Pulp Therapy in Children

The decision for pulp therapy is based primarily on pain and pulpal status.

  
If the pain is -

• Spontaneous
• Nocturnal          ------> Irreversible ------> Non Vital Pulp   
• Constant 

• Intermittent
• Thermal            ------> Reversible -------> Vital Pulp
• Chemical

Outline of Pulp Therapy in Children

Vital Pulp Therapy 

1. Protective Base
2. Indirect Pulp Capping
3. Direct Pulp Capping
4. Pulpotomy

Non Vital Pulp Therapy

1. Pulpectomy
2. Extraction

Vital Pulp Therapy

1] Protective Base  

• Radiopaque base between restoration & dentin   
• Acts as a protective barrier
• Seals dentinal tubules
• Minimizes pulp injury & allows pulpal healing 
• Preserves health and vitality of restored tooth

Examples- Dycal, Vitrebond.

2]  Indirect Pulp Capping

Objectives IDP :

• Halt the carious process .
• Allow pulp healing and reparative dentin formation.

Indications :

• symptom free tooth
• no X-ray evidence of Pulpal pathosis
• absence of furcal or periapical pathology
• negative percussion test

Procedure :

• Single appointment approach : (Most common approach used these days)

          - Excavation of caries

          - Permanent restoration is placed at the first appointment            

            itself.

          - Periodic monitoring of the tooth. 

• Two appointment approach :

 I.   First appointment :

          - Excavation of all the superficial carious dentin.

          - A layer of affected dentin is left behind to prevent potential    

            pulp exposure.

          - Pulp dressing placed or the layer of affected dentin for   
            about 6- 12 months.

II.   Second appointment : (after 6-12 months)

          - Remaining soft carious dentin excavated

          - Floor of the cavity examined for pulp exposure.

          - No pulp exposure ----------> Place Permanent restoration.

          - Pulp exposure present -------> Pulpotomy

Pulp Dressings used :

• Calcium Hydroxide
• Hybrid Ionomer materials
• Glass Ionomer materials

Permanent Restoration :

• Glass Ionomer
• Hybrid Ionomer
• Composite
• Compomer
• Amalgam
• Stainless Steel Crown

For Permanent dentition- Composite, Amalgam, stainless steel crown or cast crown restorations are usually used.