Pulp Therapy in primary teeth: Tips and Tricks
1. Behaviour Management: Always, calm the patient. Do not rush. Talk, don’t lie. Tell Show Do is actually good for calming the child.
2. Local Anesthesia: Profound pain control goes a long way. Gentle injection, resulting in disappearance of pain goes a long way. Few kids do get uncomfortable with the feeling of heaviness resulting from the local anesthesia. Explaining to them often calms them.
3. Rubber Dam: No alternative. Keeps the kid safe, and work is done pretty fast.
4. Access Opening: Do not proceed until you are sure that the anesthesia is effective. Use a small round bur, and proceed slowly, after careful caries removal. Once the drop is achieved in the pulp chamber, switch to a small straight fissure bur, and move sideways, to avoid cutting the floor.
5. A sharp spoon excavator should be used to excavate the pulp. Once the pulp chamber is clear, the root canal openings are visible, often as tiny bleeding dots. Dentinal maps help in finding the openings.
6. Enter the root canals with a #10 (mesials in mandibular and mesial and distal in maxillary molars) or #15 (Distal and palatal) K-files. Pre curve the files as per the IOPA. Proceed slowly, to one mm short of working length.
7. Remove the pulp using H-files. Personally, I do not use broaches, as primary root canals are extremely tortuous. I usually prepare mesial (Mesial and distal in maxillary) canals in mandibular primary molars till K-file #30-35 and distal (Palatal in maxillary) till K-file #35-40. Recapitulate often.
8. Irrigation: Average 5 ml per canal. I use 1% Hypo, then flush with saline, then use Chlorhexidine. Ample irrigation is the key to success.
9. Obturation: ZOE is the gold standard of obturation, but over obturation must be prevented at all the costs. First coat the canals with a slurry of ZOE, followed by a thick paste using a straight probe and cotton rolls (more details in coming articles)
10. Check with IOPA during the procedure whether the canals are adequately filled to prevent over filling.
11. Clean the pulp chamber with cotton and restore.
Pediatric and Preventive Dentist consulting in Mumbai. Passionate about treating the tiny tots. Feel free to contact for queries related to kid's teeth.
Attachments:
You must be logged in to access attached files.
.