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

Resident: Cho

Author(s): Dunston B, Coll JA

Journal: Pediatric Dentistry

Year. Volume (number). Page #’s: 2005. 30. 42-47.

Major topic: Indirect Pulp Therapy, Pulpotomy, Pulpectomy

Minor topic: Formocresol, Ferric Sulfate, Glass Ionomer, Calcium Hydroxide, ZOE

Type of Article: Scientific Article

Main Purpose: The purpose was to replicate Primosch et al survey from 1997 and survey predoctoral pediatric dental program directors and diplomates of American Board of Pediatric Dentistry (ABPD) and to determine whether the philosophies and techniques for primary tooth pulp therapy have changed.

Overview of method of research: A survey of 27 multiple-choice questions was sent to 56 US dental school pediatric departments and to ABPD diplomates. The survey was in a similar format to that of 1997 Primosch et al survey and divided into two parts. Part I was more direct questions about pulp therapy techniques being used and part II was clinical scenarios for pulp therapy.

Findings: 48 of 56 predoctoral pediatric dental program directors returned surveys. 689 out of 1200 diplomates of ABPD returned the survey. More pediatric dental programs taught IPT and direct pulp cap than in 1997. More diplomates and directors are using glass ionomer and less zinc oxide or calcium hydroxide for IPT. Calcium hydroxide remained the base of choice for direct pulp caps. However, more predoctoral pediatric dental programs gave students a choice of calcium hydroxide or glass ionomer for direct pulp caps. Significantly more directors are teaching radiograph exposures immediately after pulpectomy than in 1997.

Key points/Summary: Indirect pulp therapy is being practiced more and most are not re-entering the tooth following IPT. Formocresol is still the preferred medicament for pulpotomy. However, the usage of ferric sulfate has increased. ZOE remains the base of choice after a pulpotomy. More rotary instruments for pulpectomy are being used along with iodoform and calcium hydroxide paste for filling the canals. There is disagreement among dental directors and diplomates of when pulpotomy on a primary tooth is indicated.

Assessment of Article: This was a good comparative survey between philosophies on pulp therapy in 2005 compared to 1997. I was surprised that there was disagreement as to when a pulpotomy was indicated in the clinical scenarios. In a scenario, 4% of diplomates advocated for pulpotomy on a primary tooth with a draining sinus tract. It is surprising that even the ABPD diplomates do not always follow AAPD guidelines when it comes to pulp therapy.