Saturday, July 16, 2011

Indirect Pulp Cap

What is an Indirect Pulp Cap? For that matter, what is a direct pulp cap? I was asked this in the comment section of a few other posts, so I though I ought to clarify.

An indirect pulp cap, if done properly, and in the right cases, can help avoid the need for a root canal in severely decayed teeth.

An Indirect pulp cap is where, in a permanent tooth, most of the decay is removed. As a dentist, you find that the decay is extensive and very close to the pulp (nerve) of the tooth. In fact, it may be likely that if you did remove all of the decay, the pulp would be exposed by the infected decay thus resulting in the need for a root canal. So, in order to avoid a root canal, the last little bit of decay is left in there and a sedative temporary filling is placed, usually IRM. After a few months, the temporary filling is removed and the remaining decay is removed and the tooth restored. How does that work? In teeth that have no signs or symptoms of pulpal necrosis or abscess, and that seem to have a good blood supply (ie, the younger the patient, the more likely it will work), by removing the bulk of the nasty decay and sealing off the remaining decay from its nutrient source (the mouth), the pulp has a chance to repair itself and what I call, "scar away" from the decayed area. Once this secondary dentin layer is in place, the remaining decay can be removed without pulp exposure. It doesn't always work, as many teeth are too far along and cannot recover, but sometimes it is worth a try.

A direct pulp cap is where there is an actual exposure of the pulp and a medicament like Calcium hydroxide or Mineral Trioxide Aggregate (MTA) is placed to stimulate the secondary dentin formation. A direct pulp cap is usually done with small mechanical or traumatic exposures with no evident decay in the area.


27 comments:

Zubar u Zagrebu said...

Tnx for the information on the Pulp Cap. Did not know a lot of stuff that you told here.. Will sure look at your older posts :) best luck with the blog!

paedodontics said...

good post...like this, blog keep updating.

joe stuart said...

What are the success rate for indirect pulp caps? Success would be determined by the tooth not needing root canal treatment in the future.

Dr. Dean Brandon said...

It "works" about half the time in my experience. Problem is, most of the kids (teeth) present themselves to us when the decay is quite large and the tooth is already symptomatic, so not as much chance of catching it in time. It's still worth trying when indicated.

Kenneth said...

Nicely presented information in this post, I prefer to read this kind of stuff. The quality of content is fine and the conclusion is good. Thanks for the post.

Teeth Whitening Allentown said...

Excellent blog, witty and informative keep up the good posting!

Miami Dentist said...

Great article Doc - Thank you for sharing!

Anonymous said...

My new dentist did this to my 3 1/2 year old daughter and I'm so grateful he did... I feel sorry for my two boys though, wish I knew better then. Four of my eldest son's upper front teeth were pulled due to cavities. My second son jumped and hit his mouth hard and the pediatric dentist pulled four of his upper front teeth as well because of pain and a bit of cavities.

Anonymous said...

Can performing an indirect pulp cap lead to the NEED for a root canal sooner? My dentist wants to do 2 indirect pulp caps, but I have no pain or discomfort. Based on the limited sucess rate (60%?) may this lead to the need for a root canal sooner rather than later?

Dr. Dean Brandon said...

The need for a root canal is often dependent on the amount of inflammation/infection present in the pulp. An indirect pulp cap can reduce that inflammation and allow a reasonably healthy pulp to recover. Lack of pain might suggest a reasonably healthy pulp.

No, an indirect pulp cap will not make a root canal necessary sooner. If a tooth really needs a root canal, but the dentist is not sure the tooth really does, an IPC will, if anything buy some time. The need for a root canal for the most part depends on the extent of the decay.

Dental Exams Ft. Lauderdale said...

The blog was very informative and well written. Indirect pulp caps works most of the time saving the teeth from further decay. As it works most of the time, I think it is a good choice to go for this treatment. Anyway, I think this blog will be useful for many people. Thank you for sharing this lovely blog with everyone and keep sharing...

Browning said...

my 2 year had a filling an now she is chewing on anything an everything and she has had it in a while now and also i want to know why after she had the filling was she so mody and not her self could something in it make her sick or be allergic to?This has happened twice after each filling was done very cranky for a couple weeks after but since the second one she hasnt stop wanting to chew on things help me.

Dr. Dean Brandon said...

I do not know. I will say moodiness is a common thing in two year olds.

Anonymous said...

My 9 year old daughter needs to root canals on her primary molars . The insurance denied the referral stating that it didn't show on x ray work that extensive was needed. Her dentist tried to fix the tooth but was unable to finish she says she defiantly needs the root canal . So now my daughter had a raw tooth with a temporary caver on it. Waiting for referral to come thought again . Can this tooth still be fixed with the in direct method ? Should I be concerned of her raw tooth ?
She has no pain that is why i was surprised to hear she needed that much work is that normal ? I don't know if I should get a second opini. Before they try to fix the other side . Why didn't the insurance see it ?

Anonymous said...

Also do you cap root canals for her age 9 . Her dentist says no until she an adult do she want feel up the tooth

Dr. Dean Brandon said...

Read more here on my post about root canals: What is a root canal?

and here about pulpotomies: What is a pulpotomy?

Insurance companies are always looking for an excuse to deny payments or coverage. As you can read, baby tooth root canals are not often done, but if they are it's because the nerve of the tooth is necrotic or dead.

Dr. Dean Brandon said...

Also, many people confuse the terms root canal and baby tooth root canal, and pulpotomy. A pulpotomy is a very common procedure in baby teeth.

Anonymous said...

hi , my 2year old son has very bad teeth. his first tooth came out (top left lateral incisor) with no enamel on the tip. now, he has two brown stumps for lateral incisors, and half the enamel off his two front teeth and cavities in his top molars. his gums seem to be red and swollen. i live in the 3rd world and have no access to dental care for at least the next 3-4 months. is there anything i can do for him> he is in pain when he eatssometimes. and he doesnt like to eat much because of this. his older sister has perfect teeth. thank you

Dr. Dean Brandon said...

Early childhood caries is a growing problem. If you have no way to receive treatment my main concern would be if infection sets in, swelling, etc. If a dentist is not available I would contact a physician or go to the emergency room of the hospital to get antibiotics or appropriate treatment. Unfortunately, there are some things only a dentist can do.

Susan said...

We went to the dentist yesterday. It was a checkup for my two year old, Beatrix. During the exam I pointed out to my dentist that she had a pink tooth. Long story short, he told us we needed to see a pediatric dentist and she likely has internal resorption, which means the tooth is dissolving from the inside out.

While I was SUPER glad that it wasn't a cavity (and I'm not a terrible mother), he mentioned that the treatment could be a root canal. My question is this: how do you do a root canal on a two year old? Do they use general anasthesia? Do you have to have a spacer until the permanent teeth come in?

Thanks in advance!

browneyedgirl said...

We went to the dentist yesterday. It was a checkup for my two year old, Beatrix. During the exam I pointed out to my dentist that she had a pink tooth. Long story short, he told us we needed to see a pediatric dentist and she likely has internal resorption, which means the tooth is dissolving from the inside out.

While I was SUPER glad that it wasn't a cavity (and I'm not a terrible mother), he mentioned that the treatment could be a root canal. My question is this: how do you do a root canal on a two year old? Do they use general anasthesia? Do you have to have a spacer until the permanent teeth come in?

Thanks in advance!

Dr. Dean Brandon said...

Read my post on root canal. Any treatment on a two year old is difficult. See my other posts on behavior management.

Dr. Dean Brandon said...

Also see my post on pediatric partials--usually not necessary for space maintenance, but some people want them for looks if a front tooth is removed early.

Anonymous said...

My four-year-old had two fillings done, one on each first molar on the bottom. The dentist indicated that they were minor cavities, but for some reason (she said to prevent sensitivity) she also did indirect pulp caps on the teeth with some kind of flouride releasing material. I am concerned about this, because I thought pulp caps were supposed to be used temporarily, but she plans on leaving these until the teeth fall out naturally (in 5-7 year?) I wonder if it is safe for flouride to be constantly released into her mouth/body for that long.

Dr. Dean Brandon said...

I cannot say what was specifically done, but there are fillings that release fluoride called glass ionomers. They are pretty much like white fillings in appearance. The material sets from a chemical reaction and is very safe. The fluoride released is minuscule, and very slow over time just in that particular area. You would get much more fluoride in your mouth by brushing one time with regular toothpaste. (which you should use every day)

It is not critical which material is used in an indirect pulp cap so ling as it seals it up-- and GI is acceptable. It would hold up better than IRM but not as well as a white composite over time. Does not sound too weird to me...

Anonymous said...

My 6 year old has four cavities and Dr said he needs a root canal I know he won't cooperate and he is in pain when he eats also he has asthma and I'm afraid of the anesthesia any advise Dr please thank you.

Dr. Dean Brandon said...

It's unlikely a 6 year old would need afoot canal (at least not on a baby tooth. He might need a pulpotomy, which is very common in baby teeth. It could be a permanent tooth in front from trauma, or in the back on the "6 year molar" but I dif=gress. What I hear is that you are concerned about his behavior, or anxiety. Asthma is certainly a condition you should let them now about. If it is general anesthesia (we do this int he hospital) then certainly that would be taken into account. If it is conscious sedation (as I have outlined on this blog) then precautions should be taken, like having his inhaler available (ask your dentist on all this). We treat kids with asthma all the time. Read more here on the blog, but ask questions to your pediatric dentist as well. Good luck.