Care of the Pulp Flashcards

1
Q

what cells are in the pulp?

A

odontoblasts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what nerves are in the pulp?

A

alpha and C fibres

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what does it mean if the pulp is a vital tissue?

A

responds to stimuli and has regenerative potential

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what are the nerves of the pulp also called?

A

plexus of Raschkow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what are the functions of the pulp?

A

nutrition, sensory, protective, formative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what type of sensations can the pulp feel?

A

temperature, pressure, pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what type of protective functions does the pulp have?

A

tertiary dentine formation for reparative healing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what is the formative function of the pulp?

A

secondary dentine production

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

name some injuries that can occur to the pulp

A

caries, cavity preparation, restorations, trauma, tooth wear, periodontal pathology, orthodontic treatment, radiation therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

how can restoration materials damage the pulp?

A

toxicity, water absorption, heat of reaction, poor marginal adaptation/seal, cementation of restoration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

where happens to dentine tubules closer to the pulp?

A

they increase in number and diameter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

where is dentine permeability the greatest?

A

at the pulp

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what types of cells can pass through dentine tubules?

A

bacterial substances, polysaccharides, antibodies, immune complexes, complement proteins, tissue destruction products

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is the key part of pulpal and periradicular pathology?

A

micro-organisms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what types of pain does alpha fibres feel?

A

sharp pains

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what type of pain does C fibres feel?

A

dull/aching pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what are alpha fibres stimulated by?

A

electric pulp test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what are c fibres stimulated by?

A

increased pulpal blood flow and increased pulpal pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what are the two AAE classifications?

A

pulpal diagnosis, periapcial diagnosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what are the types of pulpal diagnosis?

A

healthy pulp, reversible pulpitis, irreversible pulpitis (symptomatic/asymptomatic), necrotic pulp, previously treated, previously initiated therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what are the different types of periapical diagnosis?

A

normal, periapical periodontitis (symptomatic, asymptomatic), acute apical abscess, chronic apical abscess, condensing osteitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what does a healthy pulp mean?

A

vital and free of inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

when are healthy pulps removed?

A

for elective/prosthetic purposes, for traumatic pulp exposure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

is a pulp with reversible pulpitis vital or non-vital?

A

vital

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what is reversible pulpitis?

A

inflamed pulp which can be reversed back to health

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

what sort of response to reversible pulpitis pulps have to sensibility test

A

regular response

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

are pulps with irreversible pulpitis vital or non-vital?

A

vital

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

what is irreversible pulpitis

A

inflamed pulp which cannot be reversed back to normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

what are the treatment options for irreversible pulpitis

A

pulpectomy then RCT or extraction if the tooth is unrestorable and patient would prefer this

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

how do you know if a pulp has irreversible pulpitis?

A

if investigations suggest that pulpal inflammation cannot heal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

what are the clinical symptoms of reversible pulpitis?

A

pain to cold, lasts a short time (A fibres), , hydrodynamic expression (microleakage) no change in blood flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

what are the clinical symptoms of irreversible pulpitis?

A

spontaneous pain, intermittent, sleep disturbance, pain to hot (C fibres), increase in pulpal blood flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

what is the vitality of a necrotic pulp?

A

non-vital

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

what is a necrotic pulp?

A

partial or total necrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

what are the treatment options for mature teeth with a necrotic pulp?

A

root canal treatment or extraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

what are the treatment options for immature teeth with a necrotic pulp?

A

pulpotomy, pulpectomy then full RCT, extraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

what does it mean if a tooth is mature?

A

the apices are closed

38
Q

what are normal periapical tissues like?

A

not sensitive to percussion or palpation, lamina dura intact, PDL space uniform

39
Q

what is symptomatic periapical periodontitis?

A

inflammation of the apical periodontium

40
Q

what are the symptoms of symptomatic periapical periodontitis

A

pain when biting, applying percussion, palpation

41
Q

what is highly indicative of a degenerating pulp?

A

pain to percussion and/or palpation

42
Q

what treatment is needed for symptomatic periapical periodontitis

A

RCT

43
Q

what is asymptomatic periapical periodontitis

A

inflammation and destruction of the apical periodontium

44
Q

what does an asymptomatic periapical periodontitis appear like?

A

an apical radiolucency on a radiograph

45
Q

what can symptomatic periapical periodontitis look like on a radiograph?

A

periapical radiolucency

46
Q

what is an acute apical abscess?

A

inflammatory reaction to pulpal infection and necrosis

47
Q

what are the symptoms of acute apical abscess?

A

rapid onset, spontaneous pain, extreme tenderness to pressure, pus formation, swelling

48
Q

what are the signs of acute apical abscess?

A

malaise, fever, lymphadenopathy

49
Q

do acute apical abscesses show up on a radiograph?

A

potentially not

50
Q

what is a chronic apical abscess?

A

inflammatory reaction to pulpal infection and necrosis with a gradual onset

51
Q

what are the symptoms of chronic apical abscess?

A

little or not discomfort, intermittent discharge of pus through sinus tract

52
Q

what shows on a radiograph with chronic apical abscess?

A

periapical/periradicular radiolucency

53
Q

how do you identify the tooth affected by the chronic apical abscess?

A

carefully place GP cone into sinus tract and take a radiograph

54
Q

what is condensing osteitisis?

A

diffuse radiopaque lesion which represents localised bony reaction to a low-grade inflammatory stimulus

55
Q

where are condensing osteitisis usually seen?

A

at the apex of tooth

56
Q

what are the signs of a non-vital tooth?

A

discolouration, sinus, gross caries, large restorations, radiographic evidence (periapical radiolucency and periradicular radiolucency)

57
Q

what types of colours do non-vital teeth display?

A

yellow, grey, pink

58
Q

what does a yellow tooth mean?

A

obliteration of dentinal tubules

59
Q

what does a grey tooth mean?

A

blood break down products in tooth

60
Q

what does a pink tooth mean?

A

resorptive process, tooth eating itself away

61
Q

where is a periapical radiolucency?

A

only around the apex

62
Q

where is a periradicular radiolucency?

A

round more surfaces of the root

63
Q

what is the function of a sensibility test?

A

to differentiate vital from non-vital pulp

64
Q

how do you conduct a sensibility test?

A

compare patients response with a contralateral tooth then re-examine same tooth

65
Q

what tests are used for sensibility tests?

A

electric pulp tests, thermal tests, test drilling

66
Q

what cold test is used as a sensibility test?

A

ethyl chloride

67
Q

what hot test is used for sensibility?

A

hot gutta percha

68
Q

what are the problems of sensibility tests?

A

stimulate nerve fibres but dont assume that nerve fibres in pulp correlates to vital blood supply, they do not indicate the state of the blood supply, tooth vitality is related to blood supply and not nerve stimulation, periradicular inflammation occurs before pulp is totally necrotic, difficulties in testing multi-rooted teeth

69
Q

what does an electric pulp test do and which nerve fibres does it stimulate?

A

stimulate sensory nerves at pulp-dentine junction, A delta fibres stimulated (C fibres sometimes respond)

70
Q

how do you conduct an electric pulp test?

A

teeth thoroughly dried, isolate tooth, conducting medium (toothpaste), EPT probe placed on incisal edge or cusp tip, patient completes circuit by holding handle of EPT, current slowly increased, patient indicates when feeling a tingling sensation

71
Q

what is a positive response of an EPT?

A

vital pulp tissue in coronal aspect of pulp chamber, no indication of reversibility of inflammation, no correlation between pain threshold and pulp condition

72
Q

what is a negative response of an EPT?

A

reliable indicator for pulpectomy procedure in 97.7% (apart from young pulps or recently traumatised teeth)

73
Q

how do thermal tests work?

A

by hydrodynamic forces (fluid movement in dentinal tubules)

74
Q

what is the procedure of a cold test?

A

teeth carefully dried and isolated, place cold object close to pulp horn

75
Q

if a cold test gives a negative response what is it indicative of?

A

pulpal necrosis

76
Q

what is the procedure of a heat test?

A

vaeline on tooth, apply hot gutta percha/green stick on tooth

77
Q

what is a negative response to a heat test indicative of?

A

necrotic pulp

78
Q

when is test drilling used

A

when full coverage restorations are present

79
Q

how do you conduct test drilling?

A

no LA given, cut into tooth

80
Q

if a patient reports pain when cutting into the tooth what does this mean

A

tooth is vital

81
Q

what is an alternative to a tooth drilling test?

A

spray with cold water and air and assess patient response

82
Q

what influences the clinical factors?

A

carious pulp exposure, age, periodontal disease, previous pulpal insult/trauma

83
Q

what treatment is usually needed for carious pulp exposure?

A

RCT

84
Q

what happens to the pulp with age?

A

continued dentine formation so reduced pulp size and volume, increased fibrous components and calcification, decreased cellular components and number of blood vessels and nerves, pulp less likely to reverse an inflammatory response

85
Q

how does periodontal disease influence the pulp?

A

moderate/severe periodontal disease results in prematurely aged pulp, pulp in periodontal tooth is less resistant to inflammation than healthy pulp

86
Q

what is the results of previous pulpal insult on the pulp?

A

tubule occlusion so pulpal fibrosis, premature aging of pulp so less likely to heal

87
Q

how do you maintain pulp vitality?

A

prevent pulpal damage and treat the pulp

88
Q

how do you prevent pulp damage?

A

know tooth anatomy, use radiographs, avoid drilling into pulp, cavity close to pulp use sealers, cavity into the pulp use direct pulp cap

89
Q

what are the effects of calcium hydroxide?

A

bacteriocidal/bacteriostatic, stimulates fibroblasts through a high pH, stimulates recalcification of demineralised dentine, neutralises low pH, cytotoxic, weak cement, soluble if not protected

90
Q

what are the possible treatment options for pulpal damage?

A

indirect pulp cap, direct pulp cap, partial pulpal removal, full pulpal removal then RCT

91
Q

what is partial pulpal removal called?

A

pulpotomy

92
Q

what is full pulpal removal called?

A

pulpectomy