This blog was created for students to interact over the material in the Predoctoral course in Pediatric Dentistry, DS443b.

Monday, March 12, 2007

Lecture 8-Pulp Therapy II

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88 comments:

Anonymous said...

When removing the pulpal tissue during a one-step pulpotomy, a clean spoon excavator should be used rather than a slow or high speed handpiece since there is a risk of perforating the furcation area (only 1mm of dentin between floor of the chamber and the furcation)

Amy Dixon #120

Anonymous said...

Jonathan Do #121

When doing a one step pulpotomy in deciduous teeth, Formocresol is the best choice for medication. When doing it for permanent teeth, MTA good or light cured CaOH is the preferred materials.

Anonymous said...

When doing pulpotomy in primary teeth, empty the pulp using an spoon excavtor, and put drops of anesthetic inside the pulp. Also be careful with Formocresol. Use rubberdam, isolation and be carful. if left on gums itll give a ulcer like burn.

Azadeh Ahmadi-Ardakani
student 101

Anonymous said...

All pulp horns should be exposed before carefully unroofing the pulp chamber of a deciduous molar. Connect the dots and the roof should come right off. If it doesn't, remove with a clean spoon excavator.

Emmy Le #142

Eric Cheung said...

For pulpotomy in primary teeth, we should find each pulp horn and connect the dots.

Formocresol will cause rather long term serious injury to adjacent tissue.
Eric Cheung #110

Anonymous said...

Be very careful when using forocresol because he can badly burn your pts.
Kim Pham #167

Unknown said...

One step pulpotomy – vital pulpotomy.
1. 1/5 dilution formocresol
2. 5 min pellet with dampen not dripping formocresol
3. ferric sulfate 20 sec
3a. always put dry cotton pellet.
4. Dress with ZOE or IRM
5. GI
6. SS crown

Jeffrey Kim 139

Unknown said...

It does sound easy to use a high speed or a low speed to remove the coronal pulp, BUT that may result in 1. Inadvertant removal of radicular dentin 2. perforation of the furcal dentin, so the best instrument to use in pulpotomy is a spoon excavator.

Anonymous said...

One step pulpotomy is not indicated in upper anterior teeth, only for molar teeth upper and lower.If we use a round bur to amputate the pulp we could pull some pulp out of the roots as well.
Heidi Gonzalez 526

Anonymous said...

i learned that most pulpotomies on vital tth can be done in one appt.
#122 Catherine Do

Unknown said...

Natalie Nguyen #159:

Pulpotomy is performed on deciduous molars only, not deciduous maxillary incisors, because they're are important functional teeth for kids. Be extra careful since deciduous pulps are LARGE and there is less than 1 mm of dentin between floor of pulp chamber and furcation.

dangerous d said...

Pulpotomy is the treatment of choice for a primary tooth pulp exposure, even a small iatrogenic one. After pulpal amputation, the site should be flushed with local anesthetic because it is sterile and the epi helps control bleeding.

Dan Nelson #157

Anonymous said...

Over 90% sucess of pulpotomy for primary teeth with or without fistula. Formocresol burns oral mucosa.
Jing Lee#144

Unknown said...

Make sure the rubber dam is forming a tight barrier among the teeth and use formocresol judiciously.
-Carol Kim (138)

William said...

You shouldn't use a slow-speed when doing a pulpotomy because you might end up whipping the stringy pulp around the bur and pulling out the pulp from the roots. A high-speed increases the risk of popping through the furcation. So, using a spoon excavator to scrape the walls of the pulp chamber is the best choice.

Will Traynor #186

Anonymous said...

Isolate the tooth well with a rubber dam when performing a one step pulpotomy so as to not get formocresol on the tissues. Also, use a spoon excavator to remove pulp from chamber to avoid perforation of the furcation.

Josh Cardwell #108

Anonymous said...

Formocresol is a good pulpal medication but we must be aware that this material is very caustic.

Shelton Chow #111

Anonymous said...

You have to make sure that the preparation is wide enough during pulpotomies because pulps on primary teeth are big. Use 1/5 diluted formocresol(Michigans) for one step pulpotomy for 5 minutes or non-diluted formocresol for 1 min and you must take be careful because it is very toxic

J. Royce Flores #130

Austin said...

For deciduous teeth, one-step pulpotomy is vital pulpotomy with formocresol applied for 1 min (or 1/5 Michigan for 5 min) and two-step pulpotomy with formocresol for 1 week is chemical endodontics. Both have high 90+% clinical success rates.
Austin Tung 187

Anonymous said...

Sean Nguyen #160

The distance from the pulpal floor to the furcation is only 1mm. That's almost the width of my 330 bur! The use of a spoon excavator is definitely required vs use of a bur to avoid perferations.

Anonymous said...

when doing a One-Step Pulpotomy do not use excessive amount of Formocresol because it is a strong caustic and may cause traumatic complication.
Soheil Yashari #191

Anonymous said...

The best way to de-roof the pulp chamber is to expose all pulp horns and connect the dots. The roof can then be removed w/ a spoon excavater.
Orly Hendizadeh #134

Anonymous said...

The best way to de-roof the pulp chamber is to expose all pulp horns and connect the dots. The roof can then be removed w/ a spoon excavater.
Orly Hendizadeh #134

Anonymous said...

When doing a pulpotomy on a primary tooth, search for the canals by lowering the entire pulpal floor. This avoids going through the furcation because the distance between the furcation and the pulp is about 1mm.

Shannon Lazarian #133

Anonymous said...

The best way to de-roof the pulp chamber is to expose all pulp horns and connect the dots. The roof can then be removed w/ a spoon excavater.
Orly Hendizadeh #134

Anonymous said...

De-roof the pulp chamber by finding all the pulp horns and "connect the dots" with a 169 bur and the roof should come off. If it doesn't then use a sharp instrument.
There is only 1mm of dentin at the furcation area so don' perf the furcation.
Karen Li #146

Anonymous said...

If you do a pulpotomy, do a stainless steel crown, except when the cavity is only in occlusal.

Claudia Rodriguez #531

Tina said...

I learned that to do a pulpectomy, we should try to find the pulp horns then "connect the dots" to remove the pulpal floor.

Tina Duong #125

Anonymous said...

formocresol can cause serious burns to the oral mucosa and skin ,use with caution.
poonam rai
#530

Lori said...

Always use a rubber dam when doing a pulpotomy using formocrestol! This material can cause major damage to vital tissue in the oral cavity. Also, make sure to obtain a good seal with your rubber dam to prevent leakage.

Anonymous said...

ONLY when you see a parulis or swelling, you prescribe antibiotics, because this is indicative of an irreversible inflammation to the pulp.

Sanam Soroudi
#180

Anonymous said...

Three things to note when using formocresol are: 1) careful handling, as the chemical is a strong caustic--in fact, it may take up to 1.5 months for contacted tissue to heal! 2) application of the rubber dam to achieve precise tooth isolation 3) drying with a cotton pellet after "swirling" the medication into the pulp chamber.

Christine Chung #112

Anonymous said...

Pulpotomy is the tx if choice for any pulp exposure on primary teeth. A sterile spoon excavator is preferred over a handpiece. For primary teeth, formocresol is the medication of choice. However, care must be exercised when handling because it can cause burns to the oral soft tissues.

Sydon Arroyo #102

Anonymous said...

Michelle Duong #123
Pulpotomy's are done on decidious molars only because they are needed for function. Pulpotomy's should be done using a spoon excavator rather than a hand-piece because the dentin is so thin and you run the risk of perforating the furcation.

Unknown said...

Remember that formocresol is very caustic and the proper application is to place the damp medicated cotton pellet over the pulp canals, with a dry pellet on top.
#193

Anonymous said...

To unroof the pulp chamber, find all the pulp horns and connect the dots. Use a very sharp spoon excavator to remove the pulp. Do not perforate the furcation.
Broc Mushet
#156

Anonymous said...

When doing a pulpotomy, remove pulpal tissue with a clean spoon excavator and use local anesthetic to clot the tooth and clean debris.

Matthew Moadel, Student #151

Anonymous said...

In performing a pulpotomy on a primary tooth, expose each pulp horn, then connect them with a tapered fissure bur. Do not de-roof like a permanent tooth since there isn't much tooth stx at the furcation.

[Colby Smith #178]

Anonymous said...

When performing a one-step pulpotomy on a deciduous tooth, use a spoon excavator rather than a handpiece to remove pulpal tissue to help prevent perforation of the furcation.

Kevin Omoto #163

Anonymous said...

Although formocresol is the medication of choice in a one-step pulpotomy, great caution must be taken not to inadvertantly allow it to come into contact with the surrounding tissues--as it is very caustic. Pulp should be removed from the pulp chamber using a sharp spoon excavator. This is preferred over using a bur in order to avoid removing root pulp and possible risk of perforation.

Jared Martin #147

Anonymous said...

The most important thing I learned was that the pulpal floor of a deciduous molar is only a milimeter from the furcation.
A spoon excavator is the instrument of choice for cleaning the pulp chamber in a one-step pulpomoty.
J. Oka 162

Anonymous said...

There are important anatomic considerations to take into account when performing a pulpotomy on a deciduous tooth: pulp horns are almost directly under the cusp tips, and there is less than 1 mm of dentin between the pulpal floor and furcation.
Joanne Kim #140

Anonymous said...

Formocresol has to be used with care and rubber dam, serious burns are possible. Put local anesthetic into canals after open them up, epi can help to control bleeding.

Alina Tiraspolskaya #183

Anonymous said...

I learned about unroofing the pulp chamber on a deciduous tooth by connecting the dots of the pulp horns.

Marc Thomas
#182

Anonymous said...

The most useful thing I learned about pulpotomies is the procedural steps. How else am I supposed to know how to do one? Here they are:
Remove the roof of the pulp chamber
Amputate w/ clean excavator
Flush w/ sterile solution
Encourage a clot
Wash away coagulum
Medicate w/ 1:5 formocresol & gluteraldehyde
Place dampened pellet in contact with pulp stumps for 5 minutes
Ferric Sulfate contact for 20s
Dress with soft mix of ZOE
Restore with SSC

Sean Young #192

Anonymous said...

Parham Saghizadeh #171
When performing a pulptomy, open the chamber and connect the dots of the exposed pulp horns.

Anonymous said...

It's important to slowly swirl the ingredients together in the Michigan dilution. Also, formocresol is caustic and should be handled with care.

Shelby Padua #166

Anonymous said...

Pulpotomy is the treatment of choice when you have a pulpal exposure in a deciduous tooth.
Paul Hoang #135

Anonymous said...

When performing pulpotomies on primary teeth, it is very easy to perforate the furcation. That is why it is extremely important to remove the roof of the pulp chamber and the pulpal tissue in the chamber with a sharp spoon excavator rather then a handpiece. This technique will also protect the radicular pulp from being removed.

Bozhena Fisher #128

Unknown said...

Deciduous anatomy:
Pulp horns are almost directly under the cusp tips.
Less than 1mm of dentin between the floor of pulp chamber and furcation.
Expose all the pulp horns and connect them when do pulpotomy.

Naomi Nguyen
#158.

Anonymous said...

When amputating the pulp of a deciduous tooth, use a sharp spoon excavator. If you use a high speed with a round bur, you might cut through the last mm of dentin into the furcation = bad idea. If you use a slow speed with round bur, the pulp will get wrapped around the bur like spaghetti, so you'll end up pulling out the pulp from all canals when you remove the bur...another bad idea.
Raquel Ulma #188

Anonymous said...

I learned that for a one step pulpotomy you should use a spoon excavator instead of a handpiece to remove the pulp and that a deciduous molar only has 1 mm of dentin above the furaction.

Cynthia Morford #153

Anonymous said...

When performing a pulpotomy, forming a tight seal with the rubber dam is critical since Formocresol will burn the oral mucosa.

Farshid Siami
#177

Anonymous said...

Pulp horns are usually located just under the cusp tips.

There is usually 1 mm between the bottom of the pulp chamber and the furcation in pedo teeth

Neilesh Patel
#165

Anonymous said...

For deciduous teeth, pulpotomy is preferred over pulp-capping following pulp exposure. Use the 2 step technique when there is a Hx. of pain in the tooth, infection indicated by pus or profuse bleeding.

Diana Craft #115

Anonymous said...

I learned that when doing a pulpotomy you want to use formocresol as the medication, however you need to use it sparingly and skillfully b/c it packs a punch and can burn the gingiva.

Morris Poole
#169

Anonymous said...

Pulp capping is silly to do in a pedo pt. Pulpotomy works better.

#176

Anonymous said...

After amputate the pulp chamber, flush with local anesthetic solution. rc109

Anonymous said...

When it comes to formocresol, less is more! Use a rubber dam, and a cotton pellet that is damp, NOT dripping with formocresol. Cover it with a dry cotton pellet to further protect the patient.

For a two step pulpotomy, you are doing endodontics by pickling the pulp like a cadaver.

Trish Barsanti #105

Anonymous said...

To unroof the pulp chamber in a deciduous molar, find the pulp horns with your bur and gently pry off the roof of the pulp chamber with an intrument. Be careful not to get formocresol on the gingiva or mucosa.

Ryan Plewe
#168

Anonymous said...

To unroof the pulp chamber in a deciduous molar, find the pulp horns with your bur and gently pry off the roof of the pulp chamber with an intrument. Be careful not to get formocresol on the gingiva or mucosa.

Ryan Plewe
#168

Anonymous said...

For primary teeth, should have at least 2/3 of the root remaining in order to do a pulpotomy/ pulpectomy. There is no point in doing a pulpotomy/ pulpectomy w/ less than 2/3 of root remaining because the tooth is on it's way out in any case.

Richard Duong #124

Anonymous said...

Formocresol should be used for pulpotomies on children. Care should be taken when placing it.

E. Lai #141

Anonymous said...

It's best to use a spoon excavator when removing the pulp so you don't perforate the furcal area. Formocresol is some nasty stuff, so you want to make sure you use a rubber dam or some form of protection to avoid damaging adjacent tissues.

Chris Claus 113

Jake said...

The spoon excavator method is preferred when exposing the pulp chamber as opposed to a slow speed because a slow speed bur can intangle itself in the "fibrous" pulp and essential pull the pulp right out of the apex, hence killing the tooth and ruining your shot at keeping the pulp healthy.

Jake Cragun #117

Anonymous said...

Deciduous pulps are large relative to crown size; pulp horns are almost directly under the cusp tips and there is less than one mm of dentin between floor of pulp chamber and furcation- beware when deroofing pulp chamber and amputate with spoon excavator

-Jeanne Wong #195

Anonymous said...

For accessing the pulp chamber of a primary tooth:
Don’t take a round burr straight down the central groove until you hit blood. Instead:
Lower whole pulpal floor until you have located all the pulp horns. Then connect the dots. Then lift the roof of the pulp chamber with a spoon. (you can use high speed round burr, but you’ll go through the floor). Slow speed doesn’t work well.
Encourage clot is by packing an anesthetic moistened pellet on top of pulp for a few minutes.

Jonathan Miller
#149

Anonymous said...

Formocresol is the material of choice for pulpotomy in deciduous teeth.However use it sparingly as less is indeed more in this case. Use rubber dam as formocresol can cause serious gingival burns.
Amandeep Iqbal
# 527.

Anonymous said...

Formocresol can lead to high success pulpotomy in deciduous teeth if used properly. Be careful no to burn the soft tissue with it.

Paredes #164

Anonymous said...

I learned that a clean spoon excavator is the tool of choice when doing a pulpotomy.
Robert Busan 107

Anonymous said...

Due to a large size of the pulp chamber in deciduos teeth there is less than 1mm of dentin separating it from furcation. Pulps must be amputated with a clean excavator and not with a handpiece to protect radicular pulpal tissue.

Edvin, #100

Unknown said...

When performing pulpotomy after getting a pulp exposure, we must lower the pulp floor so that we can see all four pulp horns, then “connect the dots”. Usually the roof of the pulp chamber will come off – if not, we should only remove it with a spoon. Also we should amputate the pulp with a clean excavator.
Enayat Astani
#308

Claudia Thomas#534 said...

Formocresol can be used in pulpotomies but has to be handle carefully because it is a very caustic agent.

Anonymous said...

Formocresol is the best choice as a medicament when doing pulpotomies. A clean excavator should be used to amputate the root as opposed to a round bur that can pull the entire root system up.
Nick Quach #170

liz said...

For pulpotomy you should use a spoon excavator to remove the pulp becuase if you use a bur it's like grabbing cotton....the entire pulp may come out.

Miltner #150

Unknown said...

Magical Minute:
It is not advised to use a slowspeed bur to remove the chamber portion of the pulp. This is because what will usually happen is that the bur will end up pulling up the root portions as well.
Paul #127

Anonymous said...

Formocresol should be used with extreme care. It is a great agent for heme control. Also to clean out the pulp chamber, it is best to use a slow speed for two reasons...to avoid perforation of a molar, for ex, at the furcation area and to prevent tearing of all pulp tissue (intracanal).

Niki Zarabian
#194

Anonymous said...

Formocresol should be used with extreme care; it is a great hemostatic agent. A slow speed should not be used when removing the pulp in the pulp chamber for two reasons...chance of perforation at furcation area of molars, for ex, is higher, and icrease in chance of tearing intracanal pulp tissue

Anonymous said...

Formocresol should be used with extreme care; it is a great hemostatic agent. A slow speed should not be used when removing the pulp in the pulp chamber for two reasons...chance of perforation at furcation area of molars, for ex, is higher, and icrease in chance of tearing intracanal pulp tissue

Niki Zarabian #194

Unknown said...

Pulpotomy is appropriate as the final treatment for a pediatric patient with a pulp-exposure. Use a rubber dam, watch out for the formocresol, and use a spoon excavator for the amputation of the pulp.

Jared Lee #143

Anonymous said...

It is important to use rubber dam for isolation especially when we are dealing with strong caustic agent like formocresol.

Sonia Lee 145

Anonymous said...

It is important to use rubber dam for isolation especially when we are dealing with strong caustic agent like formocresol.

Sonia Lee 145

Anonymous said...

Pulpotomy is the treatment of choice in pediatric patients and formocresol is the medicament used.
Alex Molayem 152

Anonymous said...

When using formocresol make sure that u get a tight seal on the rubber dam because it can damage adjacent tissue! Hamid #174, five magical minutes LATE

Unknown said...

When doing a pulpotomy to amputate the coronal portion of the pulp, it best to side on the conservative side and use a sterile spoon excavator to accomplish the same purpose as using a high speed. Doing otherwise may cause the delicate radicular pulp to become interwined on the bur shank resulting in a grievous outcome.

JEff Flores #129

Anonymous said...

Be sure to use a rubber dam when using formocresol because it can badly burn oral soft tissues.

-Harry Virk #189

Anonymous said...

It is important to use rubber dam when using formocresol due to the toxicity to oral soft tissues. Also When doing a one step pulpotomy use a spoon excavator.

Mihir Shah
175

Anonymous said...

Deciduous pulps are large in relation to crown size and pulp horns are under the cusp tips. Also there is less than 1 mm of dentin between the floor of the pulp chamber and furcation.

Regina Espinoza #126