(BDS2) L20. Care of The Pulp Flashcards by Alice Mackintosh

L20: What cells do the pulp contain?

Blood vessels;
Cells;
Nerves.

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

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

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L20: Does the pulp have regenerative potential?

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

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

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

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L20: What are the 4 functions of the pulp?

Nutrition;
Sensory;
Protective;
Formative.

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L20: What can cause pulpitis?

Caries;
Cavity preparation;
Restorations;
Trauma;
Toothwear;
Periodontal pathology;
Orthodontic tx;
Radiation therapy.

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

Heat generation;

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

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

Toxicity;
Water absorption;
Heat of reaction;
Poor marginal adaptation/ seal;
Cementation of restoration.

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L20: What is remaining dentine thickness (RDT)?

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

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

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

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

The deeper the cavity, the greater the dentine permeability.

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L20: What is dentine permeable to?

Bacterial substances;
Polysaccharides;
Antibodies;
Immune complexes;
Complement proteins;
Tissue destruction products.

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

Alpha and c fibres

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

Myelinated;

- Sharp pain.

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

Non-myelinated;

- Dull/ aching pain

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

Alpha fibres

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

c fibres

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L20: What diagnoses are there for a pulpal diagnosis?

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

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L20: What diagnoses are there for a periapical diagnosis?

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

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L20: What does a healthy pulp mean?

Vital;

- Free of inflammation.

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

Elective or prosthetic purposes;

- Traumatic pulp exposure.

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

Within 24 hours

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

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.

L20: How is reversible pulpitis treated?

Inflammation to pulp, can reverse with pulp therapy

L20: How is irreversible pulpitis treated?

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

L20: What is a necrotic pulp?

- Non-vital pulp; | - Can be partial or total.

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

- RCT; | - Extraction.

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

- Pulpotomy; - Pulpectomy then RCT; - Extraction.

L20: What does normal periapical tissues mean?

- Not sensitive to percussion or palpitation; | - Radiographically: lamina dura intact and PDL space uniform.

L20: What does symptomatic periapical periodontitis suggest?

- 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;

L20: What does asymptomatic periapical periodontitis suggest?

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

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

- 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.

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

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

L20: What is condensing osteitis?

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

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

Diffuse radiopaque lesion, usually seen at apex of the tooth

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

- Discolouration; - Sinus; - Gross caries; - Large restoration; - Radiographic evidence.

L20: What is the primary function of sensibility testing?

To differentiate between a vital and non-vital pulp

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

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

L20: What are the three main sensibility tests?

- Electric pulp test (EPT); - Thermal test (hot/ cold); - Test drilling.

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

- 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.

L20: What do EPTs test and how?

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

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

- Vital pulp tissue in the coronal aspect of the pulp chamber.

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

- Reversibility of inflammation (healing); | - Pulp condition (this does not correlate to pain threshold from EPT).

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

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

L20: What do thermal tests, test and how?

- Sensory nerve receptors in the pulp; | - Response to hydrodynamic forces in dental tubules (due to expansion/ contraction).

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

Pulp necrosis

L20: When are drilling tests used?

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

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

Non-vital pulp

L20: What can cause 'premature aging' of pulp?

- Trauma to pulp; | - Periodontal disease.

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

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

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

- 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.

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

Thermal protection from restorative materials

L20: Give three examples of cavity bases/ liners:

- Zinc phosphate; - Zinc oxide eugenol; - Calcium hydroxide (dycal); - Resin modified glass ionomers (RMGI) (vitrebond).

L20: Explain how calcium hydroxide is bacteriocidal/ bacteriostatic:

- 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.

L20: What does the colour of discoloured teeth suggest?

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