Pulp therapy in pediatric dentistry pdf

Dentin is formed continuously throughout the life of the tooth. Odontoblasts can also form a unique type of dentin in response to injury, such as occurs with caries, trauma, and restorative procedures.

Pulp Therapy in Pediatric Dentistry --A Review-- Pulp functions continued Nutrition Via dentinal tubules, pulp supplies nutrients that are essential for dentin formation and hydration. Defense Odontoblasts form dentin in response to injury, particularly when the original dentin thickness has been compromised by caries, wear, trauma, or restorative procedures.

Pulp also has the ability to elicit an inflammatory and immunologic response in an attempt to neutralize or eliminate invasion of dentin by caries- causing microorganisms and their byproducts.

Pulp Therapy in Pediatric Dentistry --A Review-- Pulp functions continued Sensation Through the nervous system, pulp transmits sensations mediated through enamel or dentin to the higher nerve centers.

The pulp of the primary tooth is histologically similar to that of a permanent tooth. The vascularity of the pulp. The absence of cariogenic and inflammatory bacteria. Pulp Therapy in Pediatric Dentistry --A Review-- The root canals of anterior primary teeth are relatively simple, have few irregularities, and are easily treated endodontically.

The root canal systems found in posterior primary teeth, conversely, contain many ramifications and deltas between canals making thorough debridement quiet difficult. Generally, there is only one canal present in each root of the primary molars when the formation of the roots has been completed.

The resorption causes the position of the apical foramen to change continually. Pulp Therapy in Pediatric Dentistry --A Review-- Simultaneously, secondary dentin is deposited within the root canal system. The deposition produces variations and alterations in the number and size of the root canals, as well a many small connecting branches between the facial and lingual aspects of the canals. Primary molar roots are widely divergent and curved to allow for the development of the succedaneous tooth.

Pulp Therapy in Pediatric Dentistry --A Review-- The maxillary primary molars may have two to five canals, with the palatal root usually rounder and longer than the two facial roots.

The primary mandibular first and second molars usually have three canals which generally correspond to the external root canal anatomy. Since the distance from the occlusal surface and the floor of the pulp chamber is much shorter than in a permanent tooth, care must be taken when making an access opening into the pulp chamber to prevent perforation into the furcation area.

Frequency how often does it hurt? Location where does it hurt? Percussion Testing is most reliable in primary teeth. Thermal sensitivity Testing is also reliable in primary teeth.

In the presence of infection, bone is destroyed. The bone destruction is seen in the furcation area of the tooth. When the infection is chronic and long-standing, the resorption can become extensive involving not only the furcation but the apical areas as well. The finding of bone resorption is indicative of widespread pulpal necrosis and nonvitality of the associated tooth. Pathologic root resorption.

Commonly associated with pathologic bone resorption is resorption of the root of the affected tooth itself. Root resorption is indicative of the presence of the infection for a prolonged period and generally precludes the employment of any pulp therapy procedure. If present, it will probably be seen in the root canals and again is evidence of advanced degenerative changes throughout the pulp. Pulp therapy will generally not be successful as the resorptive process is not readily retarded.

Calcific changes. Calcified bodies known as calcific masses or globules present in the pulp indicate advanced pulpal degeneration with inflammation spread throughout the coronal portion of the pulp. A widened PDL is usually indicative of pulpal pathology. There is a poor correlation between clinical symptoms and histologic pulp status. Infected Pulp. Moderate Infection Severe Infection Patient is taking fluids well; only slightly febrile Patient dehydrated and febrile. Eradication of infection.

Capitalization of reparative ability of the pulp. Pulpotomy formocresol 4. Pulpotomy other categories of medicaments 5. Pulpotomy non-pharmacotherapeutic 6. Definition: In essence, an IPT is the application of a drug over a minimal amount of carious dentin with no clinical exposure of the pulp with the objective of generating reparative dentin formation beneath the carious lesion.

Place calcium hydroxide Dycal or other medicament i. Vitrabond, Fuji II, etc. Can be done in primary and permanent teeth. Contraindicated for carious pulp exposures Valid for small mechanical or traumatic exposures Optimal chance for favorable prognosis depends on case selection At UKCD, direct pulp caps on primary teeth are not considered ideal or acceptable treatment.

Preserve vitality of radicular pulp 2. Amputate infected coronal pulp 3. Treat remaining pulp with medicament 4. Neutralize residual infectious process 5.

Avoid dystrophic pulpal change 6. Discover papers, protocols, and more Pediatric Dentistry. Get PDF. Associated Clinical Trials. Related Concepts. Trending Feeds. Cryogenic Electron Microscopy Cryogenic electron microscopy Cryo-EM allows the determination of biological macromolecules and their assemblies at a near-atomic resolution.

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The suspected tooth should be anesthetized and, if the diagnosis is correct, the referred pain should disappear. Occlusal pressure test: This test is useful in identifying teeth with symptoms of apical periodontitis, abscess or cracks. In patients with tooth infractions cracked tooth syndrome is pain often experienced when biting force is released rather than during the downward chewing motion Fig.

Thermal Testing is useful to assess the vitality of the pulp and to identify the offending tooth correctly in situations where the patient is unable to locate the source of the pain. An abnormal response to heat usually indicates the presence of a pulpal or periapical disorder that requires endodontic treatment. Secondly, the heat might damage the pulp, since pulp horns are highly placed in deciduous teeth and if the child is uncooperative the heat might cause injury to the soft tissue.

In cold test, the application of cold can be done by many methods like a stream of cold air, ethyl chloride, application of ice, dichlorodifluoromethane and CO 2 snow. A response to cold indicates a vital pulp, regardless of whether the pulp is normal or abnormal. Electric pulp test utilizes the tip of a testing probe Fig. The coated tip is placed in the incisal third of the facial or buccal area of the suspected tooth Fig.

A false-positive response is obtained in cases when the electrode contacts the gingiva, liquefaction necrosis, failure to isolate and dry the teeth properly and multirooted teeth where the pulp may be vital in one or more root canals. A false-negative response is seen in patients with heavily premedicated, a recently traumatized tooth, teeth with an immature apex, excessive calcification in canals and the presence of pulp protecting bases. Electric pulp testing has shown to be unreliable or rather non effective in deciduous teeth and immature permanent teeth because the relationship between odontoblasts and nerve fibers of the pulp has yet to develop.

Another reason for the unreliability of electric pulp test in deciduous teeth is that the nerve fibers are the last to develop and first to degenerate in these teeth. The advanced pulpal diagnostic aids include laser Doppler flowmetry, pulse oximetry, dualwave spectro-photometry, plethysmography, liquid crystal testing, time-temperature graph, electronic thermography, ultrasonic imaging, xeroradiography, digital imaging, subtraction radiography and computed tomography.

The laser Doppler flowmetry technique is a noninvasive, electro-optical technique, which has been shown to have a potential of assessing the vitality of teeth by detecting the presence or absence of pulpal blood flow. Studies were carried out to compare LDF with conventional pulp tests, EPT electric pulp testing and thermal tests, in children with certain dental injuries. It was concluded that LDF identified more vital and nonvital teeth correctly at earlier time periods following injury than conventional tests.

Pulse oximetry 8 is a noninvasive technique which determines the percentage of O 2 saturation of circulating arterial blood by the placement of the probe in the middle third of the crown. Dual wavelength spectrophotometry 8 is a method independent of pulsatile circulation, which detects the presence or absence of oxygenated blood at and nm. This method is noninvasive, inexpensive and do not rely on subjective patient response, and therefore yields objective results. The limitation is that it detects only the presence of hemoglobin not the circulation of blood.

Plethysmography 8 is a potential noninvasive method to detect vascularity within the dental pulp. Its advantages include less signal contamination derived from periodontal blood flow and less signal noise PDL blood flow compared to LDF due to the pathway of the light transmitted light. The time-temperature graph method 8 is a concept of diagnosing tooth vitality by temperature measurement and can provide valuable information on the integrity of the underlying pulp.

Electronic thermography 8 produces color images of the body that indicate relative differences in temperature in both superficial and deep areas. Optical reflection vitalometer is a system based on pulse oximetry, but the difference from conventional pulse oximetry is that adsorption is measured from reflected light instead of transmitted light.

Preliminary tests showed that vital and nonvital pulposus reflected the radiation differently. Ultravioletfluorescence is a test of vitality which accentuates the color changes occurring in a tooth, when pulp is damaged by trauma or inflammation. The responsibility of early detection and management of developing malocclusion rests with the pedodontists because they see the patient at a very young age at various intervals like preschool age, school age and the teenage period.

The database may be thought of as derived from three major sources:. This includes an extraoral examination which will record the general health, body type ectomorphic, mesomorphic, endomorphic , posture, and the physical growth status. Facial features include that facial type mesofacial, brachyfacial and dolichofacial , shape of the head dolichocephalic, mesocephalic, brachycephalic , profile analysis anteroposterior and vertical relationship , lip posture at rest color, size, mentolabial sulcus and relative symmetry of facial structures size and shape of nose, chin button size and contour.

Intraoral examination should record the jaw relationship anterior-posterior relationship, vertical relationship, lateral relationship , open mouth examination of teeth, soft tissue appraisal and functional assessment respiration, speech difficulties indicating dental problems, differential diagnosis of swallowing types, occlusal interference.

Evaluation of teeth and oral structures: The general guideline is that any medical problems, dental caries or pulpal pathology and periodontal disease must be under control before orthodontic treatment begins. Occlusal evaluation: Three aspects require evaluation-mastication and swallowing, speech and TMJ problems. Evaluation of excessive gingival display on smiling, inadequate anterior tooth display, excessive buccal corridors, etc.

Assessment of tooth proportions in height and width, gingival shape and contour, connectors and embrasures, black triangular holes and tooth shade. Model analysis is a valuable tool in orthodontic diagnosis and treatment planning as it provides a 3D view of arches and helps in early assessment of available space.

Mixed dentition model analysis evaluates the amount of space available in the arch for succeeding permanent teeth and the necessary occlusal adjustments. Radiographic cephalometry Fig. Clinical photographs and diagnostic radiographs help in assessing the visual treatment objective. Figure 8 shows an orthopantomograph for orthodontic diagnostic purposes. Neural age helps us to understand that the patient is mentally developed to understand the need for the treatment, to what extend he can cooperate and follow instructions.

Mental age is an index of maturation of the mind, and increases at a rate that depends on many intrinsic and environmental factors. Some of the performance tests used to measure intelligence are the Standard-Binnet test and Wechsler scale.

Physiological and Biochemical age are a series of physiological and biochemical changes occurring during growth, which can be correlated to skeletal and chronological age. Chronological age is determined by passage of time since birth, which is a poor indicator of maturity. It is closely related to the growth of the individual. Digital cephalometric involves digitization, which is a form by which analog information is converted to digital form and are recorded and stored in a data set.

This data set is starting point for the formulation of various computer generated visual treatment objectives. Video cephalometry which includes digitization of the cephalogram followed by sizing the profile video image to the cephalogram.

Digital photography enables storage of images in a digital form on a storage media and is a simple aid to transfer and manipulate such data. Three-dimensional imaging techniques provide extensive possibilities for the detailed and precise analysis of the whole craniofacial complex, for virtual on-screen simulation and real simulation of orthognathic surgery cases on biomodels before treatment as well as for the detailed evaluation of the effects of treatment.

Cone beam volumetric tomography uses a cone-shaped X-ray beam with a special image intensifier and a solid state sensor or an amorphous silicon plate for capturing the image. Other supplemental diagnostic aids include occlusograms which are tracings of a photograph or a photocopy of a dental arch, and can be used to estimate occlusal relationships along with arch length and width.

Electromyography is a procedure used for recording the electrical activity of muscles. It detects abnormal muscle activity associated with certain forms of malocclusion.