158 - Extract or Preserve? Vital Pulp Therapy for High-Risk Children

Abstract:

Purpose: Contemporary vital pulp therapy techniques using calcium silicate cements can successfully preserve restorable teeth with normal pulp or reversible pulpitis. This study sought medical expert opinions on infection concerns, and their expectations for dental clearance request before invasive medical procedures such as bone marrow and organ transplantations.

Methods: Pediatric specialists in cardiology, hematology/oncology, and transplant medicine from a major university medical center were recruited. Through virtual structured interviews, standardized scenarios of restorable teeth with deep caries lesions approaching the pulp were presented. Recorded interviews explored definitions of dental clearance by each specialty, perceived infection risk, and evidence-based dental treatment approaches. Responses were thematically analyzed to identify areas of agreement and divergence.

Results: Seven specialists across the three fields were interviewed. Experts agreed dental clearance should eliminate active odontogenic infection before periods of medical vulnerability. Teeth with clinical or radiographic signs of infection were uniformly recommended for removal. For restorable teeth without evidence of infection, most specialists did not categorically oppose conservative therapy. Recommendations were conditional and depended on immune status, timing of medical treatment, hematologic parameters, and the ability to ensure close follow-up.

Conclusions: Pediatric medical specialists supported individualized decision-making that allows vital pulp therapy for restorable teeth without infection rather than routine extraction. These findings highlighted the need for clearer, condition-specific clearance frameworks and closer medical–dental collaboration to reduce unnecessary extractions while maintaining patient safety, adequate masticatory function and occlusion.



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