A sound dentin barrier protects the pulp, and the tooth is ready for final restoration. C, Six to 8 weeks later the cavity is reopened and the remaining caries excavated. B, The gross caries has been removed and the cavity sealed with durable biocompatible cement or restorative material. A, A primary or permanent tooth with deep caries. For this reason, clinicians prefer to avoid pulp exposure during the removal of deep caries whenever possible.įigure 19-4 Indirect pulp therapy. Unfortunately, the treatment of vital exposures, especially in primary teeth, has not been entirely successful. If a carious exposure discovered at the time of the initial caries excavation could be routinely treated with consistently good results, a major problem in dentistry would be solved. 2, 3 They also showed that well over 90% of the asymptomatic teeth with deep carious lesions could be successfully treated without pulp exposure using indirect pulp therapy techniques. Work by Dimaggio and Hawes supports this observation.
Approximately 75% of the teeth with deep caries have been found from clinical observations to have pulpal exposures. Many of the lesions appear radiographically to be dangerously close to the pulp or to actually involve the dental pulp. 1Ĭhildren and young adults who have not received early and adequate dental care and optimal systemic fluoride and do not have adequate oral hygiene often develop deep carious lesions in the primary and permanent teeth. A study by Miwa and colleagues suggests that the transmitted-light technique can detect pulpal blood flow in young permanent teeth and is thus applicable to the assessment of pulp vitality. Because the testing may be uncomfortable for young patients, further dental treatment may be affected. Not only is there inaccuracy in the response of the pulp to electric stimuli, but the electric pulp tester may elicit pain. A distinct advantage of this technique is its noninvasive nature, particularly in comparison to electric pulp testing. 19-3, these methods essentially work by transmitting a laser or light beam through the crown of the tooth the signal is picked up on the other side of the tooth by an optical fiber and photocell. Two of these methods include the use of a laser Doppler flowmeter and transmitted-light photoplethysmography. Several methods have been developed and advocated as noninvasive techniques for recording the blood flow in human dental pulp. The lack of reliability is possibly related to the young child’s inability to understand the tests. Thermal tests have reliability problems in the primary dentition, too. The reliability of the pulp test for the young child can also be questioned sometimes because of the child’s apprehension associated with the test itself. A complicating factor is the occasional positive response to the test in a tooth with a necrotic pulp if the content of the canals is liquid. The test does not provide reliable evidence of the degree of inflammation of the pulp. The value of the electric pulp test in determining the condition of the pulp of primary teeth is questionable, although it will give an indication of whether the pulp is vital.