Pulpal Therapy for Primary and Young Teeth
The pulp is the hollow inner core of the tooth that contains nerves, blood vessels, connective tissue and reparative cells (see Figure 1). In children, dental caries (cavities) and traumatic injury are the two main indications for pulpal therapy (also known as “paediatric root canal,” “pulpotomy” or “pulpectomy”). The primary objective of pulpal therapy is to maintain the integrity and health of the teeth and supporting tissues; thus, its treatment objective is to maintain the vitality of the pulp of a tooth affected by caries or traumatic injury.
In young permanent teeth with immature roots, the pulp is important for the continuation of apexogenesis (the continuation of the closure of the tip of the root, or apex, as the child gets older). Long-term retention of a permanent tooth requires a root with a favourable crown/root ratio and dentinal walls that are thick enough to withstand normal function. Therefore, pulp preservation is the primary goal for the treatment of young permanent dentition. A tooth without a vital pulp, however, can still remain clinically functional.
The vitality of the pulp is the most important focus of a dental examination and check-up because it is the basis of the indications, objectives and type of pulpal therapy that will be used. The pulp may be classified as normal (i.e., symptom free and with normal response to vitality testing), with reversible pulpitis (i.e., the pulp is capable of healing), with symptomatic or asymptomatic irreversible pulpitis (i.e., vital inflamed pulp is incapable of healing), or necrotic pulp.
The clinical diagnosis is derived from a comprehensive review of the medical and dental history, including current symptoms and chief complaint; subjective evaluation of the area associated with the current symptoms/chief complaint, which is accomplished by questioning the child and parent(s) on the location, intensity, duration, stimulus, relief and spontaneity of pain;
objective extraoral examination and intraoral soft and hard tissue examination; radiograph(s) to diagnose pulpitis or necrosis showing the involved tooth, furcation, periapical area and the surrounding bone; and clinical tests such as palpation, percussion and mobility.
A treatment plan should include the following:
1. The patient’s medical history
2. The value of each involved tooth in relation to the child’s overall development
3. Alternatives to pulp treatment
4. Restorability of the tooth.
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