Essential Insights into Paediatric Pulp Therapy

• To arrest caries progression
• Provide suitable conditions for reactionary dentine formation
• Allow remineralisation of remaining dentine
• Stimulate pulpal healing

• Large cavity with a deep carious lesion
• No sign of pulpal degeneration or periapical lesions

• Gross caries removal,
• Sufficient caries are left over the pulp horn to prevent pulp exposure.
• A liner is placed over the pulp to allow repair (Common liners include GIC, RMGIC, Calcium hydroxide, and MTA)
• The cavity is sealed with a biocompatible material.

• To stimulate dentinal bridge formation at the point of pulpal exposure
• Maintaining the pulp health and vitality

• An asymptomatic carious tooth with pin-point exposure during caries removal
• Minor traumatic or non-carious pulp exposure
• Pulp exposure in an older child (1- 2 years before normal exfoliation)

• Gentle application of cotton soaked in water/saline to control pulpal haemorrhage
• Application of hard-setting calcium hydroxide or mineral-trioxide aggregate (MTA)
• Final restoration to achieve an optimum coronal seal

To remove irreversibly inflamed coronal pulp, leaving behind a healthy radicular pulp

• Asymptomatic tooth or only transient pain
• Carious or mechanical exposure of vital coronal pulp tissue

• Caries removal, including the roof of the pulp chamber and coronal pulp tissue
• Achieve pulpal haemostasis
• Medicament for direct pulp capping of radicular stumps
• Application of MTA paste or calcium hydroxide over radicular pulp

To reduce pulp inflammation and symptoms to enable pulpotomy or pulpectomy.

• Carious pulpal exposure with no signs and symptoms of loss of vitality
• Non-compliant child who may need sedation
• Hyperalgesic pulp

• Removal of caries
• Place a small pledget of cotton with a steroidal antibiotic paste on the exposure site.
• Place a well-sealed temporary dressing over the cotton pledget
• Recall after 7 to 14 days and perform a pulpotomy or pulpectomy

• To remove irreversibly inflamed or necrotic radicular pulp tissue
• To obturate root canals with a filling material that resorbs at the same rate as the primary tooth.

• Tooth diagnosed with irreversible pulpitis based on signs, symptoms and radiographic findings
• Non-vital radicular pulp with/without infection
• Good patient compliance

• Removal of caries and pulp tissue
• Identify canals and irrigate
• Perform a traditional root canal therapy
• Obturate canals with a resorbable paste (Calcium hydroxide and iodoform paste or non-setting calcium hydroxide paste)