Pulpotomy In Primary Teeth Treatment Objectives PDF

 Chief Complaint – pain while eating; it subsides after a few minutes without taking analgesics Examination Investigations – Periapical radiograph – Bitewing RG Diagnosis – reversible pulp inflammation  Diagnosis 17/11/2024 Paedodontics and Preventive Dentistry...

 Chief Complaint – pain while eating; it subsides after a few minutes without taking analgesics Examination Investigations – Periapical radiograph – Bitewing RG Diagnosis – reversible pulp inflammation  Diagnosis 17/11/2024 Paedodontics and Preventive Dentistry 3  The indications, objectives, and type of pulpal therapy depend on whether the pulp is vital or nonvital, based on the clinical diagnosis of normal pulp (symptom free and normally responsive to vitality testing), reversible pulpitis (pulp is capable of healing), symptomatic or asymptomatic irreversible pulpitis (vital inflamed pulp is incapable of healing), or necrotic pulp. 17/11/2024 Paedodontics and Preventive Dentistry 4  The clinical diagnosis A comprehensive medical history. A review of past and present dental history and treatment, including current symptoms and chief complaint. A subjective evaluation of the area associated with the current symptoms/chief complaint by questioning the child and parent on the location, intensity, duration, stimulus, relief, and spontaneity.  A objective extra-oral examination as well as examination of the intraoral soft and hard tissues. If obtainable, radiograph(s) to diagnose pulpitis or necrosis showing the involved tooth, furcation, peri- apical area, and the surrounding bone Clinical tests such as palpation, percussion, and mobility.  History Clinical Ex Radiographic Ex Extent of pulpal inflammation Operative diagnosis 17/11/2024 Paedodontics and Preventive Dentistry 7  Diagnosis and pulpal treatment planning Clinical history – History of pain – Symptoms of pain 17/11/2024 Paedodontics and Preventive Dentistry 8  Spontaneous, throbbing pain simulating an irreversible pulp condition can be observed when the inter dental gingiva is inflamed due to food impaction. 17/11/2024 Paedodontics and Preventive Dentistry 9 17/11/2024 Paedodontics and Preventive Dentistry 11  Clinical assessment – Abscess, excessive mobility, swelling, or tenderness to percussion – Tooth restorable – Extent of marginal ridge breakdown – Site of caries occlusal or proximal – attention should be paid to missing or fractured restorations 17/11/2024 Paedodontics and Preventive Dentistry 12 17/11/2024 Paedodontics and Preventive Dentistry 13 17/11/2024 Paedodontics and Preventive Dentistry 14  Palpation – Fluctuation, felt by palpating a swollen mucobuccal fold, may be the expression of an acute dentoalveolar abscess prior to exteriorization. – Bone destruction following a chronic dentoalveolar abscess can be also detected by palpation. 17/11/2024 Paedodontics and Preventive Dentistry 15  Mobility – Comparing the mobility of a suspicious tooth with its contralateral tooth is of particular importance. – Significant difference is observed, pulpal disease might be suspected – normal time of exfoliation 17/11/2024 Paedodontics and Preventive Dentistry 16  Percussion test – Sensitivity to percussion may reveal a painful tooth in which inflammation has progressed to involve the periodontal ligament (acute apical periodontitis). However, care should be taken in interpreting these tests. – Percussion should be done very gently with the tip of a finger and not with the end of a dental mirror to prevent exposing the child to unnecessary uncomfortable stimuli. 17/11/2024 Paedodontics and Preventive Dentistry 17  Clinical assessment Electrical - no Thermal – no – False positive results – apprehensive 17/11/2024 Paedodontics and Preventive Dentistry 18  Radiographic assessment high-quality bitewing radiograph – Root length – Perifurcational pathology – Internal resorption seen in root canal 17/11/2024 Paedodontics and Preventive Dentistry 19 17/11/2024 Paedodontics and Preventive Dentistry 20  Operative Diagnosis Acute inflammation – pain Pulp tissue is exposed - in pulpotomy, Persistent bleeding 17/11/2024 Paedodontics and Preventive Dentistry 22  No caries Indirect Direct Pulpotomy Vital pulpotomy Non-vital Extraction removal pulpotomy No Hx of pain or symptoms Yes Yes No Yes Yes NA NA Hx of reversible pulpitis No No No Yes Yes NA NA Hx of irreversible pulpitis No No No No Yes NA NA MR breakdown 2/3rd Yes No No Yes Yes Yes ? Occlusal caries Yes Yes No Yes Yes Yes ? Proximal caries Yes ? No Yes Yes Yes If symptomatic or sepsis Unrestorable No No No No No No If symptomatic or sepsis Sinus, swelling, TOP, mobility No No No No No No Yes Root length >1/3rd Yes Yes No Yes NA NA NA Root length