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Operative Dentistry > Care of the Pulp > Flashcards

Care of the Pulp Flashcards

1
Q

what are the functions of the dental pulp

A

nutrition
sensory functions
proprioception
dentine formation
defense
root formation and development

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2
Q

what are the cells of the dental pulp

A

fibroblasts
odontoblasts
histiocytes
macrophages
granulocytes
mast cells
plasma cells
blood vessels
nerves

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3
Q

function of odontoblasts

A

reparative dentine formation
recognition of noxious stimuli
dental pulp recognition

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4
Q

function of the myelinated a delta fibres in the pulp

A

superficial, fast conduction speed with a low stimulation threshold

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5
Q

describe the unmyelinated C fibres of the dental pulp

A

deeper, resist hypoxia, lower conduction velocity, activated by heat. higher excitation threshold

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6
Q

what are some common pulpal diagnoses

A

normal pulp
reversible pulpitis
irreversible pulpits
pulp necrosis
previously treated tooth
previously initiated treatment

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7
Q

what are the layers to a carious lesion

A

soft, infected layer that is excavated
firm, affected layer that is resistant to excavation
hard, sound layer

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8
Q

what are the dentinal zones in a carious lesion

A

infected dentine has a necrotic zone and a contaminated zone

affected dentine has a demineralised zone and a translucent zone

then there is sound dentine and tertiary dentine

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9
Q

functions of rubber dams

A

aseptic technique
retraction of soft tissues
protection of soft tissues
airway protection
improves visualisation
saves time

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10
Q

what are the two chemicals used for cavity disinfection

A

sodium hypochlorite
chlorohexidine

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11
Q

function of sodium hypochlorite

A

haemostasis
disinfection
biofilm removal
clearance of dentine chips

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12
Q

what are some common cavity liners and bases

A

glass ionomer cement
resin modified glass ionomer
zinc phosphate
zinc oxide eugenol
light cured calcium hydroxide
calcium hydroxide
calcium silicate cements

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13
Q

describe the use of dycal

A

this is calcium hydroxid, the hydroxyl ions are bactericidal and has a high pH of 12.5

features
- highly soluble
- formation of dentine bridge
- no longer recommended in direct pulp exposure
- poor quality of dentine bridge

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14
Q

what are the indications of calcium silicate cements

A

direct and indirect pulp capping
pulpotomies
root canal filling material
perforation repair
regenerative endodontic procedures

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15
Q

which features do biodentine and mineral trioxide aggregate have in common

A

both are antimicrobial, bioinductive, non cytotoxic, and has a better hermetic seal than calcium hydroxide

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16
Q

what are the differences between biodentine and mineral triode aggregate

A

biodentine has no discolouration, setting time of 10-13 minutes and the radio opacity is similar or less than dentine

MTA has crown discolouration and is more radiopaque than dentine

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17
Q

describe the features of selective caries removal

A

avoid exposing pulp tissues, magnification needed, disinfectant, and calcium silicate cement or glass ionomer cement is used

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18
Q

describe the features of non selective, total caries removal

A

inspection of pulp tissues is needed, magnification is needed, disinfectant required.
calcium silicate and restoration

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19
Q

what is the restorative method if there is no pulp exposure

A

indirect pulp capping

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20
Q

what is the restorative options for pulp exposure

A

direct pulp capping
partial pulpotomy
complete pulpotomy

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21
Q

describe indirect pulp capping

A

indicated in reversible pulpits, traumatic exposure
shadow of the pulp
apply biomaterial either biodentine or thermal
immediate final restoration

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22
Q

what is a partial pulpotomy

A

indicated if there is irreversible pulpits or traumatic exposure
removal of 1-3mm of coronal pulp tissues
bioactive layer

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23
Q

describe complete pulpotomy

A

coronal pulp tissues are removed
homeostasis
bioactive layer

24
Q

what are the factors affecting the outcome of a pulpotomy

A

rubber dam
disinfection
hemostasis
inspection of pulp tissues
choice of biomaterial
coronal restoration

25
Q

what is deep caries

A

radiographic evidence of caries reaching the inner third or inner quarter of dentine with a risk of pulp exposure

26
Q

what is extremely deep caries

A

radiographic evidence of caries penetrating the entire thickness of dentine with certain pulp exposure

27
Q

what is the colour classification of carious lesions

A

light yellow means actively progressing
light brown means slowly progressing
dark brown means slowly progressing or arrested

28
Q

how can the thickness of the dentine barrier be increased

A

by the formation of reactionary dentine in response to stimuli such as carious lesions

29
Q

what are the sensory nerve fibres of the pulp

A

afferent endings of the trigeminal nerve that reach the root canal through the apical foramen

30
Q

what are the six different diagnostic conditions of the pulp according to the American association of endodontics

A

normal pulp
irreversible pulpitis
reversible pulpitis
pulp necrosis
previously treated tooth
previously initiated treatment

31
Q

what is reversible pulpitis

A

an early stage of inflammation in the dental pulp that can be treated and reversed

32
Q

what is irreversible pulpitis

A

a dental condition where the pulp of a tooth becomes inflamed and is unable to heal.

33
Q

what are the causes of pulp disease

A

caries, which could lead to reversible, irreversible, or. in more advanced cases, pulp necrosis

34
Q

how do cracks lead to pulp disease

A

bacteria can live and make their own way to the pulp tissue

35
Q

what does iatrogenic mean

A

done by the dentist

36
Q

what is the most common cause of pulp disease

A

caries

37
Q

what is the outermost layer of a carious lesion

A

infected dentine, heavily infected with bacteria and cannot be repaired

38
Q

what is the middle layer of a carious lesion

A

affected dentine, weakened by demineralisation from the acidic environment created by bacteria but has no actually been infected
harder than infected dentine but softer than healthy dentine

39
Q

what is the deepest layer of a carious lesion

A

sound dentine, healthy and unaffected by the carious process, structurally sound

40
Q

why does a dental dam reduce chance of infection

A

when the pulpal tissue is exposed, the dental dam stops bacteria from the saliva getting in because it isolates the tooth and keeps it dry

41
Q

describe how calcium hydroxide gets its antimicrobial properties

A

hydroxyl ions create an alkaline environment which is unideal for the bacteria

42
Q

issue with using calcium hydroxide

A

Calcium hydroxide is highly soluble and water sorbing properties which softens the lining and the material which can mean the restoration is poorly sealed and this can allow leakage and means there could be pulpal inflammation and secondary caries

43
Q

how long does MTA take to set

A

8-20 hours

44
Q

what is the criteria laid out by the European society of endodontology for managing deep caries and exposed pulp

A

selective caris removal
avoid exposing pulp tissues
magnification needed
disinfectant
calcium silicate cement or glass ionomer cement

45
Q

what are the two methods for selective caries removal

A

one stage
stepwise

46
Q

describe the one stage excavation for selective caries removal

A

caries is removed until there is soft and hard dentine. aiming to avoid exposing the pulp tissues

47
Q

describe the stepwise stages to excavating selective caries removal

A

caries is removed up to the firm dentine, infected dentine has been left in place to avoid further removal of tooth structure and avoid the possibility of exposing the pulp tissues

48
Q

how long is the stepwise timeframe

A

6-12 months

49
Q

detailed description of stepwisse

A

after removing the caries tot he soft dentine, apply biomaterial for 6-12 months.

after this, ideally reparative dentine will have formed to act as a separating barrier between the carious lesion and the pulp, and the dentist can remove the remaining caries. this preserves the pulpal tissues and ensuring there is adequate thickness of the remaining dentine

50
Q

what is the first method of vital pulp therapy

A

direct pulp capping. there is actual pulp exposure, disinfectant cavity and achieve homeostasis with cotton pad soaked with sodium hypochloride.
use biodentine or bioceramic putty next. seal the bioactive material with the resin modified glass ionomer.

51
Q

what is a partial pulpotomy

A

involves removing 13mm of coronal pulp tissue, apply the bioactive layer and the definitive restoration

52
Q

what are the different techniques listed under vital pulp therapy

A

direct pulp capping
partial pulpotomy
complete pulpotomy

53
Q

what is a complete pulpotomy

A

complete removal of the coronal pulp tissues

54
Q

list how a complete pulpotomy should be done

A

ensure there is a clean floor and dentinal enamel junction
round tipped bur to remove the coronal pulp tissue - coronal amputation
disinfection and haemostasis achieved by cotton pads soaked in sodium hypochlorite applied over exposed pulp tissues.
remove the cotton pad and see the clean pulp stamps with no signs of necrosis.
bioactive material applied which will be either biodenine or bioceramic putty.
avoid further disinfection

55
Q

what are the factors affecting the outcome of vital pulp therapy

A

rubber dam - need to protect and prevent contamination from the saliva
sodium hypochlorite - achieves disinfection and haemostats
- inspect for clean pulp stamps
- biomaterial used for better clinical outcomes
- calcium hydroxide material of choice should be biodentine or bioceramic putty
- coronal restoration is important for adequate coronal seal to prevent further leakage and contamination into the tooth from the saliva to give a better clinical outcome.

Operative Dentistry (22 decks)

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