Ten Myths about the Pulp
*May be true
5.
Teeth treated with a pulpotomy should be restored with composite resin if parents want a white tooth.*
The success of pulpal therapy is dependent on three factors: 1) healthy tissue being present, 2) absence of a microbial flora, and 3) an intact coronal seal. Kakehashi, et al demonstrated in rats that teeth after pulp exposures without restorations could exhibit dentin bridging and healing if no bacteria were present.32 Moreover, a study comparing surfacesealed restorations (amalgam, zinc oxide eugenol, composite) concluded that the major determinates of healing were absence of microbial flora and an intact coronal seal.27 The American Academy of Pediatric Dentistry guidelines on pulpal therapy indicate that teeth treated with pulpal therapy should receive coronal coverage unless the tooth is expected to exfoliate in two years or less.33 Thus, parents who desire a long-term esthetic solution for coronal coverage should have their children treated with Zirconia crowns. If the tooth is expected to exfoliate in less than two years, a composite restoration may be placed.33
6.
Pulpectomies are more successful than pulpotomies on anterior primary teeth.
Three studies have been identified comparing pulpotomies to pulpectomies in anterior primary teeth. The most recent study was conducted at Baylor University, Texas A&M Health Science Center, and published in 2012. The randomized controlled clinical trial compared two groups, each composed of 37 teeth. Patients in one group received a pulpectomy, and patients in the other group received a Formocresol pulpotomy. After 23 months, radiographic success was 89 percent for the pulpotomy group, and 73 percent for the pulpectomy group. No statistical difference was found between the two groups. The other two studies that were identified by the author had a low sample size (12 per group), and used a low concentration of Formocresol (1.5 percent) with some teeth restored with composite restorations which may not have provided an adequate coronal seal.34
7.
A dark anterior primary tooth requires pulpal therapy after trauma.*
The most common age for dental trauma in the primary dentition is 1 to 3 years of age when children are learning to walk.35 Treatment at this time can involve behavioral issues that challenge practitioners as children may be pre-cooperative or uncooperative for dental treatment. Common sequelae following trauma involve discolored primary teeth. Discoloration can occur as a dark-colored tooth, or a yellowing of the tooth. Yellowish color is a result of calcific metamorphosis and the pulp laying down more dentin as a response to trauma. Discoloration can also be a greyish hue as the result of blood products staining dentin. No treatment is indicated in either of these cases unless pathology is present. The darkening of teeth after trauma was evaluated at Hebrew University and Hadassah School of Dental Medicine in Jerusalem in a study based on a change in policy. Prior to the policy change, primary teeth with discoloration were treated with root-canal therapy. After the change, teeth without clinical or radiographic pathology received only clinical and radiographic re-evaluation. No statistical difference was found between the two groups in relation to the eruption timing, path, or calcification of the permanent tooth. The study concluded that, “Root-canal treatment of primary incisors that had changed their color into a dark-gray hue following trauma with no other clinical or radiographic symptom is not necessary, as it does not result in better outcomes in the primary teeth and their permanent successors.� Teeth with darkening should be periodically reevaluated clinically and radiographically for pathologic changes.36 Tooth #S was successfully treated with an MTA pulpotomy and EZPEDO Zirconia crown.
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