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Pulp therapy in the primary dentition remains a technique generating a tremendous amount of study. Formocresol has been and continues to be the most commonly used intrapulpal medicament despite its known ability to escape the microcirculation of the pulp. Ferric sulfate has gained significant favor as a result of formocresol's disadvantages, though at the cost of requiring a much more acute awareness of the potential for remaining disease and its ability to mask that process. Mineral trioxide aggregate perhaps offers the best immediate alternative to either of the above though at this time it is still cost-prohibitive in a practice that actively treats many children. And, as MTA has no fixative properties of its own, accurately analyzing the extent of the pulpal disease becomes even more critical to the overall success of the procedure. As with other techniques in dentistry, the debate is sure to continue for severl years to come.

Objectives: This paper aims to alert the dental practitioner to the rapidly evolving therapies for treating the pulps of primary and young permanent teeth., Data Sources: Experimental research on animals, clinical studies and case reports., Study Selection: Indirect pulp capping, direct pulp capping, pulpotomies, and pulpectomies are standard procedures for treating primary teeth. However, direct pulp capping, heretofore not very successful, is being revisited. Based on studies in animals and clinical findings in humans, there has been a movement in pediatric dentistry to find alternatives to formocresol and calcium hydroxide for pulpotomy therapy. Venues range from eradication by cautery to the possibility of healing with growth factors. New studies with iodoform paste for pulpectomies are confirming the success rates of previous publications. The new dental adhesives are being tested as agents for direct pulp capping, as well as partial and complete pulpotomy protocols., Conclusions: More thought is being given by clinicians to preserving pulp, either through more ambitious indirect pulp therapy or partial pulpotomy. Formocresol and calcium hydroxide pulpotomies, while still popular, may soon be challenged by other chemical treatments, electrocautery or stimulation of reparative dentine by growth factors. Iodoform pastes are promising easier and more successful pulpectomy therapy. Total etch direct bonding materials could soon transform direct pulp capping, as well as partial and complete pulpotomy protocols.

This manuscript reports the treatment trends in a pediatric dentistry clinic from 1980 to 1992 and discusses their implication in clinical teaching. Analysis of the records of the senior year pediatric dentistry students indicated: no significant change with time in the patients/student ratio, the number of preformed crowns, pulpotomies, and pulpectomies by student or by patient; a significant decrease in the number of one-surface and > or = 2-surface restorations by student and by patient; a significant increase in the number of pit-and-fissure sealants and preventive resin restorations by student and by patient. During the thirteen-year period, the students performed an average of 7.3 one-surface; 12.9 > or = 2-surface restorations; 5.5 preformed crowns; 6.4 pit-and-fissure sealants; 2.4 pulpotomies. There was a significant increase with time in the number of students who performed pit-and-fissure sealants.