Pediatric Dentistry

Dr. Trinette Colina

02/18/2016
Finals

Pulpal Therapy In Children

Goal of Pulp Therapy

Successful treatment of cariously involved pulp, allowing the
tooth to remain in the mouth in a non-pathologic state
Maintenance of arch length and tooth space
Restoration of comfort with the ability to chew
Prevention of speech abnormalities and abnormal habits
Factors Influencing Success
Type and amount of pulpal hemorrhage
Depth of penetration of bacteria from the carious process into
the pulpal tissue
Speed of carious attack on the pulp
Diagnosis
Length of time the tooth or teeth in question are to be retained
The health of the patient
The status of the remaining dentition
The restorability of the tooth or teeth in question
Patient and parent cooperation in accepting the prevention
program, including periodic evaluation
Radiographic Assessment
Depth of caries
Involvement of bifurcation and trifurcation regions of the primary
molars
Pathologic external root and bone resorption due to pulpal
degeneration, presence of infection for a long period
Internal root resorption due to calcium hydroxide, advanced
degenerative changes
Calcific changes advanced pulpal degeneration with
inflammation spreading throughout the coronal parts of pulp
Widened periodontal ligament usually indicative of pulpal
pathology

Clinical Assessment
History
Mobility
Swelling

Types of Pulp Treatment

Indirect pulp therapy
Co, Eunice Bernadette
DFD

Pediatric Dentistry
Dr. Trinette Colina

02/18/2016
Finals

Direct pulp therapy

Pulpotomy
Pulpectomy

When a deep carious lesion is encroaching on, but not actually

into the pulp
For permanent teeth only
Use ZOE or CaOH over carious dentin to stimulate the tooth to
assist in its own recovery from the near pulpal exposure
-> Complete hard tissue barrier is formed 60 days after CaOH
application; new layer of odontoblast-like cells.
Pain history
1. No extremes
2. May be associated with eating, especially carbohydrates
3. Sometimes dull
Clinical assessment
1. No gingival pathologic condition
2. No mobility
3. Large carious lesion
Radiographic examination
1. Probable carious exposure
2. Normal periapical tissues
Objectives
1. Reversal of bacterial invasion
2. Treatment of carious dentin
3. Maintenance of normal healthy pulp
Contraindication
1. Discoloration and mobility with non-vitality
2. Sharp pain and pain prolonged at night
3. Radiographic pulp exposure
4. Radiolucency at apex
5. Interrupted lamina dura (infection has spread already)
Procedure
1. Local anesthesia, rubber dam
2. Remove all unsupported enamel. The preparation is
extended as dictated by the carious process
3. #4, 6 or 8 round bur at slow speed to remove carious
dentin. Do not expose the pulp. Large spoon excavator can
be used
4. Outermost layer of dentin will be mushy necrotic tissue,
next layer will be leathery but firmer, the last 1mm of
dentin is left
5. Apply CaOH over the last 1 mm of carious dentin
6. Place a base of IRM over the CaOH liner

Indirect Pulp Therapy

Co, Eunice Bernadette

DFD

Pediatric Dentistry
Dr. Trinette Colina

02/18/2016
Finals

7. Remove excess material from the margins and margins and

restore
8. Recall. If the radiograph shows a layer of secondary dentin,
re-entry is not necessary

Direct Pulp Therapy

Placement of CaOH preparation on a small (pinpoint) pulpal

exposure
Limited to permanent teeth
Studies have shown least desirable course of treatment with
poor prognosis and it should rarely be used on primary teeth
Primary teeth respond to caries and resultant pulpal
inflammation much faster

Pulpotomy

Indicated for carious or mechanical exposures in the primary

teeth and to induce root closures in the young permanent
dentition
Inflamed coronal portion is removed, and a medicament is placed
over the excised pulpal tissue
Teeth
o Primary teeth
o Permanent teeth where economics is a factor

Co, Eunice Bernadette

DFD