Care of the Pulp

Question 1

what are the nerve fibres in the pulp

Answer 1

alpha fibres - myelinated
C-fibres - unmyelinated

Question 2

what occurs to dentine tubules as they approach the pulp

Answer 2

increase in number and diameter

Question 3

what type of pain do the alpha fibres produce and what stimulates them

Answer 3

sharp pain
stimulated by EPT

Question 4

what type of pain do C fibres produce and what stimulates them

Answer 4

dull/ ache pain
increased pulpal blood flow and pressure

Question 5

what are the 4 pulpal diagnoses

Answer 5

healthy pulp
reversible pulpitis
irreversible pulpitis (symptomatic or asymptomatic)
necrotic pulp

Question 6

what are the 5 apical diagnoses

Answer 6

normal
periapical periodontitis (symptomatic vs asymptomatic)
acute apical abscess
chronic apical abscess
condensing osteitis

Question 7

what is the treatment for pulpal necrosis in teeth with closed apices

Answer 7

RCT
extraction

Question 8

what is the treatment for pulpal necrosis in teeth with open apices

Answer 8

pulpotomy
pulpectomy then full RCT
extraction

Question 9

difference between symptomatic and asymptomatic apical periodontitis

Answer 9

symptomatic = TTP
asymptomatic - not TTP but radiolucent area on radiograph

Question 10

how can the tooth with a chronic apical abscess be determined

Answer 10

carefully place GP into sinus tract
take radiograph

Question 11

what is condensing osteitis

Answer 11

diffuse radiopaque lesion usually seen at apex of the tooth

Question 12

what are signs of non-vital teeth

Answer 12

discolouration (yellow, grey, pink)
sinus
gross caries
periapical or periradicular radiolucency

Question 13

what is the objective of sensibility testing

Answer 13

to determine vital pulp from non-vital

Question 14

what is tooth vitality related to

Answer 14

blood supply - not nerve stimulation

Question 15

name three problems with sensibility tests

Answer 15

they dont indicate state of blood supply
difficulties when testing multi-rooted teeth
patients experience stimuli differently

Question 16

explain the procedure for EPT

Answer 16

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

Question 17

how do thermal pulp tests work

Answer 17

hydrodynamic forces - fluid movement in the dentinal tubules

Question 18

what clinical factors may influence the way a patient responds to pulp testing

Answer 18

carious pulp exposure
age
periodontal disease
previous pulpal insult/ trauma

Question 19

what occurs to the pulp in periodontally involved teeth

Answer 19

prematurely aged pulp
less resistant to inflammation than healthy pulp

Question 20

how can pulpal damage be prevented

Answer 20

know anatomy of teeth
use of cavity sealers if close to pulp

Question 21

name the actions of CaOH

Answer 21

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

Question 22

how can pulpal damage be treated

Answer 22

indirect pulp cap
direct pulp cap
partial pulpotomy
pulpectomy - progress to RCT

Question 23

what is an indirect pulp cap

Answer 23

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

Question 24

give the procedure for indirect pulp cap

Answer 24

anaesthesia
isolation
remove decay - leaving thin layer over the pulp
apply medicament - CaOH or MTA
place temporary filling
permanent restoration placed at separate visit

Question 25

what is a direct pulp cap

Answer 25

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

Question 26

what is the procedure for a direct pulp cap

Answer 26

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

Question 27

what is a partial pulpotomy

Answer 27

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

Question 28

what is the procedure for a partial pulpotomy

Answer 28

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

Question 29

what is a pulpectomy

Answer 29

procedure to remove the pulp completely from the root canal system

Question 30

what is the procedure for pulpectomy

Answer 30

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

Question 31

name the difference between partial pulpotomy and pulpotomy

Answer 31

partial pulpotomy - only superficially damaged pulp is removed
pulpotomy -removal of coronal part of the dental pulp