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BDS3 - Endodontics > care of the pulp > Flashcards

care of the pulp Flashcards

1
Q

what is the pulp

A
  • tissue that lies n the middle of the tooth
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2
Q

what cells are in the oulp

A
  • odontoblasts
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3
Q

what nerves are in the pulp

A
  • plexus of Raschow
  • alpha fibres = myelinated
  • c-fibres = unmyelinated
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4
Q

how do you know the pulp is a vital tissue

A
  • it has a blood supply
  • means it responds to stimuli
  • has regernative potential
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5
Q

what is the pulp-dentine complex

A
  • if doing something to the dentine, you are causing an effect on the pulp too
  • close relationship between pulp and dentine
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6
Q

what are the functions of the pulp

A
  • nutrition
  • sensory = temperature, pressure, pain
  • protective = tertiary dentine formation
  • formative = stimulates production of secondary dentine
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7
Q

what do we need to know the reaction of the pulp to

A
  • caries
  • operative manipulations
  • trauma
  • periodontal disease
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8
Q

what are some injuries to the pulp

A
  • caries
  • cavity preparations
  • trauma
  • restorations
  • toothwear
  • periodontal pathology
  • orthodontic treatment = lots of forces applied to tooth
  • radiation therapy
  • cavity crown prep = heat generation damages pulp (need water as coolant)
  • dehydration of dentine = from air and water during prep
  • cutting odontoblast process
  • direct injury
  • remaining dentine thickness important = more means less affect to pulp
  • restoration material = toxicity, water absorption, heat of reaction, poor marginal adaptation/seal, cementation of restoration
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9
Q

what is the dentine permeability

A
  • dentine tubules increase in number and diameter as you get closer to pulp
  • increase in permeability
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10
Q

what are some bacterial substances

A
  • enzymes
  • peptides
  • exotoxins
  • endotoxins
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11
Q

what is dental pain typically

A
  • short sharp pain by alpha fibres

- stimulated by EPT

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12
Q

what pain do c-fibres cause

A
  • dull ache
  • stimulated by increase in pulp blood flow which increases pressure but there is nowhere for pulp to expands so creates pain
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13
Q

what are some examples of pulp pathology

A
  • reversible pulpitis
  • irreversible pulpitis = a/symptomatic
  • necrotic pulp
  • ## previously treated pulp
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14
Q

why do you also give a periapical diagnosis

A
  • periapical tissues have a close relationship with pulp
  • can be normal/healthy
  • or can be:
    = periapical periodontitis = a/symptomatic
    = acute apical abscess
    = chronic apical abscess
    = condensing osteitis
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15
Q

what is a healthy pulp like

A
  • no symptoms

- vital = free of inflammation

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16
Q

in what situations may a healthy pulp need removed

A
  • elective or prosthetic purposes

- traumatic pulp exposure = if not treated within 24 hours it will need removed

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17
Q

what is reversible pulpitis

A
  • vital = can bounce back
  • inflamed pulp
  • if you treat causative agent then pulp will return to normal
  • has regular response to sensibility tests
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18
Q

what is irreversible pulpitis

A
  • symptomatic or asymptomatic
  • vital = still vital but slowly dying off
  • inflamed
  • treatment options = pulpectomy then RCT, or extraction
  • is not going to heal
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19
Q

what’s the difference between reversible and irreversible pulpitis

A
  • reversible
    = pain to cold things, lasts a short time
    = alpha fibres invovled
    = no change in pulp blood flow
- irreversible 
= spontaneous pain, intermittent, sleep disturbance
= negative to cold stimuli, pain to hot
= c fibres involved 
= increase in pulp blood flow
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20
Q

what is a necrotic pulp

A
  • non-vital
  • partial or total = in mulitrooted teeth can have partial
  • treatment options:
    = for immature teeth = pulpotomy, pulpectomy, extraction
    = for mature teeth = RCT, extraction
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21
Q

what is normal periodical tissues like

A
  • not sensitive to percussion or palpation

- radiographically = lamina dura intact, PDL space is uniform

22
Q

what is symptomatic periapical periodontitis

A
  • inflammation of apical periodontium
  • pain = on biting, percussion, palpation
  • may have periapical radiolucency
  • no way to resolve other than extraction or RCT
23
Q

what is asymptomatic periapical periodontitis

A
  • inflammation and destruction of apical perioodntium
  • appears as apical radiolucency
  • no clinical symptoms = no pain
24
Q

what is an acute apical abscess

A
  • inflammtory reaction to pulpal infection and necrosis
  • rapid onset
  • spontaneous pain
  • pus formation
  • swelling
  • may be no radiographic signs of destruction
  • fever
  • lymphadenopathy
  • treatment = drain abscess, do RCT or extraction
25
Q

what is chronic apical abscess

A
  • gradual onset
  • little or no discomfort
  • found way to drain itself so not as much pressure so not as much pain
  • intermittent discharge of pus through sinus tract
  • bad taste
  • periapical/periradicular radiolucency
  • place GP cone into sinus tract to get x-ray which will point to where infection is coming from then RCT or extraction
26
Q

what is condensing osteitis

A
  • diffuse radiopaque lesion
  • localised bony reaction to a low grade inflammatory stimulus
  • usually seen at apex of tooth
27
Q

what are the signs of non-vital teeth

A
  • discolouration = yellow (obliteration of dentine), grey (dead tissue), pink (sign of resorption of tooth)
  • sinus = grey ring around apex of tooth
  • gross caries
  • large restoration
  • radiographic evidence = periapical radiolucency, periradicular radiolucency
28
Q

what is the primary function of sensibility tests

A
  • differentiate vital from non-vital pulp
29
Q

when doing sensibility tests why do you need to test the contralateral tooth

A
  • patient responses can be very subjective
30
Q

what are some sensibility tests

A
  • EPT
  • thermal test = ethyl chloride or hot GP
  • test drilling
31
Q

what are the problems of sensibility tests

A
  • tests stimulate nerve fibres = not blood supply
  • don’t indicate blood supply
  • vitality is the blood supply = need laser doppler test
  • difficulties in testing multi-rooted teeth
32
Q

what is the EPT

A
  • electric pulp test
  • current passes through tooth = alpha delta fibres stimulated
  • stimulate nerves at pulp dentine junction
33
Q

what is the procedure of EPT

A
  • teeth thoroughly dried
  • isolate tooth
  • conducting medium needed = toothpaste, fluoride gel placed on tip of EPT probe
  • EPT placed on incisal edge or cusp tip adjacent to pulp horn
  • patient completes circuit by holding EPT
  • current slowly increased and patient indicates when they feel tingling sensation
  • number increases to 80 = closer to 80 means more non-vital
34
Q

what does a positive EPT result mean

A
  • vital pulp tissue in coronal aspect of pulp chamber
  • no indication of reversibility of inflammation - healing
  • no correlation between pain threshold and pulp condition
35
Q

what does a negative EPT result mean

A
  • reliable indicator for pulpectomy procedure in 97.7& cases

- EPT of young pulps or recently traumatise teeth is unreliable

36
Q

how many readings are usually taken for EPT

A
  • usually 3 taken and test the contralateral tooth as well
37
Q

how do thermal tests work

A
  • believed to work by hydrodynamic forces

- fluid movement in dentinal tubules which activate pulps sensory nerve receptor units in pulp

38
Q

how are cold tests carried out

A
  • frozen sticks of CO2 or ice =not reliable
  • cotton pellet/roll sprayed with ethyl chloride or endo ice of difluorodichloromethane
  • teeth carefully dried and isolated
  • place cold object close to pulp horn
39
Q

how are hot tests carried out

A
  • careful = too much heat can cause pulpal necrosis
  • initial stimulation of alpha fibres = sharp pain
  • continued stimulation of c fibres = dull pain
  • place vaseline on tooth
  • apply hot GP/green stick to tooth
  • negative response indicative of necrotic pulp
  • not possible to ascertain degrees of reversibility of inflamed symptomatic pulp
40
Q

when is test drilling used

A
  • when full coverage restorations are present
  • renders other forms of testing impossible
  • no LA is given
  • cut into tooth
  • diagnosis = patient either reports extreme pain or no pain, if there is pain then tooth is vital
41
Q

what are some clinical factors than can affect pulp

A
  • carious pulp exposure

- age

42
Q

how does carious pulp exposure affect pulp

A
  • pulp exposed to bacteria
  • vital treatment of carious exposures less than 50%
  • therefore RCT required
  • if in immature teeth can just remove necrotic parts (poulpotomy)
43
Q

how does age affect pulp

A
  • continued dentine formation = reduced pulp size and volume
  • increased = firbous components, calcification
  • decreased = cellular components, number of blood vessels and nerves
  • overall = pulp less likely to reverse an inflammatory response, pulp less likely to recover in older patients
44
Q

how can periodontal disease affect pulp

A
  • moderate to severe PD
  • result in prematurely ages pulp
  • pulp in a periodontally involved tooth is less resistant to inflammation than healthy pulp
45
Q

what can previous pulpal insult cause

A
  • premature ageing of pulp

- tubule occlusion = reparative dentine formation

46
Q

how can you prevent pulp damage

A
  • know tooth anatomy = pre-assessment radiographs
  • avoid drilling into pulp = caries can be left over pulp floor in some cases
  • use cavity sealers if close to pulp = indirect pulp cap
  • if cavity goes into pulp then use direct pulp cap
47
Q

what do cavity sealers do

A
  • protect pulp from bacteria and toxic affects from materials
  • material must adhere to dentine rather than restorative material, be thin and not dissolve in biological fluids
48
Q

what are some types of cavity sealers

A
  • varnishes
  • liners
  • base materials
49
Q

what are cavity base/liners

A
  • thicker sealant = thermal protection
  • examples = zinc phosphate, zinc oxide eugenol, calcium hydroxide (Dycal), resin modified glass ionomers (RMGI) (vitrebond)
50
Q

what are the benefits of calcium hydroxide

A
  • bactericidal/bacteriostatic = high pH which stimulates odontoblasts to make reparative dentine
  • stimulates decalcification of demineralised dentine
  • neutralises low pH from acidic restorative materials
51
Q

what are the problems with calcium hydroxide

A
  • cytotoxic = can kill pulpal teeth
  • weak cement
  • very soluble if not protected
52
Q

what are dentine bonding agents

A
  • dentine primers with/without adhesives
  • tolerated by pulp
  • marked reception in micro leakage demonstrated by these
  • BUT use is very technique sensitive

BDS3 - Endodontics (10 decks)

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