CTB41 Clinical apsects of tooth disease: dentine-pulp complex and responses to exposure and advancing caries, pulpal-periodontal interaction Flashcards
Describe briefly the 4 main stages of cavity progression:
- subsurface translucent zone
- development of the dark zone
- typical zoned structure of early white spot lesion
- cavitation, spread along ADJ, reactive changes in dentine
What non-invasive non-dril-fill can be used to stop caries progession of cavitated lesion (late)?
2) describe…
3) e.g of use
1) Hall technque
2. Decay is sealed under preformed (stainless steel) crowns, avoiding injections and drilling.
3. primmary teeth
3 theories of dentine nociception:
- nerve ending in cut aroun odontoblast and through predentine down odontoblast process into dentine within peritubular, that’s surrounded by interrubular dentine)
- odontoblast acts as a receptor
- suggests tat the receptors at the base of odontoblasts are stimulated directly or indirectly by fluid movement through the tubules.
treatment for sensitivity:
- de-sensitisation agents
- adhesive restorations
- elective devitalisation
Why can bleaching cause hypersensitivity?
2 mechanisms proposed..
Hydrogen peroxide may penetrate through the tooth to the pulp
causing an inflammatory reaction.
• Could also lead to increase tubule patency by removing staining. (as oxygenating bleach gels remove migro-debris within tooth structure as well as the plugs in DT thus fluid movement (outward=away from pulp) within DT can occur
If patient experiences sudden sharp pain usually when masticating and classically on release of pressure, what may they suffer from?
2) What diagnostic tooth is used
cracked cusp syndrome: tooth has incompletely cracked but no part of the tooth has yet broken off
2) tooth slooth (used to identify which tooth is fractured), transillumination, dyes and magnification
What are the treatment options for cracked cusp syndrome:
- bonded restoration
- “cuspal coverage” (crown)
- endodontic treatment
- extraction
describe stages from dentine hypersensitivity to peri-apical abscess:
- dentine hypersensitvity
- reversible pulpitis
- irreversible pulpitis
- apical periodontitis (asymptomatic/ symptomatic)
- peri-apical abscess (acute/ chronic)
the 4 causes of pulpal infalmmation:
- Caries
- Defective restorations
- Trauma
- Dens invagination (enamel organ folded = enamel folded into dentine)
1) Describe duration of pain in
a) reversible pulpitis
b) irreversible pulpitis
2) does pain disappear or persist on removal of stimulus
3) localised pain?
4) can spontaneous pain occur?
1) a) short b) longer
2) a) disappear b) persist
3) ab) poorly localised
4) a) n/a b) yes
What is the management for reversible pulpitis
Remove irritant and restore
• Preserve pulp
• Reivew
(no drill and filling if dentine is hard (can be discoloured) just leave it)
What is the management for irreversible pulpitis
Pulpotomy
• Pulpectomy
• Extraction
symptomatic apical periodontitis
1) What is it?
2) results of tests TTP, vitality
3) descibre PDL
caries into the pulp and close to the pulp, the pulp is still alive ,
2) tentative percussion, repsonds to sensibility pulpal tests,
3) can get widened apical PDL
asymptomatic apical periodontitis1) What is it?
2) results of tests TTP, vitality +extra
1) pulp is dead, no
2)tenentaive percussion response, no response to sensibility test ,
x-ray= radio lucency
chronic apical abscess
what is it?
results of TTC, vitality tests and x-ray
pulp and root is dead, no tenentaive percussion response (can be mild), no response to sensibility test ,
x-ray= radio lucency, theres also a draining sinus
