Pulp Therapy - What is it?
The pulp of your tooth contains nerves and blood vessels. It is protected by tooth structures – dentine and enamel. Decay and trauma can breach this protective barrier to endanger the pulp.
Ever hear your dentist say after doing a filling “This filling is deep. Come back if it bothers you”. That’s exactly what he means, the integrity of the pulp could have been breached and you could have symptoms.
Pulp Therapy is a range of procedures your dentist can perform for the above scenario. It may be as simple as applying medicament over the pulp exposure (pulp Cap) or as complex as removing the whole pulp right down to the end of the root. In between these two extremes is a spectrum of treatment. Much like a surgeon has to decide where to amputate in order to save your diseased limb, ditto with the dental pulp.
Pulpotomy
Pulpotomy is the removal of just the coronal portion of your pulp, leaving the healthy portion in the roots. The amputated pulp stumps are treated with a medicament to encourage healing. Pulpotomy is a very successful procedure (>90%) in permanent and primary teeth.
Root Canal Treatment (RCT)
When your entire pulp is infected, then root canal treatment is the removal of the entire pulp right down to the root tip.
The canals will be cleaned with small scraping tools called files, and the space once occupied by pulp will be filled with an inert material. In primary teeth, it is filled with a resorbable cement to allow the tooth to make way for the permanent tooth when it erupts. Success rate for permanent teeth is over 90% if infection has not spread to the surrounding bone, but for primary teeth, because of the anatomy of the root system which is impossible to clean, it is only 60-70%. RCT is usually completed in 2 visits.
What does pulp therapy entail?
All pulp therapy has the same goal – to preserve your child's tooth so that it does not need to be extracted. Of course in some cases, extracting the tooth may be a better alternative than this complicated and expensive treatment.
1.Since we are dealing with your dental nerve, we need to numb it (injection in the gums) with an anaesthetic
2.Beacuse we are breaching into the pulp, we must isolate it from bacteria in the mouth using a rubber shield around the tooth
3. It involves taking a few radiographs (X-rays), sometimes in the middle of RCT
4. Finally we must restore the tooth to proper function with a crown otherwise it will fracture, as pulp treated teeth are brittle.
By Dr Tan Wee Kiat
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