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BDS3 Endodontics > Care of the Pulp > Flashcards

Care of the Pulp Flashcards

1
Q

what does the pulp contain

A

cells [odontoblasts]
nerves, blood vessels
vital tissue

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2
Q

functions of the pulp

A

nutrition, sensory, temperature, pressure, pain, protective, tertiary dentine formation via odontoblasts, reparative healing, formative, secondary dentine

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3
Q

examples of injury to the pulp

A

caries, cavity preperation, restoration, restorative materials, trauma, toothwear, perio pathology, ortho tx, radiation, cutting odontoblasts, direct injury, restoration toxxicity, dehydrattion of dentine

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4
Q

arrangement of dentine and permeability

A

dentine tubules increase in number and diameter as they approach the pulp, therefore the deeper the cavity, the greater the dentine permeability

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5
Q

pain stimulated by alpha fibres results in

A

sharp pain
unmyelinated

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6
Q

pain caused by c-fibres results in

A

dull/aching pain
increased pulpal flow and pressure
unmyelinated

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7
Q

7 types of pulpal diagnosis

A
  1. healthy pulp
  2. reversible pulpitis
  3. symptomatic irreversible pulpitis
  4. asymptomatic irreversible pulpitis
  5. necrotic pulp
  6. previously treated
  7. previoiusly initiated therapy
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8
Q

healthy pulp diagnosis

A
  • vital, free of inflammation
  • can be removed if indicated for elective/prosthetic, traumatic pulp exposure, toothwear
  • treat within 24hr, if not then RCT
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9
Q

reversible pulpitis

A
  • vital, inflammed pulp
  • pain to cold, short time
  • hydrodrynamic expression microleakage
  • can reverse to health
  • regular response to sensibility tests
  • remove tissue causing issue
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10
Q

symptomatic irreversible pulpitis

A
  • vital, inflammed pulp
  • cannot heal
  • spontaneous pain, intermittent, sleep disturbance
  • negative to cold, pain to hot
  • increased pulpal blood flow
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11
Q

tx options for irreversible pulpitis

A
  1. pulpectomy followed by vital pulp therapy [if some remaining pulp is not irreversibly inflammed]
  2. pulpectomy then RCT
  3. exctraction [unrestorable tooth, pt preference]
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12
Q

asymptomatic irreversible pulpitis

A
  • vital, inflammed pulp
  • cannot heal pulpal inflammation
  • no symptoms
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13
Q

necrotic pulp

A
  • non-vital pulp
  • partial or total necrosis
  • no pain as nerve is dead
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14
Q

tx options for necrotic pulp

A

mature teeth;
- RCT
- extraction
immature teeth [open apice];
- pulpotomy
- pulpectomy then RCT
- extraction

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15
Q

what are the 6 periapical diagnosis

A
  1. normal
  2. symptomatic periapical periodontitis
  3. asymptomatic periapical periodontitis
  4. acute apical abscess
  5. chronic apical abscess
  6. condensing osteitis
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16
Q

normal periapical tissue diagnosis

A

not sensitive to percussion or palpation
radiographically = lamina dura intact, PDL space uniform

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17
Q

symptomatic periapical periodontitis

A
  • inflammation of apical periodontium
  • pain = biting, percussion, palpation
  • may have periapical radiolucency
  • severe pain to percussion/palpation indicates degenerative pulp

RCT REQUIRED

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18
Q

asymptomatic periapical periodontitis

A
  • inflammation and destruction of apical periodontium
  • apical radiolucency
  • no present clinical symptoms = no pain percussion/palpation
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19
Q

acute apical abscess

A
  • inflammatory reaction to pulpal infection and necrosis
  • rapid onset, spontaenous pain, extreme tenderness to pressure
  • pus formation, swelling
  • may be no radiographic signs of destruction
  • malaise, fever, lymphadenopathy
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20
Q

chronic apical abscess (sinus)

A
  • inflammatory reaction to pulpal infection and necrosis
  • gradual onset, little to no discomfort
  • intermittent discharge of pus through sinus tract
  • periapical/periradicular radiolucency
  • suspect tooth can be identified by placing GP cone in sinus tract and radiograph
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21
Q

condensing osteitis

A

diffuse radiopaque lesion
represents localised bony reaction to low-grade inflammatory stimulus
usually seen at apex of tooth

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22
Q

signs of a non-vital tooth

A

discolouration [grey, pink, yellow]
sinus, gross caries, large restoration, radiographically, periapical/radicular radiolucency

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23
Q

sensibility test function

A

test neuron/nerve function in tooth

subjective

24
Q

what should you always do when sensibility testing?

A

compare response with contralateral tooth and then reexamine

25
Q

what are some problems with sensibility testing

A
  • dont stimulate nerve fibres
  • dont assume that nerve fibres in pulp correlates to blood supply
  • dont indicate state of blood supply
  • tooth vitality is related to blood supply not nerve stimulation
  • periradicular inflammation occurs before nerotic pulp
  • hard to test multi-rooted teeth
26
Q

what tool is needed to assess blood flow

A

laser doppler

27
Q

electric pulp test

A

electric current used to stimulate sensory nerves at pulp-dentine
- adelta fibres stimulated
- unmyelinated c fibres may or may not respond
pt sensitive

28
Q

electric pulp test procedure

A
  1. teeth thoroughly dried [prevent current transfer to adjacent teeth]
  2. isolate tooth
  3. conducting medium [toothpaste/fluoride gel] required [tip of EPT]
  4. EPT probe placed on incisal edfe or cusp tip adjecent to pulp horn [most sensory nerves here]
  5. pt completes circuit by holding EPT handle
  6. current slowly increased
  7. pt indicates when tingling/heat sensation if felt [pull probe away]
29
Q

results of EPT generally

A

very quick removal = inflammation of tooth
no response = necrotic pup

30
Q

positive response to EPT

A
  • vital pulp tissue coronally
  • no indication of reversibility
  • no correlation between pain threshold and pulp condition
31
Q

negative response to EPT

A
  • reliable indicator for pulpectomy
  • EPT of young/open apice or recently traumatised teeth is unreliable
32
Q

how do thermal tests work

A

hydrodynamic forces, fluid movement in dentinal tubules
activates pulps sensory nerve receptor units in pulp

33
Q

cold test

A

cotton roll with ethyl chloride, endoice, endofrost
1. teeth dried and isolated
2. cold object close to pulp horn
3. negative response indicative of pulpal necrosis

34
Q

why would you use caution when performing a heat test

A

too much heat can cause irreversible pulpitis

35
Q

heat tests

A

initial stimulation of adelta = sharp pain
continued stimulation results in cfibre activation = dull radiating pain

  1. vaseline on tooth
  2. apply hot gutta percha/greenstick on tooth
  3. negative response indicative of necrotic pulp

cannot ascertain degree of reversibility

36
Q

test drilling

A

when full coverage restorations present
renders other test impossible
- pt reports severe or no pain
- sensitivity = vital tooth

37
Q

alternative to sensibility tests

A

isolate tooth with rubber dam, no LA, spray with cold water and air, assess pt response

38
Q

what 4 clinical factors can influence pulp and RCT

A
  • carious pulp exposure
  • age
  • periodontal disease
  • previous pulpal insult/trauma
39
Q

carious pulp exposure influence on RCT

A
  • exposure to caries/bacteria
  • unpredictable outcome so RCT likely to be required
  • immature teeth = condier removal of necrotic pulp only
40
Q

influence of age on endo tx

A
  • continued dentine formation so reduced pulp size/volume
  • increased = fibrous, clacification
  • decreased = cellular, no. blood vessels, nerves
  • the older you are, less lilely of pulp to reverse inflammatory response
41
Q

influence of periodontial disease on endo/RCT

A
  • moderate/severe PDD => prematurely aged pulp
  • pulp in perio tooth => less resistant to inflammation than healthy pulp
42
Q

influence of previous pulpal insult on endo/RCT

A
  • caries/caries removal
  • tubule occlusion => reperative dentine formation, pulpal fibrosis
  • premature aging of the pulp => less likely to heal than healthy pulp
43
Q

maintenance of pulp vitality

A

step-wise excavation, seal in caries

44
Q

vital pulp therapy examples

A

pulp capping
partial pulpotomy
complete pulpotomy

45
Q

how can you prevent pulpal damage

A

know the tooth anatomy
pre-assessment xray
avoid drilling too close
caries can be left over the pulp in some cases
- well-sealed restoration, step-wise excavation, remove temporary 6-12m after tertiary dentine formation, remove caries and permanent restoration

46
Q

what is the point in vital pulp therapy

A

protect pulp from bacteria and toxic effects during setting phase of restorative materials

47
Q

needs of materials in vital pulp therapy

A
  • adhere to dentine rather than restorative material
  • be thin, otherwise reduces the strength of restorative material
  • not dissolve in biological liquids
  • form a bacterial-tight seal
48
Q

examples of materials used in vital pulp therapy

A
  • calcium hydroxide [dycal]
  • RMGI [vitrebond]
  • bioceramics [MTA, biodentine]
  • zinc phosphate
  • zinc oxide eugenol
49
Q

calcium hydroxide info

A
  • bacteriostatic, high pH (12.5) to stimulate fibroblasts
  • reparative dentine formation for healing, hard tissue barrier formation
  • stimulates recalcification of demineralised dentine by sitmulating pulpal cells
  • neutralises low pH from acidic restorative materials
    BUT
  • weak cement, very soluble if not protected
50
Q

bioceramics

A
  • ## like synthetic tooth tissue, mineral trioxide aggregate
51
Q

mineral trioxide aggregate (MTA)

A
  • high pH, creates bacterial-tight seal, sets hard enough to act as base for restorative materials
  • biocompatible, can be grey or white
    BUT
  • prolonged setting time, discolourtation of crown
52
Q

biodentine

A
  • similar to MTA BUT
  • quicker setting time, no discolouration
  • contains tricalcium silicate, dicalcium silicate
53
Q

partial/cvek pulpotomy

A
  1. 1-2mm coronal pulp removed
  2. stop drilling once vital pulp tissue reached
  3. rinse with 5% NaOCl, place CaOH, MTA or biodentine over pulp tissue
  4. place sealing restoration like GI and restoration like composite
54
Q

complete pulpotomy

A
  1. remove whole pulp chamber
  2. pulp in root canals retained
  3. rinse with 5% NaOCl, place CaOH, MTA or biodentine over pulp tissue
  4. place sealing restoration like GI, place restoration like composite
55
Q

summary of treatment options for unexposed pulp

A
  1. indirect pulp cap
  2. stepwise excavation
  3. seal caries in
56
Q

summary of treatment for exposed pulp

A
  1. direct pulp cap
  2. partial coronal pulpal removal
  3. complete coronal pulp removal
  4. pulpectomy = progress to RCT
57
Q
A

BDS3 Endodontics (10 decks)

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