Beruflich Dokumente
Kultur Dokumente
Dental history
The child has been a regular patient since the age of 3. She
has required restorations in four primary molars, one
requiring local analgesia. Despite intensive preventive
advice and diet analysis, new carious lesions have been
present at each recall visit.
Examination
You ask the child to point to the painful tooth and she points
to an apparently sound upper left primary canine.
SUMMARY
A 7-year-old girl has pain from a first permanent
molar. What is the cause and how might it affect her
dental development?
History
Complaint
The patients mother reports that the child suffers intermittent spontaneous discomfort from the upper left teeth.
History of complaint
The symptoms have been vague, no sleep has been lost and
there has been no facial swelling. The patient has complained of the pain three or four times over the last month.
Medical history
The child is fit and well.
Investigations
What investigations are indicated? Why?
CASE
33
156
Features
Diagnosis
What is your final diagnosis?
Pulpitis in the upper left first permanent molar, in response to
a deep occlusal carious lesion. On the basis that pain has
been intermittent, the pulpitis is probably reversible but the
rapid progression of the caries and proximity to the pulp may
herald involvement of the pulp. Caries must be excavated to
discover the true extent of the caries.
Further investigation
The child has been cooperative for restorative care under
local analgesia in the past, so you make an appointment to
investigate and, hopefully, restore this tooth. When you
open the small occlusal cavity you discover that the underlying coronal dentine has been almost completely destroyed
by caries. Caries extends into the pulp.
Treatment planning
What are the effects of extraction of a first permanent
molar on the developing permanent dentition?
33
CASE
157
CASE
33
158
Further information
The extracted tooth is shown in Figure 33.3 What do you
see?
Part of the crown has been removed to expose the carious
cavity. On the left you can see a small periapical granuloma at
the apex of the palatal root. The pulp was therefore nonvital
despite the lack of symptoms. On the right you can see a
large defect extending from the enamel to the pulp. The
central occlusal enamel is completely unsupported but has
not fractured. The carious dentine is hardly discoloured
because it is progressing rapidly.