28 Nov Pulp Euthanasia. To Kill or Not To Kill Pulp.
An Hamletic doubt that assails the dentist quite often.
On daily base we have to take the decision to preserve or remove the pulp on decayed teeth with no symptoms or slightly asymptomatic.
Of course all pulps shall die one day. For sure they will die with the death of the patient. Sometime they shall die long before the funeral of the patient. And in some cases the Euthanasist might or must be the Dentist.
Drawing well-defined boundaries when inducing the euthanasia of the dental pulp would be arrogant and misleading.
Relying on common sense and experience is still the best resource for this kind of decision.
Based on my experience, some conditions would make me lean towards the Pulp Euthanasia. And I’m not talking just of strictly dental conditions, but also of more general health status of the patient and eventually social and psychological framework.
Dental Pulp has a a budget, that is often worn during the lifetime of the patient. And every pulp has a threshold of catastrophe, that we do not know and that changes overtime (chronobiology). A bacterial insult from a carious cavitation….or the bacterial insult from the leakage of a previous filling…or the bacterial insult coming from a crack…or the bacterial insult coming from erosive or mechanical wear….or chemical and thermal insults….drug insults (patient that had chemotherapy)….physical insults (patient that had radiotherapy of head and neck)…..virus insults….aging of the pulp….acute trauma….
But also dentist has a budget. I mean a psychological and social budget. I do not want to run any risk on a woman, who is going to marry in 2 weeks and has decayed tooth with slight symptoms. She will never forgive me if she experienced any pain or swelling the wedding day or during the honeymoon.
I do not want to run any risk in a 60 years old patient that has to start a chemotherapy.
And, dentist has also a management burden. An historical patient would forgive more than a new patient.