INDIRECT PULP TREATMENT
1. The base that should be used for indirect pulp treatment for the primary or permanent dentition is Glass ionomer.
2. After completing an indirect pulp treatment procedure in a permanent molar, restore the tooth and observe it, reentering only if symptoms arise.
Restore the tooth with a glass ionomer cement , then reenter it after a given time period (>48 days) to remove any residual caries, regardless of the absence of pathology and symptoms, and place a permanent restoration.
3. The base that should be used for a direct pulp cap in a permanent tooth is: light-cured calcium hydroxide.
PULPOTOMY
4. The medicament that should be used for a primary pulpotomy procedure is: Buckley's formocresol (1:5 dilution)or Buckley's formocresol (full strength) or Ferrie Sulfate 15%.
5. The medicated pellet should be left in the pulp chamber for 5 min before removing it for an initial evaluation.
6. The base that should be used in a primary pulpotomy procedure is: zinc oxide-eugenol, glass ionomer cement or iodoform paste.
PULPECTOMY
7. The methods that should be used to mechanically debride the root canal(s) for a primary pulpectomy are: broaches, reamers or files.
8. The root canal(s) of primary teeth should NOT be enlarged for a pulpectomy.
9. The solution that should be used to irrigate the root canal(s) in a primary pulpectomy could be any one of the following:
sterile water/saline
local anesthetic solution
sodium hypochlorite, full strength
sodium hypochlorite, diluted10. The material that should be used for the obturation (filling) of primary root canal(s) is: zinc oxide-eugenol paste (not reinforced IRM) or iodoform paste.
11. The technique that should be used to place the recommended filling material into the root canal of a primary tooth could be: a lentulo spiral, hand condenser, or syringe.
12. The number of appointments recommended for appropriate completion of a primary pulpectomy procedure is either one or two appointments -- ONE if the pulp is vital and TWO if the pulp is non-vital.
13. The frequency of exposure with periapical radiographs recommended for follow-up evaluation of a primary pulpectomy procedure is: immediately after filling and periodically there after until exfoliation.
CLINICAL CASE SCENARIOS
FOR THE FOLLOWING SCENARIOS. THE TOOTH IN QUESTION IS A PRIMARY MANDIBULAR PRIMARY SECOND MOLAR AND THE PATIENT IS 5 YEARS OLD.
14. After deep caries removal in a primary molar, if there is still caries present in the preparation, which, if removed in its entirety would result in a minimal pulp exposure. You should:
continue to remove all caries and, if the pulp is exposed, initiate a pulpotomy procedure.15. During a Class II cavity preparation with rubber dam isolation you verify that you have removed all the caries and a few moments later the patient bites down while you are completing final outline form. Upon evaluation you note that there is a small bur hole in the pulpal floor of the preparation with the pulp exposed but not hemorrhagic. You should:
do a direct pulp cap or a pulpotomy, depending upon the size of the exposure and isolation of the tooth.16. During the excavation of caries in a primary molar a carious pulp exposure occurs. The radiograph reveals no pathologic root resorption nor obvious furcation or apical radiolucencies and there are no signs of a draining fistula or mobility. You should:
do a pulpotomy.17. Three years following pulpotomy treatment in a primary second molar of an 8 year old child, a periapical radiograph reveals pathologic root resorption but there are no negative clinical signs or symptoms. Your treatment approach should be:
routine follow-up evaluations for clinical signs or symptoms.18. During a pulpotomy procedure, the amputated radicular pulp tissue is very hemorrhagic even after medicament application, hemostasis is difficult to achieve. Upon close inspection of the tooth, you determine that the pulp chamber is adequately unroofed and there is no evidence of coronal pulp tissue tags. The radicular pulp continues to appear hyperemic. You should:
do a pulpectomy procedure.19. A 5 year old patient presents with a draining fistula associated with a large carious lesion in a primary mandibular second molar that appears to be restorable with a steel crown. A periapical radiograph reveals a small furcal radiolucency, but there is no evidence of pathologic root resorption or mobility. You should do either:
a two-appointment pulpectomy (extirpate, observe, and fill, if favorable, on reappointment; a one-appointment pulpectomy; or an extraction followed by space maintenance, depending upon circumstances and professional judgement.
FOR THE FOLLOWING THREE SCENARIOS, THE TOOTH IN QUESTION IS AN INTACT, DISCOLORED
(GRAY) PRIMARY MAXILLARY CENTRAL INCISOR AND THE PATIENT IS 3 YEARS
OLD. THERE ARE NO OTHER CLINICAL SIGNS OR SYMPTOMS. MOTHER REPORTS THAT
THE PATIENT BUMPED THE TOOTH IN AN ACCIDENT 3 MONTHS AGO.
20. A 3 year old patient presents with a discolored (gray) primary central incisor traumatized in an accident about 3 months ago. The periapical radiograph shows no signs of pathology. You should:
follow-up and observe every 6 months for the development of further signs or symptoms.21. The above patient presents for 6 month follow up. There are still no clinical signs or symptoms of pathology. A periapical radiograph reveals a 2-mm, poorly defined apical lucency. You should do:
a pulpectomy.22. The above patient presents for 6 month follow up. The radiograph reveals a 2-mm, poorly defined periapical radiolucency. Clinical examination reveals a labial parulis associated with the tooth. The patient does not report any symptoms you should do either:
a pulpectomy or extraction depending upon the extent of the abscess.23. A 3 year old patient presents with an Ellis class III fracture (exposure of the pulp) of a primary maxillary incisor that occurred less than 1 hour ago. Soft tissues are intact, the tooth in its natural position and is only slightly mobile. A periapical radiograph is normal except for the fracture. You should do:
a pulpectomy24. A 7 year old patient presents with an Ellis Class III fracture of a permanent maxillary central incisor that occurred less than 1 hour ago. Soft tissues are intact, the tooth in its natural position and is only slightly mobile. A periapical radiograph is normal except for the fracture. You should do either:
a direct pulp cap with light-cured calcium hydroxide base
or
partial pulpotomy (Cvek technique) using calcium hydroxide powder
depending upon circumstances and professional judgement.25. A 9 year old presents with deep caries in a permanent mandibular first molar. A bitewing radiograph shows a most likely carious pulp exposure if all caries were removed. A periapical radiograph shows no evidence of abscess. You should do:
indirect pulp treatment.