Primary Teeth-Pulp Therapy
Objective: Preserve pulp tissue
Reason: Primary teeth with vital pulp tissue have a better prognosis and thus a better chance to exfoliate on time (avoiding space maintenance and orthodontic issues).
1. Problem: Deep caries
Treatment: PROTECTIVE LINER; excavate decay, place a liner like caoh, dentin bonding agent, or glass ionomer, and cover with a permanent restoration.
2. Problem: Small carious pulpal exposure and no significant pain indicating pulpal degeneration.
Treatment: INDIRECT PULP CAP; excavate the gross caries, however leave the caries directly over the pulp chamber to avoid pulpal exposure, cover with a biocompatible material like caoh or glass ionomer to stimulate healing, and that is covered with a permanent restoration.
3. Problem: Pinpoint pulpal exposure encountered during cavity preparation or traumatic injury, and no significant pain.
Treatment: DIRECT PULP CAP: the pulp tissue is covered with a biocompatible base like caoh or mta and a permanent filling is placed on top.
4. Problem: Large carious pulpal exposure and no significant pain.
Treatment: PULPOTOMY: pulp tissue in the pulp chamber is removed, the pulp chamber is dabbed with a wet cotton pellet of sodium hypochlorite, and once bleeding is controlled, the chamber is filled with; 1.buckleys solution (formocresol and ferric sulfate), 2.gluteraldehyde and caoh (less successful), or 3.mta (most successful), then a permanent restoration is placed on top for a proper seal and covered with a stainless steel crown (most effective long term).
5.Problem: Non-vital pulp tissue, furcal bone loss, or pain i.e. irreversible pulpitis pain.
Treatment: PULPECTOMY; fill the canals with resorbable material like 1.kri (z.o.e and iodoform paste) or 2.vitapex (iodoform and caoh), that will resorb along with the roots, and then a permanent restoration is placed on top.
6. Problem: No permanent successor and the tooth has non-vital/necrotic pulp tissue or pain i.e. irreversible pulpitis pain.
Treatment: conventional RCT with a nonresorbable root filling like gutta percha and sealer or Mta.
Note: space maintenance rule:
If the ‘e’ tooth or primary second molar is lost early, space maintenance is always necessary to allow the permanent successor i.e. premolar to erupt into place.
If the ‘d’ tooth, or primary first molar is lost early, then it depends. If the 6 year molar has already erupted fully, then space maintenance is not necessary, however if it has not erupted into place yet, then space maintenance will be necessary, for its eruption will drive the ‘e’ tooth mesially thus blocking out the premolar from erupting.