ENDO Flashcards
The Pulp contains
- Loose fibrous CT w/nerves, BVs, and Lymphatics
- Fibroblasts
- Odontoblasts
- Undifferentiated Mesenchymal Cells
Primary vs Secondary vs Tertiary Dentin
Primary Dentin:
* before complete root formation
Secondary Dentin: (aka Reactionary Dentin)
* after complete root formation
* reaction to minor damage
* ex: Chronic Attrition
Tertiary Dentin: (aka Reparative Dentin)
* repair major damage
* ex: pulp exposure
Fibroblasts
secrete fibrous CT
Odontoblasts
Secrete Dentin
Undifferentiated Mesenchymal Cells
Stem cells-> become new cells (secondary Odontoblasts)-> Tertiary Dentin–>protect pulp from injury
Pulp properties
Surrounded by hard dentin
* limits ability to expand
Lacks collateral circulation
* limited ability to deal w/infection
Scelortic Dentin
Calcification of tubules in respose to:
* slow advancing caries
* aging
Hardened Dentin
Histologic Zones of Pulp
Predentin: not mineralized
Odontoblastic layer: where nuclei are laying down dentin
Cell free zone of Weil: 0 nuclei/no cells
Cell-rich zone
Pulp core
Dentinal Pain Vs Pulpitis Pain:
Dentinal Pain=A delta Fibers
* large myelinated afferent nerve
* course coronally through pulp
* Sharp transient “First Pain”
* associate w/Cold
Pulpitis Pain=C fibers
* small unmyelinated afferent nerve
* course centrally in the pulp stroma
* Dull throbbing “Second pain”
* Heat
Pain Sensitization
Hyperalgesia
* heightened response to pain
Allodynia:
* reduced pain threshold, stimulus that usually doesn’t cause pain
* sunburnt skin is an example of aloe-dynia
Referred Pain
Preauricular pain(in front of ear)
* refers from mandibular molars
* both share V3 innervation
Endo Pulpal Diagnosis
- Normal Pulp
- Reversible Pulpitis
- Symptomatic Irreversible Pulpitis
- Asymptomatic Irreversible Pulpitis
- Pulp Necrosis
- Previously Treated Pulp
Endo Periapical Diagnosis
- Normal Apical Tissues
- Symptomatic Apical Periodontitis
- Asymptomatic Apical Periodontitis
- Acute Apical Absscess
- Chronic Apical Abscess
Cold Test
Endo Ice: dichlorodifluoromethane, -30 C
chilled pellet applied to middle 1/3 of facial surface for 5 seconds
Intensity & Duration=pulp diagnosis
Pulp Capping
Place CaOH liner
* irritates odontoblasts to form Secondary/Tertiary dentin (depends on distance from pulp)
* forms dentin wall/barrier
Normal Pulp
Asymptomatic
Thermal & Electrical Stimuli=Mild to moderate transient response
Electrical Pulp Test (EPT)
Least reliable pulp vitality testing
Indicates: vital sensory fibers in pulp
* no info about vascular supply to pulp (Vascular supply=true determinant of pulp vitality)
Contraindicated: Pacemaker
What is the true determinant of pulp vitality?
Vasculary supply to pulp
Reversible Pulpitis
Symptomatic–>symptom NOT disease
Thermal (cold) stimulus causes:
* quick, sharp, hypersensitive, transient response
* Heightened but NOT NLINGERING
* No Spontaneous pain
Caused by:
* an irritant that affects the pulp
Symptomatic Irreversible Pulpitis
Symptomatic:
* Spontaneous intermittent or continuous pain
* Cold stimulus= Lingering pain
Postural changes (Bending over or lying down)
* exacerbate dental pain
Radiographs are insufficient
* EPT not valuable
Asymptomatic Irreversible Pulpitis
Asymptomatic
microscopically similar to sympatomatic irrervsible pulitis but NO Clinical Symptoms (normal)
* micro abscesses of pulp
Pulp Necrosis
Asymptomatic, but not always
Can be partial or total
* due to long term interuption of blood supply to pulp
Anterior Teeth=Crown discoloration
* tx w/RCT or internal bleaching
What happens if a necrotic pulp is left untreated?
Toxins spread beyond the apical formaen and leads to:
* thickened PDL
* tenderness to percussion/palpation
* Apical Disease
Normal Apical Tissues
Asymptomatic
No pain on percussion or palpation