Care of the Pulp (endodontics) Flashcards by L T

what cells found within the pulp help to form the tooth?

ODONTOBLASTS

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what type of tissue is the pulp?

a VITAL TISSUE

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what is meant by a vital tissue?

regenerative material

- responds to stimuli

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what are the functions of the pulp?

nutritive
protective
sensory
formative

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what is meant by the PROTECTIVE function of the pulp?

it forms tertiary dentine during reparative healing

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what is involved in the SENSORY function of the pulp?

temperature
pressure
pain

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what is meant by the FORMATIVE function of the pulp?

it forms secondary dentine (part of the ageing process of the tooth)

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explain the size of the pulp in a young person?

LARGE

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explain how the pulp changes as a person ages?

pulp gets narrower and narrower over time due to laying down of SECONDARY DENTINE

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what can injure the pulp?

caries
cavity prep
restorative materials
trauma
toothwear
periodontal pathology
orthodontic treatment
radiation therapy

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how can cavity/crown prep damage the pulp?

the high speed burr moves very fast which generates heat !
type of burr used may damage pulp

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how to avoid damaging the pulp when using the high speed hand-piece?

always have the water spray on !

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what is meant by RDT?

remaining dentine thickness

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what is important about RDT?

a low RDT may cause damage to pulp

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why may a low RDT cause damage?

dental tubules more permeable

- restorative material can be toxic

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how can a restorative material damage the pulp?

toxic
heat of setting reaction
water absorption
poor marginal adaption/seal
cementation of restoration

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explain the dentine tubules as they get closer to pulp?

increase in number

- increase in diameter (closer together)

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the DEEPER THE CAVITY….

the GREATER THE DENTINE PERMEABILITY

- easier for substances to reach pulp

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what travels through dental tubules?

bacterial substances
polysaccharides
antibodies
immune complexes
complement proteins
tissue destruction products

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what BACTERIA can be found in dental tubules?

endotoxins
exotoxins
enzymes
peptides

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what is DENTAL PAIN caused by?

the activation of ALPHA FIBRES and C-FIBRES

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explain the myelination of alpha fibres:

myelinated

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explain the myelination of C-fibres:

non-myelinated

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what type of pain is caused by activation of alpha fibres?

SHARP PAIN

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what type of pain is caused by activation of C-fibres?

DULL/ACHING PAIN

when are C-fibres stimulated in the pulp?

- when pulpal blood flow is increased | - when pulpal pressure is increased (dentine and enamel doesn’t swell)

what different ways can a pulp be diagnosed?

- healthy pulp - reversible pulpitis - irreversible pulpitis - necrotic pulp

describe a healthy pulp:

- vital | - free of inflammation

describe a pulp that has reversible pulpitis:

- vital - inflamed pulp - regular response to sensibility tests

describe a pulp that has irreversible pulpitis:

- vital - inflamed - pulpal inflammation cannot heal

treatment options for irreversible pulpitis?

- pulpectomy required then RCT | - extraction

how to tell the difference between reversible and irreversible pulpitis in reference to PAIN:

REVERSIBLE = pain to cold, lasts a shot time IRREVERSIBLE = spontaneous pain, intermittent pain, sleep disturbance, pain to HOT (unresponsive to cold)

how to tell the difference between reversible and irreversible pulpitis in reference to PULPAL BLOOD FLOW:

REVERSIBLE = no change in pulp blood flow IRREVERSIBLE = increase in pulp blood flow

how to tell the difference between reversible and irreversible pulpitis in reference to NERVE FIBRES ACTIVATED:

REVERSIBLE = A-fibres IRREVERSIBLE = C-fibres

explain a necrotic pulp:

- non-vital pulp - partial or total necrosis - pulp full of dead nerve tissue and blood vessels

what is the treatment for a necrotic pulp in mature teeth?

- root canal treatment | - extraction

what is the treatment for a necrotic pulp in immature teeth?

- pulpotomy - pulpectomy then RCT - extraction

what is the difference between mature teeth and immature teeth?

mature teeth have CLOSED APICES | immature teeth have OPEN APICES

what is meant by an OPEN APICE?

richer blood flow

explain what you would find on examination of NORMAL PERIAPICAL TISSUE?

- not sensitive to percussion or palpation | - radiographically = lamina dura intact & PDL space is uniform

explain what you would find on examination of SYMPTOMATIC PERIAPICAL PERIODONTITIS?

- inflammation of the apical periodontium - pain when: BITING, PERCUSSION, PALPATION - may have periapical radiolucency

explain what you would find on examination of ASYMPTOMATIC PERIAPICAL PERIODONTITIS?

- inflammation and destruction of the apical periodontium (of pulpal origin) - appears as an apical radiolucency - no present clinical symptoms (no pain on palpation/percussion)

what is an acute apical abscess?

inflammatory reaction to pulpal infection & necrosis with a RAPID ONSET

what occurs in an acute apical abscess?

- rapid onset & spontaneous pain - pus formation and swelling - may be no radiographic signs of destruction

explain the symptoms experienced when you have an acute apical abscess?

- extreme tenderness to pressure - malaise and fever - lymphadenopathy

what is lymphadenopathy?

lymph nodes are abnormal in size/consistency

what is meant by percussion of the teeth?

press around the teeth

what is meant by palpation of the teeth?

tap on tooth

what is a chronic apical abscess?

inflammatory reaction to pulpal infection and necrosis with a GRADUAL ONSET

explain the symptoms of a chronic apical abscess?

- little or no discomfort experienced | - periapical/periradicular radiolucency

what is condensing osteitis?

a localised bony reaction to a low-grade inflammatory stimulus

explain the radiographic findings of condensing osteitis

- diffuse radiopaque lesion | - usually seen at apex of tooth

what are the signs of a non-vital tooth?

- discolouration - sinus - gross caries - large restoration - radiographic evidence

what may a yellow tooth suggest?

obliteration of dental tubules

what may a grey tooth suggest?

blood breakdown in the tooth

what may a pink tooth suggest?

resorptive process occurring

what are some sensibility tests?

- electric pulp tests - thermal tests - test drilling

describe the problems with sensibility tests:

- they stimulate nerve fibres (no correlation to vital blood supply) - do not indicate state of blood supply - teeth can be partially necrotic

what determines if a tooth is vital?

- related to BLOOD SUPPLY NOT NERVE STIMULATION

do nerve fibres in pulp correlate to vital blood supply?

what is involved in an electric pulp test?

- electric current used to stimulate sensory nerves at the pulp-dentine junction

describe the response of fibres during an ELECTRIC PULP TEST:

* A-delta fibres stimulated | * C-fibres may or may not respond