The causes of pulp injury can be various, such as cavities, trauma or iatrogenic surgical techniques.
The objectives of pulp therapy in a primary tooth include:
- Increase the time of permanence of these teeth without pathology
- Preserve the dental arch space.
- Avoid alterations in the dentition.
- Prevent the appearance of tongue habits or other parafunctions (or try to reduce them).
- Avoid phonation problems.
- Do not harm aesthetics.
- Avoid psychological effects due to tooth loss.
It is of great importance to make a good pulp diagnosis before carrying out any treatment. Always follow the medical history, clinical examination and radiological examination.
Pulp therapy In pediatric dentistry
In pediatric dentistry, there are four main types of pulp therapy: indirect pulp capping, direct pulp capping, pulpotomy, and pulpectomy.
The indirect pulp capping It is performed in teeth with deep caries close to the pulp but without symptoms of pulp involvement. If the infected dentin can be removed, the affected dentin can be remineralized, placing a biocompatible material on it, in order to maintain pulp vitality, stimulate the formation of tertiary dentin and remineralize the caries dentin (slows the progression of caries). The materials that are used are calcium hydroxide, glass ionomer, and there is controversy about zinc oxide-eugenol.
The direct pulp capping It is a treatment that consists of the application of calcium hydroxide on the exposed pulp to promote the formation of a dentin bridge. To perform it, it is essential that the tooth is asymptomatic, when there is a pulp exposure of less than 1 millimeter and that there is no contamination of oral fluids.
The pulpotomy It is performed in lesions that reach the cameral pulp, with vitality of the root pulp (pulp intact root). Some of its main indications are the following:
- Pain not spontaneous or persistent.
- No existence of root pulpitis.
- There is no pain to percussion.
- Absence of abscess or fistula.
- There is no internal resorption or pulp calcifications.
- The bleeding is not excessive.
- The tooth is restorable and there are at least two thirds of the root (the tooth is about to exfoliate).
The pulpectomy, total biopulpectomy or root canal treatment is the indicated technique when there are pulp degenerative changes in the root tissues. It is the most complex treatment available to preserve a primary tooth. The prognosis depends on the degree of degeneration of the dental tissue (how muchmore degeneration, worse prognosis). Its main indications are if:
- The root pulp is inflamed (irreversible pulpitis) or necrotic.
- There is spontaneous or persistent pain.
- The tooth can be restorable.
- The bleeding is not controllable by pressure and the pressure is dark red.
- There is mobility (not physiological by reabsorption).
- There is a moderate bone loss.
- Presence of abscess or fistula.
