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CLINICAL PRACTICE OF PULPOTOMY BY DENTISTS IN CHENNAI A

QUESTIONNAIRE BASED STUDY


*Aroonika S. Bedre1, Dr. Ganesh Jeevanandham2

1
III year BDS student, Saveetha dental college, Chennai.
2
Dept. Of Paedodontics, Saveetha dental college, Chennai.

*Aroonika S. Bedre email ID: aroonika.bedre@gmail.com


Contact no: 8807040124
ABSTRACT

AIM
To assess the clinical practice of pulpotomy by general dental practitioners in Chennai.

MATERIALS AND METHODS


A survey questionnaire comprising of 10 close ended questions was prepared and administered to
50 general dental practitioners. Results were compiled based on the information obtained from the
participants.

RESULTS
1. 55% of the general dental practitioners perform pulpotomies in clinical practice:
2. 52% of the people used formocresol as a haemostatic agent in clinical practice.
3. 98% of the people were unware of latest haemostatic agents used in clinical practise.
4. 87% of them were unaware of the duration of use of formocresol after pulpotomy.
5. 48% of the people used ZOE as a restorative material after pulpotomy.
6. 83% of the people have not performed pulpotomies in permanent carious teeth.
7. 49% of the people were unaware of the success rate of pulpotomies.
8. 94% of the people were unaware of the difference between management of primary and
permanent teeth during pulpotomy.

CONCLUSION
The results of the survey shows wide variations in the knowledge, awareness and clinical practice of
pulpotomy among various general dental practitioners. This suggests the importance in the need for
various dental education programs and workshops to be conducted.

KEYWORDS
pulpotomy, haemostatic agent, formocresol, ZOE, clinical practise

INTRODUCTION

Pulpotomy is a procedure performed when the coronal pulp is exposed by caries, caries removal, or
trauma in a primary tooth.[1] The infected and inflamed coronal pulp is amputated, leaving vital
and uninfected radicular pulp tissue which contributes to apexogenesis.[2] The pulp stump can be
treated by electrosurgery,[3] Er:YAG laser,[4] or with a dressing such as formocresol (FC),[5]
calcium hydroxide,[2] glutaraldehyde,[6] enriched collagen solution,[7] ferric sulfate,[8] or mineral
trioxide aggregate (MTA),[5] which can protect remaining pulp tissue and promote healing.
Although many techniques have been suggested,[9] there is no agreement as to the most appropriate
technique in a recent Cochrane Review.[10] FC was firstly used for pulpotomy by Sweet in 1930
with a reported success rate of 97%.[11] It produces an area of necrosis in the pulp adjacent to the
pulp wound. Most often the pulp tissue is altered by the formaldehyde and appears fixed in situ
and therefore does not undergo immediate liquifactive necrosis in the root canal.[12] FC has been
the most popular pulp dressing.

MATERIALS AND METHODS


A survey questionnaire comprising of 8 close ended questions was prepared and administered to 50
general dental practitioners. The questions were related to the clinical practise of pulpotomy.
Paedodontists were excluded from the study to prevent any bias. Results were compiled based on
the information obtained from the participants.

RESULTS
1. Whether pulpotomies are performed by general dental practitioners in clinical practice:
55% of the people said yes, while 45% of the people said no.

2. Their use of haemostatic agents in clinical practice:


52% of the people used formocresol, while 33% did not use any haemostatic agent, 13% of people
used ferric sulphate, and 2% used glutaraldehyde.

3. Whether they are aware of latest haemostatic agents used in clinical practise.
98% of the people were unaware of the latest haemostatic agents used it clinical practise, while only
2% were aware.

4.Awareness of duration of use of formocresol after pulpotomy:


87% were unaware, while 13% were aware.

5. Restorative material used after pulpotomy:


48% of the people used ZOE, while 27% of the people used GIC, and 24% of the people used a
combination of both.

6. Whether they have performed pulpotomies in permanent carious teeth:


83% of the people said no, while 17% of the people said yes.

7. Their knowledge of success rate of pulpotomies:


49% of the people were unaware, while 38% of the people claimed that it is higher in primary teeth,
11% claimed that it is same for both, and 2% claimed that it is higher in permanent teeth.

8. Awareness of difference between management of primary and permanent teeth during


pulpotomy:
94% of the people were unaware, while 6% were aware.

DISCUSSION

This study is a long term retrospective comparison of two treatment modalities done in a private
practice setting for the management of deep caries in primary molars. The results show that IPT and
FP can be used to treat deep caries, with IPT having a significantly higher percent of success (93%)
than FP (74%). There was a statistical difference in the success rates of IPT and FP, but prospective
randomized clinical trials are still indicated.

The 74% success rate for FP in this study is similar to that reported in other long term FP
studies15,16,23,30 . The 93% success rate for IPT is similar to that reported by researchers that
evaluated the effect of placing Ca(OH)2 or a ZOE base over a carious lesion in primary molars.7-
9,24,25 All previous IPT studies have had shorter follow-ups and none compared the effectiveness
of treating deep caries with ITP vs. FPin primary molars.

The rationale for treating IPTs with a glass ionomer liner and immediate steel crown was two fold.
It was felt the glass ionomer liner was a dentin bonder that would seal the pulpand prevent
microleakage and stimulate reparative dentin formation. The immediate steel crown placement was
believed to seal the dentine tubules from any subsequent microleakage and improve the chance of
the IPTs success.

Deep caries may induce reversible and or irreversible inflammatorychanges in the pulp. Therefore,
IPT treatment based on a diagnosis of reversible pulpitis may improve the prognosis for the tooth
and maintain its vitality. A carefully taken history together with symptoms and clinical/radiographic
findings should help form the final diagnosis. The results of this study show that a child diagnosed
with pain from reversible pulpitis can be successfully treated with either an IPT or a FP. In teeth
with a history of pain associated with reversible pulpitis,85% of those treated with IPT were
successful versus 76% with FP. These results are similar to the findings of Gruythuysen and
Weerheijm18, where all seven of the cases they diagnosed with pain elicited by eating sweets were
successfully treated with a Ca(OH)2 pulpotomy.

CONCLUSION
The results of the survey shows wide variations in the knowledge, awareness and clinical practice of
pulpotomy among various general dental practitioners. This suggests the importance in the need for
various dental education programs and workshops to be conducted.

REFERENCES
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Pedod 2:115-27, 1978.2. Law DB, Lewis TM: Formocresol pulpotomy in deciduous teeth. J Amer
Dent Assoc 69:601-7, 1964.3. Doyle WA, McDonald RE, Mitchell DF: Formocresol versus calcium
hydroxide in pulpotomy. J Dent Children 29:86-97, 1962.4. Morawa AP, Straffon LH, Han SS,
Corpron RE: Clinical evaluation of pulpotomies using dilute formocresol. J Dent Child 42:360-63,
1975.5. Fuks AB, Bimstein E: Clinical evaluation of diluted formocresol pulpotomies in primary
teeth of school children. Pediatr Dent 3:321-24, 1981.6. Garcia-Godoy F, Novakovic DP, Carvajal
IN: Pulpal response to different application times of formocresol. J Pedod 6:176-93, 1982.7. Rolling
I, Lambjerg-Hansen H: Pulp condition of successfully formocresol-treated primary molars. Scand J
Dent Res 86:267-72, 1978.8. Myers DR, Shoaf HK, Dirksen TR, Pashley DH, Whitford GM,
Reynolds KE: Distribution of 14C-formaldehyde after pulpotomy with formocresol. J Am Dent
Assoc 96:805-13, 1978.9. Myers DR, Pashley DH, Whitford GM, Sobe! RE, McKinney RV: The
acute toxicity of high doses of systemically administered formocresol in dogs. Pediatr Dent 3:37-41,
1981.10. Myers DR, Pashley DH, Whitford GM, McKinney RV: Tissue changes induced by the
absorption of formocresol from pulpotomy sites in dogs. Pediatr Dent 5:6-8, 1983.11. Schroder U:
A 2-year follow-up of primary molars, pulpotomized with gentle technique and capped with
calcium hydroxide. Stand J Dent Res 86:273-78, 1978.12. Heilig J, Yates J, Siskin M, McKnight J,
Turner J: Calcium hydroxide pulpotomy for primary teeth: a clinical study. JAm Dent Assoc
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