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88 comments:
Wow, I can't believe I forgot to post again! darn...Anyways, the thing that I thought was most important about the lecture was the statement that stainless steel crowns can have a 100% success rate if done correctly....
Sean Nguyen #160
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The moment you work on a tooth you are causing pulpal pathology. Even the smallest occlusal restorations have an effect on the pulp. Also, even though a electric pulp testing can be convenient, it really isn't reliable enough for clinical Dx.
Jake Cragun
#117
I thought the most informative statement was about the rule of three's, 3 years for calcication, 3 years for eruption, 3 years after eruption for apical closure.
Sean Nguyen, #160
The electric pulp tester is useless as a diagnostic tool for endo when applied on deciduous and immature permanent teeth.
-Shelton Chow #111
EPT is useless for primary tooth dx. Also, do not use CO2 on primary teeth for cold testing because it can cause craze lines, use endo ice.
Orly Hendizadeh, #134
As a dentist, it's important to identify the state of inflammation of the pulp in order to determine if the tooth is vital or nonvital.
The last post was written by Tina Duong #125
The electric pulp test is not very useful for deciduous teeth. Do not directly ask patients if they feel pain, they will react when they really do.
E. Lai #141
pulp test: No difference btw hot and cold test.
Jeffrey Kim #139
When taking history of chief complaint, remember that 18% of normal, atrophic pulps also report pain. Also, endo-ice is best for pulp testing primary teeth.
For pulp therapy in teeth with deep caries,leave behind some softened dentin to form a dentin cap (hopefully).
Emmy Le
#142
Dental pulp is affected by ANY cavity preparation, however major or minor. Also, the best material to cap pulp is dentin, even if it is softened, affected dentin.
Christine Chung #112
The best pulp test for primary teeth is ice or endo ice. Also, the pulps of diciduous teeth are large in relation to crown size, and the pulp horns found directly under the cusp tips.
In deciduous teeth, pulpotomy is the teatment of choice (No pulp capping). Whilst in permanent teeth with open apices, pulp capping is preferable.
Dilshad Abtin #524
During the pulp test do not ask the kid to tell you when it hurts because they will react immediately to the stimulus, just tell them to tell you when it feels ice like ice cream. Also EPT is useless in decidious teeth and inmature permanent teeth.
Heidi Gonzalez #526
Natalie Nguyen #159:
Indications for pulp capping include 1mm or smaller exposure, clean field, no history of spontaneous pain, and open apices or young permanent tooth. Pulpotomy is the treatment of choice for deciduous teeth.
If you prepare a tooth in the dark, you will see sparks and the bur will be red-hot. If you raise the pulp temp by 10 C, you have a 50% chance of killing it.
[Colby Smith #178]
Dentin is the best pulp cap even if it is soften or decalcified. leaving the decalcified dentin in is better than having micro-exposure and caping with GI base.
Soheil Yashari #191
Jonathan Do #121
With electric pulp testers, In adults 70% non-vital teeth gave no response which makes it quite successful in diagnosing non-vital teeth. However, EPT are considered useless in decidous and immature permanent teeth.
It is important to sterilize a cavity after you have prepared it.
-Carol Kim (138)
Use endo-ice but not CO2 to cold test primary teeth. Sterilize deep caries near the pulp with bleach to kill as many bugs as possible.
Dan Nelson #157
I learned that it is important to sterilize all of your cavity preps because bacteria causes the pulpal insult. Also, we need to recognize the state of survival that the pulp is in in order to treat it correctly and to avoid damaging it further.
Shelby Padua #166
50,000 microtubules/mm in adult dentin and 20,000 microtubules/mm in deciduous dentin. Pulp cap young perm. tooth or tooth with open apex if clean field, no hx of spontaneous pain, 1mm or less exposure.
Jing Lee #144
Currently we don't know enough about pulp physiology to provide the optimal tx. EPT is not a best diagnostic tools when it comes to decidous teeth.
Sonia Lee (145)
Liz Miltner #150
Prepping a tooth can cause damage to the pulp and this can be seen by cutting a tooth in the dark. The bur will turn red hot and sparks will fly! Also learned the concept that you should sterilize every cavity prep before restoring.
Although no difference between hot and cold test, use endo-ice or ice and ask when it feels like biting an ice-cream and EPT aint helpful; Increase 10 degreeC, 50% of pulp will die.
Eric Cheung #110
majic moment:endo ice is the best test for primary teeth.
poonam rai #530
majic moment :endo ice is the best test for primary teeth.
poonam rai #530
Be prepared for pulp therapy when treating caries. Affected dentin is OK to leave when caries is deep near the pulp. GI base is not necessary for composite restorations and thermally isolates amalgam restorations.
Austin Tung 187
Taking an accurate history is the most important step in pulp evaluation/treatment.
Amy Dixon #120
That you need to sterilize every prep you make...even if they're just enamel preps.
Catherine Do #122
when doing pulp testing, always tell a child something like, "tell me when u feel something cold like ice cream," NOT, "tell me when this hurts," because the result will be inconclusive. Also, there is no difference between cold and hot sensation, so a cold test using endo ice is sufficient.
Sanam Soroudi #180
The best pulp test for deciduous teeth is endo ice. The worst test to use is electric pulp test.
Mihir Shah #175
pufWhen treating pedo patients use fun words like ice cream or ice cube rather than painful cold or hot, also EPT is not useful on deciduous teeth, Hot/cold is more diagnostic.
Farshid Siami #177
Drilling on a tooth causes damage to the pulp. Therefore, the less drilling one is able to do the better for the long-term survival of the tooth.
EPT is not very accurate/useful for primary teeth. When cold testing - don't say: 'tell me when it hurts' - say: 'tell me when feels like ice cream cold'.
Alina Tiraspolskaya #183
When done well a stainless steel crowns are a very good way to restore a broken down decidous tooth.
The rule of three is good to remember regarding tooth development. Also, don't ask young pts if they felt something is painful because they will expect for something to hurt instead of hot/cold.
Kim Pham 167
Pulpal harm (reversible or irreversible pulpitis) may occur when preparing a large carious lesion but to the lack of irrigation. There is also no difference in pulpal response from heat or cold, but heat test present a negative psychological response.
Jun Flores #130
I learned that a good idea would be to sterilize every cavity prep with concepsus or NaOCl. Also it is a good practice to line deep and very deep amalgams with GI.
Shannon Lazarian
#133
I enjoyed the comments in class about the importance of keeping cavity preparations sterile. There was also a good review of the procedure to treat a pulp exposure.
Marc Thomas 182
The best pulp cap is dentin. Leaving some affected dentin over the pulp is better than exposing the pulp and placing a cap.
Broc Mushet #156
When there is a pulp exposure in an immature tooth, the best treatment option is direct pulp capping. If the exposure is in a primary molar the treatment is pulpotomy.
Claudia Rodriguez #531
Raising the temperature of the tooth by even 10 degrees C. will cause the tooth pulp to have a 50% chance of dying or becoming necrotic.
Neil Patel
#165
EPT is considered useless in decidous and immature teeth.
Hoang #135
Deciduous 1-step pulpotomy medications include:
1. Formocresol (1/5 dilution)
2. Glutaraldehyde (2-5%)
3. Ferric Sulfate
4. Electrocautery
5. Calcium Hydroxide
Naomi Nguyen,
#158
There is no difference in the hot or cold test when testing pulp vitality, differences are only psychological.
Matthew Moadel, Student #151
Pulp is affected to some degree whenever a tooth is being prepared. There is a 50% chance of pulpal death if the temperature of the pulp is raised by 10 degrees C. When performing thermal testing, endo ice should be used.
Jared Martin #147
EPT is useless for pulp testing deciduous and immature permanent teeth. Endo-ice or ice is best for children.
Kevin Omoto #163
I did not know that ept does not work on primary and immature perm teeth. rc 109
A few neat things that I learned in class:
In primary teeth, radiolucencies are usually located in furcations (not around root apices as with permanent teeth). Therefore, bitewings will be more useful than PA radiographs in determinig the extent of the child's radiolucency.
I also learned that Dr. Duperon has taught many of our faculty including Dr. White.
Raquel Ulma #188
The best material for pulp capping is a think layer of dentin. Though, you can add DyCal to enhance healing for a period of time (2-6 months).
Paredes #164
rule of 3's. Tooth begins to calcify 3 years before it erupts. Apex of the roots do not close for 3 years after the tooth has errupted.
Ryan Plewe
#168
The most important things for me:
1. 18 % of normal pulp teeth will show senzitivity
2. There is no diference between cold and hot pulp testing
Cornel Crasnean #525
Pulp testing isn't black and white b/c even 20% of vital teeth can give no response and only 70% of non-vital teeth may give no response.
Morris Poole #169
EPT is not reliable on primary teeth or open apex. Ice is better for testing.
Tiffany Hsu #529
Electric pupl test is useless as a dianostic tool for deciduous eeh and permanent teeth with open apices.Cold test is more reliable preferrably with endo ice.
Amandeep Iqbal
#527
Electric pulp testers are not accurate on primary teeth. The temperature test, either cold or hot, is the most accurate and is advised. For the cold test, use either ice or endo ice but never CO2 because it can cause craze lines on the tooth.
Sydon Arroyo #102
The electric pulp test is useless on deciduous teeth. Endo ice is a much better pulp test in primary teeth.
Josh Cardwell #108
When pulp exposure occurs while removing caries on a deciduous tooth, irreversible pulpitis is assumed and polpotomy is the treatment of choice. However, when working on a young permanent tooth with open apices pulp capping may be our best treatment option.
When pulp exposure occurs while removing caries on a deciduous tooth, irreversible pulpitis is assumed and polpotomy is the treatment of choice. However, when working on a young permanent tooth with open apices pulp capping may be our best treatment option.
Bozhena Fisher #128
EPT testing is not accurate in primary teeth. Also, A bit of soft dentin is the best pulp cap so it's best to leave behind some softened dentin, however carious.
Sanaz Hamzehpour 132
Always need to remember that drilling itself disturb the pulp and affect the treatment outcome, so, should use new bur and copious irrigation when prep the tooth.
Lei Zeng, #535
That Cold/Endo Ice is the most effective pulp testing for kids. And that Cold and hot pulp testing method doesn't really differ that much from each other.
Karen Li #146
It was interesting to find out that EPT shouldn't be used on pediatric patients. Rather endo ice or even ice itself should be used. And when working with a child, one shouldn't ask them "tell me when this hurts" - but rather ask them "tell me when this feels like really cold ice cream." Asking about pain may lead the child to expect pain and give you a false reading - or they may just respond to any sort of stimulus.
-Enayat Astani #308
CO2 is contraindicated for children during pulp testing because it will cause craze lines on teeth. When endo ice isn't available, keeping some old amalgam capsules filled with water in the freezer can come in handy. When drilling, every time you cut a dentinal tubule, you damage an odontoblast.
Sujain Dissanayake #119
Our lecturer suggested that NaOCl or another sterilization agent should be used after gross caries removal.
Jared Lee #143
The most magical of all minutes:
I thought the most important thing that I learned was that a cold test is better than a hot test for kids because you can just tell them to let you know when there tooth "feels cold" like when they eat ice cream. This is much better than telling him/her that you are going to stick a hot instrument in their mouth and to tell you when it feels hot like a fire.
Paul Field #127
Even with minimal invasive technique, caries removal and restorative preps can cause a reactive and reversible pulpitis. Excavation to get every last bit of affected and infected caries could compromise the long term health of the tooth. Therefore in these cases, it is better to leave a thin, affected wall of dentin subject to a minimal irritation to serve as a pulp cap. This rather than pursuing the thinnest possible wall coinciding with a more severe irritation that could irreversibly damage the long-term prognosis and health of the tooth.
This last one was Jeff Flores #129
One new idea that stuck out is the suggestion to clean out each cavity prep with bleach. I also found the whole pulp testing issue of primary teeth interesting...that CO2 can cause crazing in primary teeth. Better to use Endo Ice...just keep it on hand so you don't have to mess with ice in carpules, etc.
Sean Young #192
The most useful information I took away from the lecture was the rule of 3's: 3 yrs for teeth to finish calcifying, 3 yrs then to erupt, 3 yrs then to finish developing the roots. Also, I had not realized how much heat is generated by cutting enamel with a bur (though the burned teeth in my typodont should have given me a clue!)
Will Traynor #186
Sterilize your cavity preps! That was the biggest thing I learned from this lecture.
Steph Morphis #154
Any drilling, even if it is minimal, can potentially affect the pulp. Pulpal diagnosis is not very clear cut, and definitive diagnosis can only truly be done histologically. Also, if you drill on a tooth in the dark, the cutting portion of the bur will be red hot.
Robert Busan #107
Compared to the perminant teeth, the success rate in primary teeth pulp capping is much more significant and has to be considered as an important treatment option on affected pulps.
Pedram Sooferi
#179
Just by increasing the temp 10 deg it can kill 50% of dental pulps. Therefore wet-cut. For incipient shallow lesions sterilize w Consepsus or NaOCl.
Dave Tajima #181
EPTs are not reliable on deciduous teeth because research has shown that a significant amount of teeth do not respond to an EPT in an expected manner. Surprisingly, 20% of vital teeth do not respond to electric pulp testing and as a result, unnecessary pulp therapy could be performed on an otherwise healthy tooth.
Richard Duong #124
Following caries removal and prior to placing a comp or Ag restoration material, it is important to sterilize the cavity w/NaOCl to improve the success of the treatment. The restorations on deep carious lesions of permanent teeth should be re-entered in 6-12 months to remove remaining caries and restore, however this is not done on decidious teeth.
Edvin #100
Endo-ice, rather than the EPT, is the best pulp vitality test for deciduous teeth.
Amy Tran #184
That ice or endo ice are the most effective means of pulp testing in deciduous teeth, and that EPT is ineffective.
Steve Kim, #528
Pulp is effected by almost any type of procedure.
Jan Slapnicka
#533
I learned that Endo Ice is the most effective pulp testing for children
Niki Zarabian #194
The point made by Dr. Duperon that stuck in my mind was not to use CO2 on cold testing on primary teeth. It's actually too cold and may cause craze lines in the enamel. Instead use Endo Ice or natural ice if it's available.
J. Oka #162
maJiK moment: Every prep needs to be sterelized before restoring it. It is important to use irrigation when prepping to minimize the trauma to the pulp.
Varo Boyajyan #106
The best way to pulp test primary teeth is to use endo ice. The EPT will not provide reliable results because of the open apex.
-Harry Virk #189
Primary tooth radiolucencies typically occur at the furca. Not at the apex of the roots like permanent teeth.
Electric pulp testing doesn't work for primary teeth and immature permanent teeth.
Chris Claus 113
Electric pulp testing is useless for deciduous teeth and premature permanent teeth. Also, endo ice or ice is the best material to use in children.
Regina Espinoza #126
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