Care of the Pulp Flashcards
what are the functions of the dental pulp
nutrition
sensory functions
proprioception
dentine formation
defense
root formation and development
what are the cells of the dental pulp
fibroblasts
odontoblasts
histiocytes
macrophages
granulocytes
mast cells
plasma cells
blood vessels
nerves
function of odontoblasts
reparative dentine formation
recognition of noxious stimuli
dental pulp recognition
function of the myelinated a delta fibres in the pulp
superficial, fast conduction speed with a low stimulation threshold
describe the unmyelinated C fibres of the dental pulp
deeper, resist hypoxia, lower conduction velocity, activated by heat. higher excitation threshold
what are some common pulpal diagnoses
normal pulp
reversible pulpitis
irreversible pulpits
pulp necrosis
previously treated tooth
previously initiated treatment
what are the layers to a carious lesion
soft, infected layer that is excavated
firm, affected layer that is resistant to excavation
hard, sound layer
what are the dentinal zones in a carious lesion
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
functions of rubber dams
aseptic technique
retraction of soft tissues
protection of soft tissues
airway protection
improves visualisation
saves time
what are the two chemicals used for cavity disinfection
sodium hypochlorite
chlorohexidine
function of sodium hypochlorite
haemostasis
disinfection
biofilm removal
clearance of dentine chips
what are some common cavity liners and bases
glass ionomer cement
resin modified glass ionomer
zinc phosphate
zinc oxide eugenol
light cured calcium hydroxide
calcium hydroxide
calcium silicate cements
describe the use of dycal
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
what are the indications of calcium silicate cements
direct and indirect pulp capping
pulpotomies
root canal filling material
perforation repair
regenerative endodontic procedures
which features do biodentine and mineral trioxide aggregate have in common
both are antimicrobial, bioinductive, non cytotoxic, and has a better hermetic seal than calcium hydroxide
what are the differences between biodentine and mineral triode aggregate
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
describe the features of selective caries removal
avoid exposing pulp tissues, magnification needed, disinfectant, and calcium silicate cement or glass ionomer cement is used
describe the features of non selective, total caries removal
inspection of pulp tissues is needed, magnification is needed, disinfectant required.
calcium silicate and restoration
what is the restorative method if there is no pulp exposure
indirect pulp capping
what is the restorative options for pulp exposure
direct pulp capping
partial pulpotomy
complete pulpotomy
describe indirect pulp capping
indicated in reversible pulpits, traumatic exposure
shadow of the pulp
apply biomaterial either biodentine or thermal
immediate final restoration
what is a partial pulpotomy
indicated if there is irreversible pulpits or traumatic exposure
removal of 1-3mm of coronal pulp tissues
bioactive layer
describe complete pulpotomy
coronal pulp tissues are removed
homeostasis
bioactive layer
what are the factors affecting the outcome of a pulpotomy
rubber dam
disinfection
hemostasis
inspection of pulp tissues
choice of biomaterial
coronal restoration
what is deep caries
radiographic evidence of caries reaching the inner third or inner quarter of dentine with a risk of pulp exposure
what is extremely deep caries
radiographic evidence of caries penetrating the entire thickness of dentine with certain pulp exposure
what is the colour classification of carious lesions
light yellow means actively progressing
light brown means slowly progressing
dark brown means slowly progressing or arrested
how can the thickness of the dentine barrier be increased
by the formation of reactionary dentine in response to stimuli such as carious lesions
what are the sensory nerve fibres of the pulp
afferent endings of the trigeminal nerve that reach the root canal through the apical foramen
what are the six different diagnostic conditions of the pulp according to the American association of endodontics
normal pulp
irreversible pulpitis
reversible pulpitis
pulp necrosis
previously treated tooth
previously initiated treatment
what is reversible pulpitis
an early stage of inflammation in the dental pulp that can be treated and reversed
what is irreversible pulpitis
a dental condition where the pulp of a tooth becomes inflamed and is unable to heal.
what are the causes of pulp disease
caries, which could lead to reversible, irreversible, or. in more advanced cases, pulp necrosis
how do cracks lead to pulp disease
bacteria can live and make their own way to the pulp tissue
what does iatrogenic mean
done by the dentist
what is the most common cause of pulp disease
caries
what is the outermost layer of a carious lesion
infected dentine, heavily infected with bacteria and cannot be repaired
what is the middle layer of a carious lesion
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
what is the deepest layer of a carious lesion
sound dentine, healthy and unaffected by the carious process, structurally sound
why does a dental dam reduce chance of infection
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
describe how calcium hydroxide gets its antimicrobial properties
hydroxyl ions create an alkaline environment which is unideal for the bacteria
issue with using calcium hydroxide
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
how long does MTA take to set
8-20 hours
what is the criteria laid out by the European society of endodontology for managing deep caries and exposed pulp
selective caris removal
avoid exposing pulp tissues
magnification needed
disinfectant
calcium silicate cement or glass ionomer cement
what are the two methods for selective caries removal
one stage
stepwise
describe the one stage excavation for selective caries removal
caries is removed until there is soft and hard dentine. aiming to avoid exposing the pulp tissues
describe the stepwise stages to excavating selective caries removal
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
how long is the stepwise timeframe
6-12 months
detailed description of stepwisse
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
what is the first method of vital pulp therapy
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.
what is a partial pulpotomy
involves removing 13mm of coronal pulp tissue, apply the bioactive layer and the definitive restoration
what are the different techniques listed under vital pulp therapy
direct pulp capping
partial pulpotomy
complete pulpotomy
what is a complete pulpotomy
complete removal of the coronal pulp tissues
list how a complete pulpotomy should be done
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
what are the factors affecting the outcome of vital pulp therapy
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.
