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3d. BDS3 CDS Endodontics > (BDS2) L20. Care of The Pulp > Flashcards

(BDS2) L20. Care of The Pulp Flashcards

1
Q

L20: What cells do the pulp contain?

A
  • Blood vessels;
  • Cells;
  • Nerves.
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2
Q

L20: Is the pulp vital and what does this mean?

A

Yes it is, this means that is it tissue that is able to respond to stimulus (electrical/ heat/ cold).

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3
Q

L20: Does the pulp have regenerative potential?

A

Yes - it is able to heal (reversible pulpitis), but not always (irreversible pulpitis).

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4
Q

L20: What is problematic about diagnosing/ treating the pulp, for dentists?

A

Little correlation between histopathological state and symptoms, i.e. pulpitis can be asymptomatic.

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5
Q

L20: What are the 4 functions of the pulp?

A
  • Nutrition;
  • Sensory;
  • Protective;
  • Formative.
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6
Q

L20: What can cause pulpitis?

A
  • Caries;
  • Cavity preparation;
  • Restorations;
  • Trauma;
  • Toothwear;
  • Periodontal pathology;
  • Orthodontic tx;
  • Radiation therapy.
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7
Q

L20: How can cavity/ crown preparation cause damage to the pulp?

A
  • Heat generation;

- Type of bur used (size, speed, sharpness, force, vibration).

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8
Q

L20: How can restoration materials cause damage to the pulp?

A
  • Toxicity;
  • Water absorption;
  • Heat of reaction;
  • Poor marginal adaptation/ seal;
  • Cementation of restoration.
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9
Q

L20: What is remaining dentine thickness (RDT)?

A

The thickness of dentine left between a cavity preparation and the pulp.

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10
Q

L20: What is the relationship between dentinal tubules and the pulp?

A

They increase in number and in diameter as they approach the pulp.

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11
Q

L20: How does the relationship between dentinal tubules and the pulp affect the dentine permeability, with regards to cavity preparation?

A

The deeper the cavity, the greater the dentine permeability.

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12
Q

L20: What is dentine permeable to?

A
  • Bacterial substances;
  • Polysaccharides;
  • Antibodies;
  • Immune complexes;
  • Complement proteins;
  • Tissue destruction products.
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13
Q

L20: What type of nerve fibres give rise to dental pain?

A

Alpha and c fibres

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14
Q

L20: What type of nerve fibres are alpha fibres and what type of pain do they radiate?

A
  • Myelinated;

- Sharp pain.

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15
Q

L20: What type of nerve fibres are c fibres and what type of pain do they radiate?

A
  • Non-myelinated;

- Dull/ aching pain

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16
Q

L20: Which nerve fibres in the pulp are stimulated by an electric pulp test (EPT)?

A

Alpha fibres

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17
Q

L20: Which nerve fibres in the pulp are stimulated by an increase in blood flow or pressure in the pulp?

A

c fibres

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18
Q

L20: What diagnoses are there for a pulpal diagnosis?

A
  • Healthy pulp;
  • Reversible pulpitis;
  • Irreversible pulpitis (symptomatic or asymptomatic);
  • Necrotic pulp;
  • Previously treated;
  • Previously initiated therapy.
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19
Q

L20: What diagnoses are there for a periapical diagnosis?

A
  • Normal;
  • Periapical periodontitis (symptomatic or asymptomatic);
  • Acute apical abscess;
  • Chronic apical abscess;
  • Condensing osteitis.
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20
Q

L20: What does a healthy pulp mean?

A
  • Vital;

- Free of inflammation.

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21
Q

L20: Why might endodontic tx be indicated for a healthy pulp?

A
  • Elective or prosthetic purposes;

- Traumatic pulp exposure.

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22
Q

L20: How quickly does pulp exposure, due to trauma, need to be treated before requiring RCT?

A

Within 24 hours

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23
Q

L20: Symptomatically, what re the differences between reversible and irreversible pulpitis?

A

Reversible:

  • Pain to cold, short-lasting;
  • Hydrodynamic expression, micro leakage (A-fibres);
  • No change in pulp blood flow.

Irreversible:

  • Spontaneous pain;
  • Intermittent;
  • Sleep disturbance;
  • Negative to cold, pain to hot (e.g. tea/ coffee, c-fibres);
  • Increase to blood flow.
24
Q

L20: How is reversible pulpitis treated?

A

Inflammation to pulp, can reverse with pulp therapy

25
Q

L20: How is irreversible pulpitis treated?

A

Inflammation to pulp that cannot heal, pulpectomy then RCT or extraction

26
Q

L20: What is a necrotic pulp?

A
  • Non-vital pulp;

- Can be partial or total.

27
Q

L20: What are the tx options for mature teeth (closed apices) with a necrotic pulp?

A
  • RCT;

- Extraction.

28
Q

L20: What are the tx options for immature teeth (open apices) with a necrotic pulp?

A
  • Pulpotomy;
  • Pulpectomy then RCT;
  • Extraction.
29
Q

L20: What does normal periapical tissues mean?

A
  • Not sensitive to percussion or palpitation;

- Radiographically: lamina dura intact and PDL space uniform.

30
Q

L20: What does symptomatic periapical periodontitis suggest?

A
  • Inflammation of the apical periodontum;
  • Pain (biting/ percussion/ palpitation);
  • [Severe pain to the above is highly indicative of a degenerating pulp - RCT];
  • May have radiolucency in this area;
31
Q

L20: What does asymptomatic periapical periodontitis suggest?

A
  • Inflammation and destruction of the apical periodontum (pulpal region);
  • Appears as an apical radiolucency;
  • No present clinical symptoms.
32
Q

L20: What are the clinical signs and symptoms of an acute apical abscess?

A
  • Inflammatory reaction to pulpal infection and necrosis;
  • Quick onset;
  • Spontaneous pain;
  • Extreme tenderness to pressure;
  • Pus;
  • Swelling;
  • May be no radiographic signs of destruction;
  • Malaise;
  • Fever;
  • Lymphadenopathy.
33
Q

L20: What are the clinical signs and symptoms of a chronic apical abscess?

A
  • Inflammatory reaction to pulpal infection and necrosis;
  • Gradual onset;
  • Little or no discomfort;
  • Intermittent discharge of pus through a tract;
  • Radiolucency (periapical/ periradicular).
34
Q

L20: What is condensing osteitis?

A

An inflammatory reaction to a dental infection causing bone construction, rather than destruction in the effected area

35
Q

L20: What would you expect, radiographically, from condensing osteitis?

A

Diffuse radiopaque lesion, usually seen at apex of the tooth

36
Q

L20: What are the signs of non-vital teeth?

A
  • Discolouration;
  • Sinus;
  • Gross caries;
  • Large restoration;
  • Radiographic evidence.
37
Q

L20: What is the primary function of sensibility testing?

A

To differentiate between a vital and non-vital pulp

38
Q

L20: What is the main issue with sensibility testing and patient’s response?

A

Patient responses are very subjective (compare with a contralateral tooth)

39
Q

L20: What are the three main sensibility tests?

A
  • Electric pulp test (EPT);
  • Thermal test (hot/ cold);
  • Test drilling.
40
Q

L20: What is a the problem with using sensibility tests to determine the vitality of a pulp?

A
  • Tests stimulate nerve fibres;
  • Can’t assume that nerve fibres correlate to blood supply;
  • Tooth vitality = blood supply, not nerve stimulation;
  • Can have partial necrosis so problematic for diagnosing multi-rooted teeth.
41
Q

L20: What do EPTs test and how?

A
  • Electric pulp current used to stimulate sensory nerves at pulp-dentine junction;
  • A-delta fibres stimulated;
  • c fibres sometimes respond.
42
Q

L20: What does a positive response (yes) to an EPT suggest?

A
  • Vital pulp tissue in the coronal aspect of the pulp chamber.
43
Q

L20: What cannot be determined by a positive response to an EPT?

A
  • Reversibility of inflammation (healing);

- Pulp condition (this does not correlate to pain threshold from EPT).

44
Q

L20: What does a negative (no) response to an EPT suggest?

A

Non-vital pulp, requiring pulpectomy (for mature teeth with close apices only)

45
Q

L20: What do thermal tests, test and how?

A
  • Sensory nerve receptors in the pulp;

- Response to hydrodynamic forces in dental tubules (due to expansion/ contraction).

46
Q

L20: What does a negative response to a thermal test suggest?

A

Pulp necrosis

47
Q

L20: When are drilling tests used?

A

When full coverage restorations are present (other forms of testing impossible)

48
Q

L20: What does a negative response to a drilling test suggest?

A

Non-vital pulp

49
Q

L20: What can cause ‘premature aging’ of pulp?

A
  • Trauma to pulp;

- Periodontal disease.

50
Q

L20: How does ‘premature aging’ of pulp influence its healing process?

A

Less likely to heal compared to healthy pulp as less resistant to inflammation

51
Q

L20: Cavity sealers are often used to protect the pulp after cavity preparation, name a few properties these should have.

A
  • Material must adhere to dentine, rather than restorative material;
  • Must be thin (so that it doesn’t interfere with strength of restorative material);
  • Not dissolve in biological liquids.
52
Q

L20: What is a primary purpose of cavity bases/ liners?

A

Thermal protection from restorative materials

53
Q

L20: Give three examples of cavity bases/ liners:

A
  • Zinc phosphate;
  • Zinc oxide eugenol;
  • Calcium hydroxide (dycal);
  • Resin modified glass ionomers (RMGI) (vitrebond).
54
Q

L20: Explain how calcium hydroxide is bacteriocidal/ bacteriostatic:

A
  • High pH so stimulates fibroblasts and formation of reparative dentine;
  • Stimulates recalcification of demineralised dentine, by stimulating pulpal cells;
  • Neutralises low pH from acidic restorative materials.
55
Q

L20: What does the colour of discoloured teeth suggest?

A
  • Pink: resorption of tooth;
  • Yellow: obliteration of dentine tubules (less light passing through);
  • Grey: blood products in dentine tubules (i.e. from pulp).

3d. BDS3 CDS Endodontics (8 decks)

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