Care of the Pulp Flashcards
what are the contents of the pulp?
- cells
- nerves
- BV
vital tissue
what types of nerve fibre are found in the pulp?
alpha and c fibres
what are 2 key things about the vital tissue in the pulp?
- responds to stimuli
- regenerative potential
what are the 4 main functions of the pulp?
- nutritive
- sensory
- protective
- formative
what cells in the pulp form odontoblasts? what function of the pulp is this a part of?
protective response by forming tertiary dentine
what are potential sources of injury to the pulp?
- caries
- cavity preparation (heat generated and tpe of bur)
- restorations (microleakage, chemicals and toxins)
- trauma
- tooth wear
- periodontal pathology
- orthodontic treatment
- radiation therapy
dentine tubules increase in what as they approach the pulp?
size and diameter
in deeper cavities, what happens to the dentine?
the deeper the cavity the greater the dentine permeability
what sort of things can diffuse into the pulp space via the dentinal tubules?
- bacterial substances (enzymes, peptides, endotoxin e.g LPS)
- polysaccharides
- antibodies
- immune complexes
- complemet proteins
- tissue destruction products
what type of pain is usually associated with alpha fibres?
sharp pain
what type of pain is usually associated with c fibres?
- dull ache
what 2 pulpal conditions activate pain from c fibres?
- increased pulpal BF
- increased pulpal pressure
what are some of the clinical difference between reversible and irreversible pulpitis presentation?
reversible
- = pain to cold that lasts a short time
- hydrodynamic expression = microleakage (alpha fibres react)
- no change in pulpal BF
irreversible
- pain on heat
- no pain to cold
- spontaneous pain
- increased pulpal BF
what are the treatment options in endodontics for mature teeth?
- RCT
- extraction
what are the treatment options in endodontics for immature teeth?
- pulpotomy
- pulpectomy then full RCT
- extraction
what are some signs of a non-vital tooth?
- discolouration
- sinus
- gross caries
- large restorations
- radiographic evidence of PAP or PRP
what problems can be encountered with sensibility testing?
- only stimulates nerve fibres
- do not indicate BF
- periradicular inflammation occurs before complete necrosis
- difficulties in multirooted teeth
what nerve fibres are stimulated by the EPT?
alpha
how are thermal tests believed to work?
by stimulating the fluid movement in the dentinal tubules in response tot the hydrodynamic forces
what are clinical factors than can influence endodontic outcomes?
- carious pulp exposure
- age of the pulp
- periodontal disease
- previous pulpal insult or trauma
why does previous carious pulp exposure influence pulp outcomes?
- previously exposed to caries and bacteria
- vital treatment for carious exposure <50% success
- more success in immature teeth
how does age of the pulp affect the pulpal outcomes?
- continued dentine formation = reduced pulp size and volume
- increased fibrous components and calcification
- decreased cellular component, BV and nerves
- all leads to a decreased chance of reversing inflammation
how does the presence of periodontal disease affect pulpal outcome?
- severe disease may prematurely age the pulp
- the pulp in a periodontally compromised tooth may be less resistant to inflammation than a healthy pulp
how does previous pulpal insuly affect the pulpal prognosis?
- caries, caries removal and restorative processes all cause tubule occlusion
- this leads to reparative dentien formation and pulpal fibrosis
- this leads to premature ageing of the pulp making it less liely to heal
what are the 2 main ways of maintaining pulp vitality?
- preventing pulpal damage
- treating pulpal damage
how can you prevent pulp damage?
- know the anatomy of the tooth and pulp well (proximity, size and location)
- avoid drilling into the pulp (stepwise caries, stop if close)
- use sealants and liners in cavities close to the pulp
- apply a direct pulp cap if the pulp is exposed
what do cavity sealers protect the pulp from?
- bacteria and their producs
- the toxic effects of the setting phase of restorative materials
what must cavity sealers do to be effective?
bond to the dentine
what are the positive effects of CaOH?
- high pH which is bacteriostatic
- high pH which stimulates fibroblasts to form reparative dentine
- stimulates recalcification of the demineralised dentine
- neutralises low pH from restorative materials
what are some of the negative effects of CaOH?
- cytotoxic to pulp cells
- denatures dentine
- weak cement
- very soluble
