Care of the Pulp Flashcards
what are the nerve fibres in the pulp
alpha fibres - myelinated
C-fibres - unmyelinated
what occurs to dentine tubules as they approach the pulp
increase in number and diameter
what type of pain do the alpha fibres produce and what stimulates them
sharp pain
stimulated by EPT
what type of pain do C fibres produce and what stimulates them
dull/ ache pain
increased pulpal blood flow and pressure
what are the 4 pulpal diagnoses
healthy pulp
reversible pulpitis
irreversible pulpitis (symptomatic or asymptomatic)
necrotic pulp
what are the 5 apical diagnoses
normal
periapical periodontitis (symptomatic vs asymptomatic)
acute apical abscess
chronic apical abscess
condensing osteitis
what is the treatment for pulpal necrosis in teeth with closed apices
RCT
extraction
what is the treatment for pulpal necrosis in teeth with open apices
pulpotomy
pulpectomy then full RCT
extraction
difference between symptomatic and asymptomatic apical periodontitis
symptomatic = TTP
asymptomatic - not TTP but radiolucent area on radiograph
how can the tooth with a chronic apical abscess be determined
carefully place GP into sinus tract
take radiograph
what is condensing osteitis
diffuse radiopaque lesion usually seen at apex of the tooth
what are signs of non-vital teeth
discolouration (yellow, grey, pink)
sinus
gross caries
periapical or periradicular radiolucency
what is the objective of sensibility testing
to determine vital pulp from non-vital
what is tooth vitality related to
blood supply - not nerve stimulation
name three problems with sensibility tests
they dont indicate state of blood supply
difficulties when testing multi-rooted teeth
patients experience stimuli differently
explain the procedure for EPT
teeth thoroughly dried
isolate tooth
conducting medium placed on tip of EPT probe
EPT placed on incisal edge or cusp tip
patient completes circuit by holding handle of EPT
current slowly increased
patient pulls away when tingling/ heat sensation felt
how do thermal pulp tests work
hydrodynamic forces - fluid movement in the dentinal tubules
what clinical factors may influence the way a patient responds to pulp testing
carious pulp exposure
age
periodontal disease
previous pulpal insult/ trauma
what occurs to the pulp in periodontally involved teeth
prematurely aged pulp
less resistant to inflammation than healthy pulp
how can pulpal damage be prevented
know anatomy of teeth
use of cavity sealers if close to pulp
name the actions of CaOH
high pH which stimulates fibroblasts to produce reparative dentine
neutralises pH from acidic restorative materials
however it is cytotoxic and very soluble if not protected
how can pulpal damage be treated
indirect pulp cap
direct pulp cap
partial pulpotomy
pulpectomy - progress to RCT
what is an indirect pulp cap
procedure used to treat deep carious lesions without exposing the dental pulp
leaving a thin layer of affected dentine over pulp to protect from further damage
give the procedure for indirect pulp cap
anaesthesia
isolation
remove decay - leaving thin layer over the pulp
apply medicament - CaOH or MTA
place temporary filling
permanent restoration placed at separate visit
what is a direct pulp cap
dental pulp has been exposed due to trauma or decay but the exposure is limited and the pulp is still vital
aim to seal the exposed pulp to prevent infection and promote healing
what is the procedure for a direct pulp cap
anaesthesia
isolation
pulp exposure management - remove debris from exposed pulp using excavator or high speed drill
rinse with saline
apply pulp capping agent (CaOH or MTA)
place sealing layer (GIC)
final restoration
follow up
what is a partial pulpotomy
treating a tooth with traumatic exposure of pulp by removing affected portion of the pulp tissue to promote healing and preserve vitality of remaining pulp
what is the procedure for a partial pulpotomy
anaesthesia
isolation
pulpotomy access - remove any overlying tooth structure to the pulp
exposed pulp is inspected and remove superficial layer of pulp using excavator or high speed
haemostasis - ensure the bleeding is controlled using sterile saline
apply CaOH or MTA directly onto the remaining healthy pulp tissue
seal using GIC or composite resin
follow up
what is a pulpectomy
procedure to remove the pulp completely from the root canal system
what is the procedure for pulpectomy
anaesthesia
isolation
access opening
remove pulp tissue using endo files
clean and shape canals
irrigation
antimicrobial medication placed in the canal (for only a specific time prior to obturation)
obturation with GP
seal access cavity with composite or amalgam
name the difference between partial pulpotomy and pulpotomy
partial pulpotomy - only superficially damaged pulp is removed
pulpotomy -removal of coronal part of the dental pulp
