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