its contralateral tooth is crucial
Significant difference may indicate pulpal disease, or is considered normal during exfoliation.

Percussion Tests

Sensitivity to percussion may reveal a painful tooth with progressed periodontal ligament inflammation (acute apical periodontitis).
Percussion should be performed gently with a fingertip, not a dental mirror, to avoid discomfort.

Electrical and Thermal Tests

Electrical and thermal tests are typically not useful due to potential false positive results or patient apprehension

Radiographic Assessment

High-quality bitewing radiographs are essential
Assess root length, identify perifurcational pathology, and look for internal root canal resorption

Operative Diagnosis: Acute Inflammation

Acute inflammation of the pulp
Exposed pulp tissue
Deep pulpotomy
Persistent bleeding

Pulpotomy in Primary Teeth: Treatment Objectives

Eradicate infection
Quiescent tooth state
Preserve space for permanent tooth
Retain primary tooth if the permanent is congenitally absent

Indications of Pulpotomy

Deep caries without pulp exposure
Carious/traumatic pulp exposure with transient pain
Normal physiologic tooth mobility
Normal soft tissues
No percussion sensitivity (except food impaction)
Intact periodontal ligament space
Intact periapical and furcation bone

Confounding Pulpal Diagnosis Factors

Pulp hemorrhage color is not a reliable indicator of pulp status
Excessive bleeding may indicate degenerative changes in pulp tissue
One-third of teeth with caries and pulp exposures/exposures have "normal" pulps and one-third have "abnormal" pulps

Essentials for Successful Pulp Therapy

Patient cooperation
Local anesthetic (LA)
Rubber dam isolation
Postoperative restoration
Follow-up

Steps of Pulpotomy

Local anesthesia and isolation.
Remove caries and locate pulp exposure.
Remove pulp chamber roof.
Remove coronal pulp with a spoon excavator or a round bur.
Apply saline cotton pellet for one minute.
Apply medicament to radicular pulp with a cotton pledget for 15 seconds
Remove cotton pledget and assess for hemorrhage.
Fill pulp chamber with ZOE cement and consolidate with damp cotton pledget
Place a SSC coronal restoration

Materials for Pulpotomy

Ferric sulfate & Hemostat
MTA

Ferric Sulfate

Current standard for radicular pulp application
Reliable haemostatic agent
On contact with blood, a ferric ion protein complex seals the vessels.

Pulp Dressing (Objectives/Characteristics)

No details provided

Problems (Potential Errors)

Piercing the pulp chamber floor
Difficulty in locating the pulp floor which is approximately at the gingival margin

Safe Ended Burs

Tungsten carbide (Endo-Z bur)
Diamond abrasive

Removing Coronal Pulp

No specific details provided

Finding Canal Orifices

No specific details provided

Additional Topics

No additional topics provided

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Description

This quiz covers the key aspects of pulpal therapy and diagnosis, focusing on conditions like reversible pulp inflammation and the necessary clinical evaluations. It includes understanding the indications and objectives of various types of pulp health. Perfect for dental students and practitioners looking to refresh their knowledge on endodontics.