Pulp cap for six year-old
My niece who is six years old has a very badly decayed primary molar. The dentist told me that the pulp is exposed, and he did a pulp cap for her. However, he said that if the capping is not successful, he will have to do a pulpotomy or a pulpectomy of the tooth. The material he used for the exposed pulp is only dycal and zinc oxide.
May I know whether is it the right way for pulp cap and what is the percentage of recovery? What is the best material to use for a pulpotomy? I heard from another friend that only zinc oxide eugenol is used for pulpotomy. What are the chances of having the tooth flaring up?
Question:Dear Pauline,
Direct pulp caps are most effective when placed on small exposures in a sterile environment. If the exposures are large or occur in unsterile conditions, pulp capping is not nearly as successful. The most widely used and successful material used for pulp capping is calcium hydroxide (e.g. Dycal). Generally this causes the pulp tissue in the area to react by becoming necrotic. Then, the dentin (layer of tooth between the enamel and the pulp tissue) is stimulated to lay down what is termed "reparative dentin". This closes off and protects the pulp tissue. If a pulp cap fails, in a primary tooth, it will assume the form of internal resorption, and in a permanent tooth, the result is pulpal necrosis. Because the formocresol pulpotomy has a higher success rate in primary teeth than the calcium hydroxide pulp cap, the pulpotomy is generally preferred. With close follow-up (which may be easier with a zinc oxide eugenol temporary filling) and the conditions associated with the pulp cap procedure, it is not necessarily wrong to try the capping procedure. If the capping procedure fails, there may be pain associated with the tooth and radiographic (x-ray) evidence of resorption of tooth structure.
If the pulp cap fails or is contraindicated, there are a couple of procedures which can be done instead. One is a pulpotomy and the other is a pulpectomy. In the pulpotomy procedure, pulp tissue is actually not removed from the roots themselves. The pulp tissue in the crown of the tooth is removed, and the health of the pulp tissue in the canals is assessed. A cotton pellet impregnated with formocresol is placed in the opening of the tooth for five minutes. The formocresol has been shown to suppress cellular activity; the tissue next to the formocresol becomes fixed. Then zinc oxide mixed with eugenol and sometimes some formocresol is placed over the pulp stumps and into the pulpal chamber. Success of treatment is noted by no pain or infection. Generally, failure is most often indicated by infection in the area and sometimes increased mobility of the tooth. The success rate of single treatment formocresol pulpotomy in vital teeth is about 90-98%, with the highest failure rate occurring about 2-3 years post treatment. Pulpectomy involves removal of the pulp tissue in the canals; a pulpectomy can be used as an alternative to a pulpotomy, unless involvement of the tissue in the roots is noted, then a pulpectomy should be done. This is more labor intensive and a little more risky for damaging the underlying permanent tooth. The filling material can vary in this procedure, although one material of choice is still zinc oxide eugenol. Recent studies have shown pulpectomies to result in about the same success rate as pulpotomies.
These procedures can help the primary teeth to be functional for a certain time period. If extraction should become necessary, a space maintainer should be placed in the posterior region to maintain space for the erupting permanent teeth.
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