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Formation
Odontoblasts form dentin. Dentin is formed continuously throughout
the life of the tooth. Odontoblasts can also form a unique type of
dentin in response to injury, such as occurs with caries, trauma, and
restorative procedures.
Pulp Therapy in Pediatric Dentistry
--A Review--
Pulp functions (continued)
Nutrition
Via dentinal tubules, pulp supplies nutrients that are
essential for dentin formation and hydration.
Defense
Odontoblasts form dentin in response to injury,
particularly when the original dentin thickness has been
compromised by caries, wear, trauma, or restorative
procedures. Pulp also has the ability to elicit an
inflammatory and immunologic response in an attempt to
neutralize or eliminate invasion of dentin by caries-
causing microorganisms and their byproducts.
Pulp Therapy in Pediatric Dentistry
--A Review--
Pulp functions (continued)
Sensation
Through the nervous system, pulp transmits sensations
mediated through enamel or dentin to the higher nerve centers.
The primary tooth root will begin to resorb as soon as the root
length is completed.
Primary molar roots are widely divergent and curved to allow for
the development of the succedaneous tooth.
Pulp Therapy in Pediatric Dentistry
--A Review--
The maxillary primary molars may have two to five canals, with
the palatal root usually rounder and longer than the two facial
roots.
Extent of Lesion
Location
Color
Mobility
Differentiate between physiologic root resorption and
pathologic root/bone loss
Pulp Therapy in Pediatric Dentistry
--Clinical Assessment of Pulp Status--
Soft Tissue Swelling/Lymphadenopathy
Pulp exposure
Hemorrhagic versus Necrotic
Pulp Therapy in Pediatric Dentistry
--A Review--
Pulp Therapy in Pediatric Dentistry
--A Review--
Pulp Therapy in Pediatric Dentistry
--Clinical Assessment of Pulp Status--
Pulp Testing
Eradication of infection.
Maintenance of tooth/teeth in a state of health.
Preservation of space for underlying permanent
tooth/teeth.
Capitalization of reparative ability of the pulp.
Pulp Therapy in Pediatric Dentistry
--Vital Pulp Therapy--
Techniques of Vital Pulp Therapy
Indications
Success Rate
62 to 97% (depending on the study and follow up
protocol)
Clinical Success Radiographic Success Histological
Success
Formocresol is the standard against which pulpotomy
alternatives are rated.
Pulp Therapy in Pediatric Dentistry
--Vital Pulp Therapy--
Actions of Formocresol in Pulpotomy
Technique
Bactericidal
No dentinal bridging
Pulp Therapy in Pediatric Dentistry
--Vital Pulp Therapy--
Formocresol Local Toxicity
Ranly, 1984
Histologic failurepersistent chronic inflammation
Immunologic risk
Succedaneous tooth damage
Effect on exfoliation (accelerated?)
Lack of resorbability
Pulp Therapy in Pediatric Dentistry
--Vital Pulp Therapy--
Formocresol Tissue Effects
1/5 dilution
1 part formocresol
3 parts glycerin
1 part distilled water
Comparable to full strength in terms of histology
and clinic success
Neither produces ideal histology
Long-term clinical success of 1/5 dilution is
questionable
At UKCD, we use Buckleys Solution (19%
Formaldehyde, 35% Cresol, and 17.5% Glycerin)
Pulp Therapy in Pediatric Dentistry
--Vital Pulp Therapy--
Time of Formocresol Application