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Oral Biology > Care of the Pulp > Flashcards

Care of the Pulp Flashcards

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AP® Biology flashcards Biology 101 flashcards
1
Q

What makes up the pulp (5)

A
  1. Cells
  2. Nerves
  3. BV’s
  4. Vital tissue
  5. Part of the dentine-pulp complex
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2
Q

What nerves are present in the pulp? (2)

A
  1. Alpha fibres (myelinated)

2. C-fibres (unmyelinated)

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3
Q

Function of vital tissue in the pulp? (2)

A
  1. Responds to stimuli

2. Regenerative potential

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4
Q

List functions of the pulp (4)

A
  1. Nutrition
  2. Sensory
    - Temperature
    - Pressure
    - Pain
  3. Protective
    - Tertiary dentine formation (odontoblasts)
    - Reparative healing
  4. Formative
    - Secondary dentine
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5
Q

List possible injuries to pulp (4)

A
  1. Caries
  2. Cavity prep
  3. Restorations
    - Restorative materials
    - Microleakage
  4. Periodontal pathology
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6
Q

How does pulp injury occur through cavity prep? (6)

A
  1. Heat generation
    - Use coolant
  2. Type of bur used
    - Size, speed, sharpness, force, vibration
  3. Dehydration of dentine
    - Air + water
  4. Cutting odondoblast processes
  5. Direct injury to pulp
  6. Remaining dentine thickness
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7
Q

How does pulp injury occur through restoration material? (5)

A
  1. Toxicity
  2. Water absorption
  3. Heat of reaction
  4. Poor marginal adaptation /seal
  5. Cementation of restoration
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8
Q

Where are there more dentine tubules?

A

They increase in no. and diameter as they approach the pulp

The deeper the cavity the greater the dentine permeability

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9
Q

What do dentine tubules contain? (6)

A
  1. Bacterial substances
  2. Polysaccharides
  3. Antibodies
  4. Immune complexes
  5. Complement proteins
  6. Tissue destruction products
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10
Q

List examples of bacterial substances present in the pulp (4)

A
  1. Enzymes
  2. Peptides
  3. Exotoxins
  4. Endotoxins
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11
Q

Function of micro-organisms in respect to pulp health

A

Maintain pulpal and periradicular pathology

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12
Q

What fibres contribute to dental pain (2)

A
  1. Alpha fibres

2. C fibres

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13
Q

What type of pain do Alpha fibres cause?

A

Sharp pain

Myelinated

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14
Q

What type of pain do C fibres cause? (4)

A
  1. Non myelinated
  2. Dull aching pain
  3. Increased pulpal blood flow
  4. Increased pulpal pressure
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15
Q

What test stimulates alpha fibres?

A

EPT

- Electric Pulp Test

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16
Q

How is endodontic disease diagnosed? (2)

A
  1. Pulpal diagnosis

2. Periapical diagnosis

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17
Q

How quickly should traumatic pulp exposure be treated?

A

Ideally within 24hrs, if not RCT required

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18
Q

Reversible pulptitis tx

A

If adequate vital pulp therapy is performed

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19
Q

Irreversible pulpitis tx (2)

A
  1. Pulpectomy followed by RCT

2. Extraction

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20
Q 
Compare:
Reversible Pulpitis (3)
Irreversible Pulpitis (3)
A

REVERSIBLE PULPITIS:

  • Pain to cold, lasts a short time
  • Microleakage (A-fibres)
  • No change in pulpal blood flow

IRREVERSIBLE PULPITIS:

  • Spontaneous intermittent pain with sleep disturbance
  • Negative to cold, pain to hot (C-fibres)
  • Increase in pulpal blood flow
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21
Q

Necrotic pulp tx for mature teeth - with closed apices (2)

A

Mature teeth (closed apices):

  1. RCT
  2. Extraction
22
Q

Necrotic pulp tx for immature teeth - with open apices (3)

A
  1. Pulpotomy
  2. Pulpectomy then RCT
  3. Extraction
23
Q

How does an acute apical abscess present? (5)

A
  1. Rapid onset
  2. Spontaneous pain
  3. Pus formation
  4. Extreme tenderness to pressure
  5. Swelling
24
Q

How does a chronic apical abscess present? (3)

A
  1. Gradual onset
  2. Little/no discomfort
  3. Intermittent discharge of pus through sinus tract
25
Q

Where is a condensing osteitisis usually seen?

A

Usually seen at apex of tooth

26
Q

List some signs of non-vital tooth (5)

A
  1. Discolouration
    - Yellow
    - Grey
    - Pink
  2. Sinus
  3. Gross caries
  4. Large restoration
  5. Radiographic evidence
    - Periapical radiolucency
    - Periradicular radiolucency
27
Q

Function of sensibility testing

A

Differentiate ‘vital’ from ‘non-vital’ pulp

  • Pt response can be very subjective so compare the response with a contralateral tooth then re-examine the same tooth
28
Q

Examples of sensibility tests (3)

A
  1. EPT
    - Electric Pulp Test
  2. Thermal Tests
    - Cold tests (Ethyl Chloride)
    - Heat Tests (Hot Gutta Percha)
  3. Test drilling
29
Q

What are the problems with sensibility tests (2)

A
  • These tests stimulate nerve fibres but do not indicate state of blood supply
  • Tooth vitality is related to blood supply not nerve stimulation
30
Q

What assesses pulpal blood flow?

A

Laser doppler

31
Q

What teeth are difficult to test for sensibility testing?

A

Multi-rooted teeth

32
Q

Function of an EPT

A

> Electric current used to stimulate sensory nerves at pulp-dentine junction
A-delta fibres stimulated

33
Q

What does a negative response for an EPT indicate?

A

Indicator for pulpectomy

34
Q

What does a negative response for a Thermal test indicate?

A

Indicator for pulpal necrosis

35
Q

Why are heat tests a caution? (2)

A

Too much heat may cause irreversible pulpititis

  1. Initial stimulation of A-delta fibres
    - Sharp pain
  2. Continued stimulation of C fibres
    - Dull radiating pain
36
Q

When is test drilling used? (2)

A
  • When full coverage restorations are present

- No LA given and cut into tooth

37
Q

What does a test drilling diagnosis show?

A

Patient reports severe pain/no pain felt when cutting dentine

38
Q

What is an alternative to test drilling?

A
  1. Isolate crowned tooth with rubber dam
  2. No LA
  3. Spray cold water + air
39
Q

Influence of clinical factors for the care of the pulp (4)

A
  1. Carious pulp exposure
  2. Age
  3. PDL disease
  4. Previous pulpal trauma
40
Q

How do we prevent pulpal damage? (4)

A
  1. Know tooth anatomy
    - Size, location + proximity of pulp
  2. Avoid drilling into pulp
    - Caries can be left over pulpal floor in some cases
  3. Cavity close to pulp
    - Use of cavity sealers
    - Indirect pulp cap
  4. Cavity into pulp (exposure)
    - Direct pulp cap
41
Q

Function of cavity sealers (2)

A
  1. Protect pulp from bacteria + products

2. Toxic effects during setting phase of restorative material

42
Q

Where do cavity sealers adhere to?

A

Adhere to dentine rather than restorative material

43
Q

Different types of cavity sealers (3)

A
  1. Varnishes
  2. Liners
  3. Base materials
44
Q

Difference of cavity base/liners to sealers?

A

Thicker sealant

45
Q

Examples of cavity liners (3)

A
  1. Zinc phosphate
  2. Zinc oxide eugenol
  3. CaOH
  4. RMGI
46
Q

Effects of CaOH (3)

A
  1. Bacteriocidal
    - High pH stimulates fibroblasts
    - Reparative dentine formation
  2. Stimulates decalcification of demineralised dentine by stimulating pulpal cells
  3. Neutralises low pH from acidic restorative materials
47
Q

Negative effects of CaOH (3)

A
  1. Cytotoxic
    - Can kill pulp
  2. Weak cement
  3. Very soluble if not protected
48
Q

Function of dentine bonding agents?

A

Reduction in micro-leakage

49
Q

Name for a partial pulpal removal?

A

Pulpotomy

50
Q

Name for a full pulpal removal?

A

Pulpectomy

- Progress to RCT

Oral Biology (10 decks)

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