Care of the Pulp (endodontics) Flashcards
what cells found within the pulp help to form the tooth?
ODONTOBLASTS
what type of tissue is the pulp?
a VITAL TISSUE
what is meant by a vital tissue?
- regenerative material
- responds to stimuli
what are the functions of the pulp?
- nutritive
- protective
- sensory
- formative
what is meant by the PROTECTIVE function of the pulp?
it forms tertiary dentine during reparative healing
what is involved in the SENSORY function of the pulp?
- temperature
- pressure
- pain
what is meant by the FORMATIVE function of the pulp?
it forms secondary dentine (part of the ageing process of the tooth)
explain the size of the pulp in a young person?
LARGE
explain how the pulp changes as a person ages?
pulp gets narrower and narrower over time due to laying down of SECONDARY DENTINE
what can injure the pulp?
- caries
- cavity prep
- restorative materials
- trauma
- toothwear
- periodontal pathology
- orthodontic treatment
- radiation therapy
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
how to avoid damaging the pulp when using the high speed hand-piece?
always have the water spray on !
what is meant by RDT?
remaining dentine thickness
what is important about RDT?
- a low RDT may cause damage to pulp
why may a low RDT cause damage?
- dental tubules more permeable
- restorative material can be toxic
how can a restorative material damage the pulp?
- toxic
- heat of setting reaction
- water absorption
- poor marginal adaption/seal
- cementation of restoration
explain the dentine tubules as they get closer to pulp?
- increase in number
- increase in diameter (closer together)
the DEEPER THE CAVITY….
the GREATER THE DENTINE PERMEABILITY
- easier for substances to reach pulp
what travels through dental tubules?
- bacterial substances
- polysaccharides
- antibodies
- immune complexes
- complement proteins
- tissue destruction products
what BACTERIA can be found in dental tubules?
- endotoxins
- exotoxins
- enzymes
- peptides
what is DENTAL PAIN caused by?
the activation of ALPHA FIBRES and C-FIBRES
explain the myelination of alpha fibres:
myelinated
explain the myelination of C-fibres:
non-myelinated
what type of pain is caused by activation of alpha fibres?
SHARP PAIN
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?
no
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
