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FINALS - Endodontics > Care of the Pulp > Flashcards

Care of the Pulp Flashcards

1
Q

Whatt type of nerves are in the pulp?

A

A-Beta
A-Delta
C fibres

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2
Q

What does it mean if the pulp is a vital tissue?

A

Responds to stimuli and has regenerative potential

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3
Q

What is the main nerve plexus in the tooth?

A

plexus of Raschkow

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4
Q

What are the functions of the pulp?

A

Nutrition, sensory, protective, formative

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5
Q

What type of sensations can the pulp feel?

A

Temperature, pressure, pain

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6
Q

what type of protective functions does the pulp have?

A

Tertiary dentine formation for reparative healing

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7
Q

What is the formative function of the pulp?

A

Secondary dentine production

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8
Q

Name the types of injury that can occur to the pulp.

A

Caries
Cavity preparation
Restorations
Trauma
Tooth wear
Periodontal pathology
Orthodontic treatment
Radiation therapy

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9
Q

How can restoration materials damage the pulp?

A

Toxicity, water absorption, heat of reaction, poor marginal adaptation/seal, cementation of restoration

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10
Q

What happens to the structure of dentine tubules closer to the pulp?

A

They increase in number and diameter

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11
Q

Where is dentine permeability the greatest?

A

At the pulp

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12
Q

What types of cells can pass through dentine tubules?

A

Bacterial substances, polysaccharides, antibodies, immune complexes, complement proteins, tissue destruction products

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13
Q

What is the key part of pulpal and periradicular pathology?

A

Micro-organisms

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14
Q

What types of pain does alpha fibres feel?

A

Sharp pains

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15
Q

What type of pain does C fibres feel?

A

Dull/aching pain

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16
Q

What are alpha fibres stimulated by?

A

Electric pulp test

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17
Q

What are c fibres stimulated by?

A

Increased pulpal blood flow and increased pulpal pressure

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18
Q

What are the two AAE classifications?

A

Pulpal diagnosis, periapcial diagnosis

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19
Q

What are the types of pulpal diagnosis?

A

Healthy pulp
Reversible pulpitis
Irreversible pulpitis (symptomatic/asymptomatic)
Necrotic pulp
Previously treated
Previously initiated therapy

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20
Q

What are the different types of periapical diagnosis?

A

Normal
Periapical periodontitis (symptomatic, asymptomatic)
Acute apical abscess
Chronic apical abscess
Condensing osteitis

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21
Q

What does a healthy pulp mean?

A

Vital and free of inflammation

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22
Q

When are healthy pulps removed?

A

For elective/prosthetic purposes, for traumatic pulp exposure

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23
Q

Is a pulp with reversible pulpitis vital or non-vital?

A

Vital

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24
Q

What is reversible pulpitis?

A

Inflamed pulp which can be reversed back to health

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25
Q

What sort of response to reversible pulpitis pulps have to sensibility test?

A

regular response

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26
Q

Are pulps with irreversible pulpitis vital or non-vital?

A

vital

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27
Q

What is irreversible pulpitis?

A

Inflamed pulp which cannot be reversed back to normal

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28
Q

What are the treatment options for irreversible pulpitis?

A

Pulpectomy then RCT/extraction if the tooth is unrestorable and patient would prefer this

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29
Q

How do you know if a pulp has irreversible pulpitis?

A

If investigations suggest that pulpal inflammation cannot heal

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30
Q

What are the clinical symptoms of reversible pulpitis?

A

Pain to cold
Lasts a short time (A fibres)
Hydrodynamic expression (microleakage)
No change in blood flow
Not keeping patient up at night
Doesn’t occur spontaniously

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31
Q

What are the clinical symptoms of irreversible pulpitis?

A

Spontaneous pain, can last hours
Intermittent
Sleep disturbance
Pain to hot (C fibres)
Increase in pulpal blood flow

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32
Q

What is the vitality of a necrotic pulp?

A

Non-vital

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33
Q

What is a necrotic pulp?

A

Partial or total necrosis of the pulpal tissue.

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34
Q

What are the treatment options for mature teeth with a necrotic pulp?

A

Root canal treatment or extraction

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35
Q

What are the treatment options for immature teeth with a necrotic pulp?

A

Pulpotomy, pulpectomy then full RCT, extraction

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36
Q

What does it mean if a tooth is mature?

A

The apices are closed

37
Q

What are normal periapical tissues like?

A

Not sensitive to percussion or palpation, lamina dura intact, PDL space uniform

38
Q

What is symptomatic periapical periodontitis?

A

Inflammation of the apical periodontium

39
Q

What are the symptoms of symptomatic periapical periodontitis

A

Pain when biting, applying percussion, palpation, periapical radiolucency

40
Q

What is highly indicative of a degenerating pulp?

A

Pain to percussion and/or palpation

41
Q

What treatment is needed for symptomatic periapical periodontitis?

A

RCT or XLA

42
Q

What is asymptomatic periapical periodontitis?

A

Inflammation and destruction of the apical periodontium

43
Q

What does an asymptomatic periapical periodontitis appear like?

A

An apical radiolucency on a radiograph

44
Q

What can symptomatic periapical periodontitis look like on a radiograph?

A

Periapical radiolucency

45
Q

What is an acute apical abscess?

A

Inflammatory reaction to pulpal infection and necrosis, reslting in suppative infection of the apical tissues.

46
Q

What are the symptoms of acute apical abscess?

A

Rapid onset, spontaneous pain, extreme tenderness to pressure, pus formation, swelling

47
Q

What are the systemic signs of acute apical abscess?

A

Malaise, fever, lymphadenopathy

48
Q

What are the symptoms of chronic apical abscess?

A

Little or not discomfort, intermittent discharge of pus through sinus tract

49
Q

What shows on a radiograph with chronic apical abscess?

A

Periapical/periradicular radiolucency

50
Q

How do you identify the tooth affected by the chronic apical abscess?

A

carefully place GP cone into sinus tract and take a radiograph

51
Q

what is condensing osteitisis?

A

diffuse radiopaque lesion which represents localised bony reaction to a low-grade inflammatory stimulus

52
Q

where are condensing osteitisis usually seen?

A

at the apex of tooth

53
Q

what are the signs of a non-vital tooth?

A

discolouration, sinus, gross caries, large restorations, radiographic evidence (periapical radiolucency and periradicular radiolucency)

54
Q

what types of colours do non-vital teeth display?

A

yellow, grey, pink

55
Q

what does a yellow tooth mean?

A

obliteration of dentinal tubules

56
Q

what does a grey tooth mean?

A

blood break down products in tooth

57
Q

what does a pink tooth mean?

A

resorptive process, tooth eating itself away

58
Q

where is a periapical radiolucency?

A

only around the apex

59
Q

where is a periradicular radiolucency?

A

round more surfaces of the root

60
Q

what is the function of a sensibility test?

A

to differentiate vital from non-vital pulp

61
Q

how do you conduct a sensibility test?

A

compare patients response with a contralateral tooth then re-examine same tooth

62
Q

what tests are used for sensibility tests?

A

electric pulp tests, thermal tests, test drilling

63
Q

what cold test is used as a sensibility test?

A

ethyl chloride

64
Q

what hot test is used for sensibility?

A

hot gutta percha

65
Q

what are the problems of sensibility tests?

A

stimulate nerve fibres but dont assume that nerve fibres in pulp correlates to vital blood supply, they do not indicate the state of the blood supply, tooth vitality is related to blood supply and not nerve stimulation, periradicular inflammation occurs before pulp is totally necrotic, difficulties in testing multi-rooted teeth

66
Q

what does an electric pulp test do and which nerve fibres does it stimulate?

A

stimulate sensory nerves at pulp-dentine junction, A delta fibres stimulated (C fibres sometimes respond)

67
Q

how do you conduct an electric pulp test?

A

teeth thoroughly dried, isolate tooth, conducting medium (toothpaste), EPT probe placed on incisal edge or cusp tip, patient completes circuit by holding handle of EPT, current slowly increased, patient indicates when feeling a tingling sensation

68
Q

what is a positive response of an EPT?

A

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

69
Q

what is a negative response of an EPT?

A

reliable indicator for pulpectomy procedure in 97.7% (apart from young pulps or recently traumatised teeth)

70
Q

how do thermal tests work?

A

by hydrodynamic forces (fluid movement in dentinal tubules)

71
Q

what is the procedure of a cold test?

A

teeth carefully dried and isolated, place cold object close to pulp horn

72
Q

if a cold test gives a negative response what is it indicative of?

A

pulpal necrosis

73
Q

what is the procedure of a heat test?

A

vaeline on tooth, apply hot gutta percha/green stick on tooth

74
Q

what is a negative response to a heat test indicative of?

A

necrotic pulp

75
Q

when is test drilling used

A

when full coverage restorations are present

76
Q

how do you conduct test drilling?

A

no LA given, cut into tooth

77
Q

if a patient reports pain when cutting into the tooth what does this mean

A

tooth is vital

78
Q

what is an alternative to a tooth drilling test?

A

spray with cold water and air and assess patient response

79
Q

what influences the clinical factors?

A

carious pulp exposure, age, periodontal disease, previous pulpal insult/trauma

80
Q

what treatment is usually needed for carious pulp exposure?

A

RCT

81
Q

what happens to the pulp with age?

A

continued dentine formation so reduced pulp size and volume, increased fibrous components and calcification, decreased cellular components and number of blood vessels and nerves, pulp less likely to reverse an inflammatory response

82
Q

how does periodontal disease influence the pulp?

A

moderate/severe periodontal disease results in prematurely aged pulp, pulp in periodontal tooth is less resistant to inflammation than healthy pulp

83
Q

what is the results of previous pulpal insult on the pulp?

A

tubule occlusion so pulpal fibrosis, premature aging of pulp so less likely to heal

84
Q

how do you maintain pulp vitality?

A

prevent pulpal damage and treat the pulp

85
Q

how do you prevent pulp damage?

A

know tooth anatomy, use radiographs, avoid drilling into pulp, cavity close to pulp use sealers, cavity into the pulp use direct pulp cap

86
Q

what are the effects of calcium hydroxide?

A

bacteriocidal/bacteriostatic, stimulates fibroblasts through a high pH, stimulates recalcification of demineralised dentine, neutralises low pH, cytotoxic, weak cement, soluble if not protected

87
Q

what are the possible treatment options for pulpal damage?

A

indirect pulp cap, direct pulp cap, partial pulpal removal, full pulpal removal then RCT

88
Q

what is partial pulpal removal called?

A

pulpotomy

89
Q

what is full pulpal removal called?

A

pulpectomy

FINALS - Endodontics (4 decks)

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