Care of the pulp Flashcards
What is the pulp?
- Tissue that lies in the middle of the tooth
Is the pulp a vital tissue?
- Yes because it has a blood supply
What cells are present in the pulp?
- Odontoblasts
What nerves are present in the pulp? (2)
- Alpha fibres (myelinated)
- C-fibres (unmyelinated)
What characteristics does pulp have since it is a vital tissue? (2)
- Responds to stimuli
- Has regenerative potential
What is the nerve plexus of Raschkow?
- Sensory nerve fibres that originate from superior and inferior alveolar nerves innervate the odontoblast layer of the pulp cavity
- These nerves enter the tooth through the apical foramen as myelinated nerve bundles
- They branch to form subodontoblastic nerve plexus of Raschkow
What are the functions of the pulp? (4)
- Nutrition
- Sensory
- Protective
- Formative
What are the sensory functions of the pulp? (3)
Can sense:
- Temperature
- Pressure
- Pain
What is the protective function of the pulp?
- Tertiary dentine formation (odontoblasts) - reparative healing
What is the formative function of the pulp?
- Secondary dentine
What is the correlation between clinical symptomatology and pulpal histopathology?
- Poor correlation between what’s going on histopathologically and what the patient is feeling (symptoms)
What different things do we need to know the pulps reaction to? (4)
- Caries
- Operative manipulations
- Trauma
- Periodontal disease
Etc.
What are things that can cause injuries to the pulp? (14)
- Caries
- Cavity preparation
- Restorations (materials: microleakage, etch)
- Trauma
- Tooth wear
- Periodontal pathology
- Orthodontic treatment (forces applied to the tooth)
- Radiation therapy
- Cavity/crown preparation (heat generation, type of bur)
- Dehydration of dentine (air, water)
- Cutting odontoblast processes
- Direct injury to the pulp
- Remaining dentine thickness
- Restoration material
For what reasons can the type of restoration material cause damage to the pulp? (5)
- Toxicity
- Water absorption
- Heat of reaction
- Poor marginal adaptation/seal
- Cementation of restoration
What do dentinal tubules do as they approach the pulp?
- They increase in diameter
Therefore: the deeper the cavity, the greater the dentine permeability - Dentine tubules DO NOT increase in number as they approach the pulp
What is dentine permeable to? (6)
- Bacterial substances
- Polysaccharides
- Antibodies
- Immune complexes
- Complement proteins
- Tissue destruction products
What is key towards initiating and maintaining pulpal and periradicular pathology?
- Micro-organisms
Pain will typically fall into 2 categories. What are the 2 categories and what type of fibre stimulates them?
- Sharp pain = alpha
- Dull/aching pain = C fibres
What are the characteristics of alpha fibres? (3)
- Myelinated
- Sharp pain
- Stimulated by electric pulp testing
What are the characteristics of C fibres? (4)
- Non-myelinated
On stimulation:
- Dull/aching pain
- Increased pulpal blood flow
- Increased pulpal pressure
Why is there increased pulpal pressure when c fibres are stimlated?
- When C fibres are stimulated you get increased blood flow into the tooth which increases the pressure in the tooth - as it has no where to expand
What are the different possible pulpal diagnoses? (6)
- Healthy pulp
- Reversible pulpitis
- Irreversible pulpitis (symptomatic/asymptomatic)
- Necrotic pulp
- Previously treated
- Previously initiated therapy
What is the pulpal diagnosis ‘previously treated’?
- A clinical diagnostic category indicating that the tooth has been endodontically treated and the canals are obturated with various filling materials, other than intracanal medicaments
What is the pulpal diagnosis ‘previously initiated therapy’?
- A clinical diagnostic category indicating that the tooth has been previously treated by partial endodontic therapy e.g. pulpotomy/pulpectomy