A Survey of Primary Tooth Pulp Therapy as Taught in US Dental Schools and Practiced by Diplomats of the American Board of Pediatric Dentistry

Author(s): Bryan Dunston, DDS; James A. Coll, DMD, MS
Journal: Pediatric Dentistry
Volume (number): 30(1)
Month, Year: Jan / Feb 2008
Major topic: current pulp therapy practice
Minor topic(s):
Type of Article: research – survey
Main Purpose: to repeat a 1997 survey of current pulp therapy practice and to compare results.
Overview of method of research: The Primosch et al survey of 1997 was replicated. The survey was sent to all 56 US dental school pediatric dentistry departments and to ABPD diplomats. The predoctoral program directors were asked to complete the survey according to the department’s philosophy on primary tooth pulp therapy. The diplomats were asked to complete the survey according to their philosophy for pulp therapy in primary teeth. The survey contained 27 questions and was divided into 2 parts. Part I was designed to ascertain which primary tooth pulp therapies were taught in predoctoral pediatric dental programs or used in practice by the diplomats. Part II presented various clinical scenarios for pulp therapy in primary teeth.
Findings: In 2005 significantly more directors taught and diplomats practiced the use of glass ionomer cement for IPT, and not re-entering a tooth after placing an IPC. Conversely, significantly fewer directors taught and diplomats practiced the use of calcium hydroxide base and ZOE base for IPT. Calcium hydroxide remained the base of choice for direct pulp caps, but more predoctoral pediatric dental programs gave students the choice of CaOH or glass ionomer cement as a base for DPC in primary teeth in 2005 as compared to 1997. For pulpotomies, in 2005 significantly more dental schools taught and diplomats used ferric sulfate compared to 1997, although formocresol remained the medicament of choice. ZOE remained the base of choice from 1997 to 2005. For pulpectomies, hand instruments remained the debridement method of choice from 1997 to 2005, and sodium hypochlorite continued to be preferred canal irrigant from 1997 to 2005. ZOE remained the material of choice for obturation of root canals in 2005, but significantly more diplomats and directors advocated other filler pastes such as CaOH and iodoform than in 1997. Significantly fewer diplomats and directors used or taught 2-appointment pulpectomies compared to 1997 directors.
Key points/Summary: The increase in the teaching of IPT in 2005 may reflect the mounting evidence showing IPT success rates of greater than 90%. However, there is no reimbursement code for IPT. There is also evidence that a 1-appointment IPT is highly successful. The AAPD guidelines endorse CaOH, ZOE, and glass ionomer cement for IPT’s, but the shift to GI may reflect using the GI cement for SSC’s as a 1-step cement and IPT liner. The AAPD guidelines state that DPC is indicated only for small mechanical or traumatic exposures. This study shows there is an increasing trend to teach and use DPC. In 2005 there was a large decrease in the teaching of formocresol for pulpotomy, and a trend toward ferric sulfate. This shift may have occurred due to rising concerns over systemic distribution of formocresol. In the clinical scenarios, there were some disagreements over pulp therapy in 2 cases: uncontrolled bleeding during pulpotomy and a primary molar with a sinus tract. Some directors and diplomats are not applying the AAPD pulp therapy guidelines. Significantly fewer diplomats and directors advocated 2-appointment pulpectomy technique; many studies have shown that 1-appointment pulpectomies have high clinical success rates.
Assessment of article: Interesting to know what people are doing out there.