What are the common minimally invasive dentistry (MID) approaches to pulp therapy in primary teeth?

• A. Full pulpectomy for all cases.
• B. Indirect pulp therapy, indirect pulp capping, and pulpotomy using cautious technique with biocompatible materials.
• C. Direct pulp capping as the only method.
• D. Extraction of non-restorable teeth.

Answer: (B)

In pediatric dentistry, minimally invasive pulp therapy aims to preserve the vitality of the tooth whenever possible by sealing caries and using materials that support healing. The common MID approaches for primary teeth include indirect pulp therapy, indirect pulp capping, and pulpotomy performed with a cautious technique and biocompatible materials.

Indirect pulp therapy involves removing most of the infected dentin but leaving a thin layer of dentin over the pulp to avoid exposure. The tooth is then sealed with a protective liner and a restoration. This creates a bacteria-tight seal and allows the pulp to respond by laying down reparative dentin, helping to preserve vitality.

Indirect pulp capping is a closely related approach used when the caries is near the pulp but exposure is avoided. A biocompatible liner or material is placed over the remaining dentin, and the tooth is sealed to protect the pulp and encourage healing.

Pulpotomy is a different MID option where the coronal portion of the pulp is removed, but the radicular pulp remains alive. The procedure is done with meticulous technique to prevent exposure and contamination, and a biocompatible dressing is placed to promote healing and maintain pulp vitality in the remainder of the tooth. Materials often used include calcium silicate cements and other bioactive options that are well tolerated by primary teeth.

Choices like full pulpectomy for all cases, direct pulp capping as the sole method, or extraction represent more invasive or non-pulp-therapy approaches and are not typically considered MID strategies in routine management of primary teeth.