Pulp Therapy of Primary and Young Permanent Teeth PDF

PULP THERAPY OF PRIMARY AND YOUNG PERMANENT TEETH Mahmoud Abd-Elmotelb lecturer of Pediatric and Community Dentistry Faculty of Dentistry Minia University  To retain every primary tooth as a fully functional component in the dental arch to p...

PULP THERAPY OF PRIMARY AND YOUNG PERMANENT TEETH Mahmoud Abd-Elmotelb lecturer of Pediatric and Community Dentistry Faculty of Dentistry Minia University  To retain every primary tooth as a fully functional component in the dental arch to preserve proper Mastication phonation Natural space maintainer psychological confidence - Dentine protect the pulp in combination with enamel (Crown) and cementum (Root) - Pulp provide dentine with its reparative capacity -70 % Inorganic, 20 % Organic matrix and 10 % Water -DT being wider from DEJ (1mm) to pulp (3mm) and in increased number occupied from 1% of dentinal area at DEJ to 45% at pulp -Nerve fibers, Mylinated (A, Delta 90% and Beta 10%) and non mylinated (C fibers)) Based on the extent of pulpal damage, disease of the pulp can be classified as: 1- Pulpitis A)Reversible pulpitis B)Irreversible pulpitis C)Hyperplastic pulpitis/Internal resorption 2- Pulp degeneration-pulp calcification 3-Necrosis  1- History of pain The absence of toothache does not preclude a histologic pulpitis. The active lives of children, together with their short attention spans, may mean that minor discomfort passes without comment in a whirlwind of activities  1- History of pain A positive history of toothache suggests definite pulp pathology. However it is difficult to correlate the type of pain with the degree of pathosis  Provoked Vs Un-provoked 1- History of pain Momentary Vs Lingered Reversible pulpitis, Transient momentary pain that provoked due to osmotic (eating) or thermal (hot and cold) stimulus and relived once stimulus removed as brushing or with OTC analgesics as paracetamol Irreversible pulp damage, Unprovoked or provoked lingered throbbing pain that awake child up  2- Clinical examination I- IO a) Tooth mobility ? Unreliable ?, provide info about Pulp/PL b) Percussion  Finger tap?, provide info about PL c) Swelling, fistula, sinus tract or un explained gingival inflammation irreversible damage d) Size of exposure & amount of bleeding Size (1mm or more) and exudate (Watery and pus) II- EO a) Swelling (cellulitis) b) Fistula 3- Pulp testing Sensibility (Nerve testing) EPT unreliable for children as immature nerve fibers, apprehension, liquefaction necrosis, physiological root resorption Thermal test more reliable than EPT, Cold test (Ice cones, Ethyl chloride (- 41°C), Dichlorodifluoromethane (DDM)(-0°C) and Dry ice (-72°C) more reliable than heat (Hot GP, Inst or water) 3- Pulp testing Vascularity (Blood supply) - LDF - Pulse Oximater 4- Radiographic examination - Proximity of carious lesion from the pulp (not pulp exposure) - Periapical or interradicular bone radiolucenies - Widening of PMS - Pulp calcification - IRR and/or ERR - Evaluation of treatment Any tooth with reversible pulpitis: -Characterized by transient momentary pain stimulated by osmotic or thermal stimulus relived by removal of stimulus, teeth brushing or OTC analgesics Vital pulp therapy (IDPC or Pulpotomy) Any tooth with irreversible pulp damage: -Characterized by sever prolonged spontaneous or stimulated pain which usually awake child up Non vital pulp therapy (Pulpectomy) 1- An un restorable tooth 2- Internal resorption in roots visible in radiograph (can be treated) 3- Farcul involvment 4- Excessive pathologic root resorption exceed one third of the root 5- Cyst 6- Tooth approach shedding 7- Pulp degeneration as (fibrous and calcific) 8-Uncooperative patients 9-Poor parent attitude 1- Local anesthesia administration  Rubber dam Isolation 2- Caries removal NO Detection of pulp exposure Ideal treatment is IDPC using Regenerative Materials, RMGIC, CaOH, RZOE, Dentine bonding agents or GIC Followed by Full Coverage Two visits (6-8 ws interval) Versus One visit? (New AAPD EB Guide lines 2021) Medicament? 2- Caries removal Detection of pulp exposure  favorable DPC Direct pulp capping DPC Mechanical exposure (