Clinical Classification Of The Status Of Thhe Pulp And Root Canal Flashcards
What is necrobiosis?
Part of the pulp necrotic and infected; the rest is irversibly inflamed
How does pulpal disease typically progress (stages)?
Normal Inflammatiion Necrosis Infection Loss of pulpal tissue (pulpless canals)
What are the features of a clinically normal pulp?
Asymptomatic
React to cold test with mild pain for about 1-2 seconds after stimulus is removed
No ttp or tenderness to palpation
What are the features of dentinal hypersensitivity?
Pain occurs when thermal, chemical, tactile or osmotic stimuli affects exposed dentine.
Severe and sharp pain on applicatioof stimulus but dissapears on removal
What are the features of reversible pulpitis?
Pulp mildly inflammed and capable of healing when irritating stimulus is removed.
Pain only when stimulus is applied to the tooth and ceases within a few seconds or immediately upon removal of stimulus
No significant radiographic changes
Pain on biting may indicate a crack in the tooth
How should a tooth with reversible pulpitis be managed?
As the diagnosis of reversible pulpitis should always be considred a “provisional diagnosis”, the tooth should be restored conservatively and the status of the pulp should be reviewed (pulp sensibility tests) in about 3 months. If symptoms have gone back to normal, the diagnosis can be confirmed as reversible. If not, it is irreversible pulpitis.
What are the classic symptoms of irreversible pulpitis?
Lingering pain induced by thermal stimuli (only mild tempature changes reqred to induce pain)
Initial reaction is a sharp pain that lingers for minutes to hours after stimulus is removed
Lingering is usually a dull ache of throbbing pain
Spontaneous pain which may wake the patient up at night
If periapical tissues involved, tooth usually tender to percussion
What are the differences between acute and chronic irrevesible pulpitis?
Acute irreversible pulpitis usually has a sudden onset that can wake the patient up at night. Pain is spontaneous with moderate the severe intensity. Pain may be intensified with postural changes.
With chronic irreversible pulpitis, similar signs and symptoms but less severe. Pain may be intermittent
With a tooth with pulpal necrosis, what might the patients demtal history and radiographs reveal?
Hx: past trauma, previous history of pain, history of restorations or caries
Radiographs: may have signs of untreated caries, extensive restorations, previous pulp capping
Radiographic changes at root apex only if periapical involvement present. This only occurs when necrotic tissue is infected.
When should a necrotic pulp be suspected?
Negative response to pulp sensibility tests (need to be cautious).
Occasionally, dull continuous ache exarcebared by heat but relieved by cold water. This usually occurs about 2 months from the initial invasion by bacteria.
What are the symptoms of a pulpless canal?
No pain from tooth itself but may have occasional discomfort. No response to sensibility testing.
No signs on radiograph but may have periapical radiolucency within 2-10 months
Besides inflammation, how else can a pulp respond to noxious stimuli?
Degeneration such as atrophy or fibrosis, calcification, root resorption and hyperplasia.
What is pulpal atrophy?
A normal physiologecal process that occurs with age. It may result in nomal or delayed pulp sensibility testing.
