Pulp cap questions

[felinefan67]

I recently switched to a new dentist who fixed two cavities for the first time on me. The lower left molar's cavity turned out to be much bigger than the X-ray indicated and the dentist made a comment that the "nerve was involved." I didn't know what that meant exactly but it didn't sound great.

He explained he put a pulp cap on it but it had only a 50/50 shot of "taking" otherwise I will need a root canal within the next several months to a year most likely.

I did some research (on-line on pulp caps) and discovered there are two types: direct and indirect. He told me nothing of the procedure so I emailed him, talked to his assistant (who assured me he'd call back which he hasn't) and also got his wife (his other assistant) on the phone at home.

As I understand it: Indirect pulp caps are a temporary measure that requires follow-up treatment and care. Direct pulp caps don't but they are much less likely to succeed on adult, permanent teeth with a cavity as the reason for the cap. Most web sites said that it is almost pointless to do a pulp cap and to go with a root canal for a deep cavity because they are more successful. The reason being that decay or bacteria can be trapped in the sealed off tooth and multiply causing decay and infection again.

I tried to pin down the dentist to tell me which type he did. He said (at the time of the filling) that I didn't need to come back unless I experienced pain.

Now his WIFE later said that he "probably did an indirect pulp cap as a pre-cautionary measure to allow the tooth to heal." That doesn't sound right to me. WHY would the dentist tell me no follow-up is needed (if he did do an indirect pulp cap?)

I am confused and scared, yet his assisant and wife both said "It's nothing to worry about."

I've never had a root canal and am understandably nervous about both my unidentifed pulp cap and related questions and an impending root canal! My mother has had 3 or 4 root canals and told me "they aren't that bad." and that they didn't hurt her all that much.

Can someone PLEASE clarify the pulp cap procedures?? Can an INDIRECT pulp cap BE permenant? (requiring no follow-up as the dentist claimed?)

You can see I have trust issues and more so now that he isn't getting back to me directly.

 

[felinefan67]

Anyone?? *crickets chirping*

 

[letsconnect]

No, not yet

 

[felinefan67]

Nobody knows anything about pulp caps and the difference between the two kinds?? and how effective they are or aren't?? wow.

 

[brit]

Nobody knows anything about pulp caps and the difference between the two kinds?? and how effective they are or aren't?? wow.

None of the people who have answered so far are actually dentists - so you will have to wait until one of them comes on line for a professional answer.
You are coming over as being quite rude though....do you think people on here are paid for the service or something?
This website covers the whole English-speaking world and anyone else who wishes to join in as well....have you never heard of ....timezones?

 

[Zzzdentist]

....do you think people on here are paid for the service or something?

Wha what? We're not getting paid for this? Hold on a second here! I thought Letsconnect was going to send me a biiiig cheque at the end of the month. She promised! Oh this isn't right. Where's my agent??!!

Oh well, I may as well give my 2 cents on the big pulp cap question. Pulp caps are attempted when the decay gets really close to the nerve because a cavity has gotten to be the size of a mini-grand canyon. They are the dentist's last ditch effort to help avoid a root canal for the patient by covering up the area and "seeing how she goes."

It's kind of like when Mr. Scott pushes the warp engines into overdrive and offers a little prayer after giving in to a request from Captain Kirk for warp 8.5. He's certain that the Enterprise will fly apart into a million pieces, but there is that slight chance that the ship might hold together so he goes for it anyways.

An indirect pulp cap means that the nerve hasn't been exposed. That is, the naked butt of the nerve isn't poking through a hole in what tooth structure remains above the nerve after all the decay has been removed. Typically the dentist can see that they are close, but no bleeding or nerve tissue is exposed to the air.

Usually a calcium hydroxide (eg. Dycal) sedative agent which is dentin promoting and bacteriocidal can be placed to encourage the nerve to retreat from the area and build up more tooth structure there. With silver amalgam fillings, due to leakage, it usually is best to seal over the calcium hydroxide with something like Vitrebond (a modified glass ionomer liner I believe it is) to help prevent it from being dissolved away. With composite fillings, it's not really as much of a concern since the tooth is sealed up a bit better. I'm not up to date on the current research on the subject so this information might be a bit dated.

With a direct pulp cap, a small exposure of the nerve has been made due it's covering being removed with the decay. If there is no pus, minor bleeding, and a clean field, a dentist might attempt a direct pulp cap to see whether the tooth might be okay with that. I think there are quite different camps on the success and techniques regarding this procedure so let's just say that the dentist is going to toss a coin and tell you that it might work or it might not because honestly they don't know. It really depends on the technique, the extent of exposure, the cleanliness of the area, what the dentist ate for lunch, and whether you feel lucky punk <said in a Dirty Harry kind of voice>.

Personally, I don't think the direct caps tend to work all that well. Sometimes in desperation (usually due to patient finances) I will try it and warn the patient that it's going to be a bit of a crapshoot, but the alternatives are root canal or extraction so usually they are willing to try it. I only will try them on people who can accept the possible consequences of a severe toothache if it doesn't work. Otherwise, I just open the tooth open for a root canal right there and then if they just don't want to try it or if I feel the chances of success are slim.

The wife and assistant are being nice and trying to comfort you over a procedure with an unpredictable outcome. Yes, a successful pulp cap can last quite some time, but the amount of time will vary. Your best bet is to try to relax and see whether the Enterprise makes it through okay or not. Let Captain Kirk and Scotty try to take care of it for you.

 

[felinefan67]

None of the people who have answered so far are actually dentists - so you will have to wait until one of them comes on line for a professional answer.
You are coming over as being quite rude though....do you think people on here are paid for the service or something?


I wasn't rude. Just suprised that in over six hours (any timezone) that in a world-wide forum, no one had answered yet. I was also looking for people who may have had similiar experiences WITH this procedure, not necessarily a dentist who performs them (although they are the experts!).

The dentist did what he could. But I'm an "answers" person who hates unpredictible odds. He hasn't returned my inquiries in almost a week and I think THAT'S rude for a new dentist who worked on a BRAND new patient who's a bit scared of an iffy procedure!

Bottom line: He did what he felt he had to do given the circumstances and is keeping his fingers crossed it will hold for a while. I realize now that I WILL need a root canal in the future; its just a matter of when.

 

[letsconnect]

Wha what? We're not getting paid for this? Hold on a second here! I thought Letsconnect was going to send me a biiiig cheque at the end of the month. She promised! Oh this isn't right. Where's my agent??!!

*cough, cough* ahemmm... I was talking about a proverbial cheque (just like the proverbial carrot...)

 

[felinefan67]

Well, I stopped in again at the dentist and he came out and answered my questions.

Yes, it WAS a direct pulp cap, however; he said the nerve was NOT exposed per sae, just that they "got down to it" and could see the whole thing" Not sure I get how that's possible without nerve exposure, but anyway, he said it could fail in a "month, six months, a few years, or never".

So basically he did what he could to save the tooth and isn't promising anything for the future.