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4a. mx of deep caries & pulpally involved primary teeth - Coggle…
4a. mx of deep caries & pulpally involved primary teeth
objectives for conserving primary teeth
maintaining arch length
prevent & relieve pain/infx
restore aesthetics & fx
prevent speech problems
prevent aberrant tongue habits
prevent adverse effects on underlying permanent teeth (eg. Turner's tooth)
avoid negative impact on child's psychological & social functioning
pre-operative assessment --> to decide mx & tx
med hx
indications
disorders where you DO NOT wna exo
bleeding disorders & coagulopathies
few teeth le, so rlly wna keep teeth!
oligodontia
contraindications
congenital heart conditions at risk of subacute bacteria endocarditis (SBE)
immunocompromised children (cos dw leave things that can cause infx like pulpally-involved tooth)
poor healing ability eg. in juvenile diabetes
behavioural factors
previous dental experience
attendance hx
child's ability to co-operate
parental attitude & dental awareness
dental factors
general dental condition
absence of permanent successor
think abt the tooth
can it be saved? (restorability)
if it worth saving?
does the saved tooth have a long time left before exfoliation? (life span)
is the prognosis gd?
amt of bone support
others (eg. pulp calcification, pathological root resorption)
how significant is this tooth to the dental arch?
tx approaches/principles of tx
preventative
aim to slow down & arrest caries
via institution of rigorous caries preventive measures, inlcuding use of F (eg. varnish, SDF)
can only do this if
caries is initial/minimal OR can be made self-cleansing eg. by disking
pt & parent complaint, will attend regular R/V
biological
incomplete caries removal, place restoration w good seal to arrest remaining caries
eg. Hall technique, interim therapeutic restoration, indirect pulp cap
conventional (surgery)
pulpy thingthangs
first things first! dx of pulp status in primary teeth
how?
pain hx & characteristics (duration, nature, spontaneous vs provoked)
discolouration, mobility of tooth
surroundign soft tissues (redness, swelling, sinus tract)
EPT NOT valid!!!!!!! this thing j sucks for paeds
percussion, thermal tests (questionable reliability tho)
radiographs (pathology at apical/furcal areas, BL, pulpal calcification, pathological root resorption)
colour of and nature of bleeding from exposed pulp during procedure
how do results influence tx? diff types of pulp therapy accordingly
vital pulp therapy (for normal pulp & reversible pulpitis)
considerations
absence of spontaneous pain
pain elicited from thermal testing does not linger
NTTP, NTTPp, mobility WNL
no soft tissue lesions eg. swelling, sinus
no perifurcation/pa lesion on radiograph
tx
Hall technique
Protective liner
Indirect pulp cap
lowkey same as ITR
both leave thin layer of affected dentine
butttt
ADD DIFF!
Direct pulp cap
Pulpotomy
what is it? removal of coronal pulp, followed by placement of a medicament over radicular pulp stumps
3 main outcomes
preserve radicular pulp in healthy state
render radicular pulp inert
encourage tissue regeneration & healing @ site of radicular pulp amputation
indications
carious of traumatic pulp exposure in a primary tooth w normal pulp or reversible pulpitis
inflam/infx deemed to be confined to coronal pulp & raidcular pulp is vital
clinical procedure
also know the medicaments that can be used
1/5 dilution Buckley's formocresol
2 more items...
MTA
Ferric sulphate
possible complications
know procedure for each
need to do follow-up, slide 31
non-vital pulp therapy (irreversible pulpitis & necrotic pulp)
tx
pulpectomy
pts to note when doing pulpec for primary teeth
clinical procedure
also know root canal filling material
criteria for RCT material for primary teeth
options
possible complications
lesion sterilisation/tissue repair
if tooth cannot be conserved / tx failure: EXO :(((( so SAD
need addn extractions? balancing / compensating extractions
need space maintainer?