Care of the Pulp

Question 1

pulp function (4)

Answer 1

1. nutrition
2. sensory - temp pain pressure
3. protective - tertiary dentine
4. formative dentine - secondary dentine

Question 2

what is RDT

Answer 2

RDT - remaining dentine thickness - space between base of cavity and apex of pulp

Question 3

correlation between dentine permeability and distance to pulp

Answer 3

dentine tubules increase in number and diameter as they approach the pulp so the deeper the cavity the greater the dentine permeability so the more likely there will be infection

Question 4

alpha fibres

Answer 4

myelinated
sharp pain
stimulated by EPT

Question 5

alpha fibres

Answer 5

myelinated
sharp pain
stimulated by EPT

Question 6

C fibres

Answer 6

non myelinated
stimulation is dull aching pain
increased pulpal blood flow
increased pulpal pressure

Question 7

pulpal diagnosis (6)

Answer 7

1. healthy pulp
2. reversible pulpitis
3. irreversible pulpitis - symptomatic/asymptomatic
4. necrotic pulp
5. previously treated
6. previously initiated therapy

Question 8

periapical diagnosis (5)

Answer 8

1. normal healthy tissue
2. periapical periodontitis - symptomatic / asymptomatic
3. acute apical abscess
4. chronic apical abscess
5. condensing osteitis

Question 9

reversible pulpitis

Answer 9

pain to cold but only lasts a short while 
hydrodynamic expression (due to microleakage)
no change in pulpal blood flow

Question 10

irreversible pulpitis

Answer 10

spontaneous pain, intermittent, disturbs sleep
negative to cold, pain to hot
increase in pulpal blood flow

Question 11

necrotic pulp

Answer 11

completely non vital, pulp chamber is full of dead tissue and vessels and can go brown

Question 12

treatment options for necrotic pulp (2)

Answer 12

1. mature teeth - closed apices - RCT/extraction

2. immature teeth - open apices - pulpotomy/pulpectomy/extraction

Question 13

symptomatic periapical periodontitis

Answer 13

inflammation of apical periodontium
pain on biting as well as percussion and/or palpation
may have periapical radiolucency

Question 14

asymptomatic periapical periodontitis

Answer 14

inflammation and destruction of apical periodontium
no present clinical symptoms - no pain on percussion/palpation
may have periapical radiolucency

Question 15

chronic apical abscess

Answer 15

inflammatory reaction to pulpal infection and necrosis
gradual onset
little to no discomfort
intermittent discharge of pus through sinus tract
will have periapical/periradicular radiolucency

Question 16

condensing osteitis

Answer 16

diffuse radiopaque lesion
usually seen at apex of tooth
localised bony reaction to inflammatory stimulus

Question 17

5 signs of non vital teeth

Answer 17

1. discolouration
2. sinus
3. gross caries
4. large restoration
5. radiographic evidence

Question 18

3 discolouration’s of teeth and what they mean

Answer 18

yellow - obliteration of dentinal tubules
grey - blood breakdown products in tooth
pink - resorptive process going on within root

Question 19

sensibility tests

Answer 19

EPT
thermal - hot and cold
test drilling

Question 20

limitations of sensibility tests

Answer 20

difficulties in assessing multi-rooted teeth
periradicular inflammation occurs before pulp is totally necrotic
do not indicate state of blood supply (vitality related to this not nerve stimulation)

Question 21

what does a score of 80 indicate on an EPT

Answer 21

a completely non responsive pulp

Question 22

positive score on EPT

Answer 22

vital pulp tissue in coronal aspects of pulp chamber
no indication of reversibility of inflammation
no correlation between pain threshold and pulp condition

Question 23

negative score on EPT

Answer 23

reliable indicator for pulpectomy in almost 98% of cases

EPT unreliable in teeth with open apices/recently traumatised teeth

Question 24

materials used for cold tests

Answer 24

ethyl chloride
difluorodichloromethane
endo ice

Question 25

issue with heat tests

Answer 25

too much heat can cause irreversible pulpitis

not possible to ascertain degree of reversibility of inflamed symptomatic pulp

Question 26

when to use test drilling

Answer 26

if a patient has a full coverage restoration i.e. a crown

Question 27

influence of clinical factors (4)

Answer 27

carious pulp exposure
age - pulp less likely to reduce inflammatory response
periodontal disease - prematurely aged pulp so less resistant
previous pulpal trauma - same as above

Question 28

impact of age on the pulp

Answer 28

continuous dentine formation - reduced pulp size and volume
increased fibrous components and calcification
decreased cellular components and no of blood vessels and nerves
less likely to reverse inflammatory response

Question 29

4 ways to prevent pulp damage

Answer 29

1. know tooth anatomy
2. avoid drilling straight into pulp
3. use cavity sealers/indirect pulp cap
4. if exposed use direct pulp cap

Question 30

3 requirements of cavity sealers

Answer 30

1. must adhere to dentine not restorative material
2. be thin as thickness reduces strength of restorative material
3. not dissolve in biological liquids

Question 31

examples of cavity base/liners

Answer 31

zinc phosphate
ZOE
calcium hydroxide (dycal)
RMGI (vitrebond)

Question 32

pros of dycal

Answer 32

bacteriostatic 
high pH (stimulates fibroblasts to induce reparative dentine formation)
stimulates recalcification of demineralised dentine

Question 33

cons of dycal

Answer 33

cytotoxic to pulpal cells
weak so need thick amount
very soluble if not protected

Question 34

pros and cons of DBAs

Answer 34

pro - marked reduction in microleakage with their use

con - use is very technique sensitive