Etiology of Pulpal Disease

Question 1

Pulpal Irritants

Answer 1

Living: microbial (bacteria, fungii, viruses)

Non-living: mechanical, thermal, chemical

Question 2

T or F: Direct pulp exposure is NOT a prerequisite for pulpal response and inflammation

Answer 2

True

Question 3

Factors affecting pulpal response

Answer 3

Virulence of bacteria, ability to release inflammatory fluids, host resistance, amount of circulation, lymph drainage

Question 4

Sequence of pulp destruction

Answer 4

severe bacterial invasion -> inflammation leads to interruption of blood flow to the pulp -> pulp will become necrotic -> colonized by bacteria -> byproducts and other irritants from necrotic tissue will diffuse from the canal into the periapical tissues causing destruction of these tissues

Question 5

Kakehashi Study

Answer 5

Pulp exposure in conventional and germ free rats -> bacteria and pulpal disease

Question 6

Mechanical irritants to the pulp

Answer 6

operative procedures, trauma, orthodontics, periodontal scaling (removes cementum exposing dentinal tubules)

Question 7

Chemical irritants to the pulp

Answer 7

antibacterial agents, acids, acidic liners and bases, temporary and permanent filling materials

Question 8

**Can the pressure come on all of a sudden?

Answer 8

**Pressure increases occur in small “compartmentalized” regions and progress slowly

Question 9

Pain associated with inflammatory mediators

Answer 9

Lower sensory nerve threshold, effect on vascular permeability which results in elevated tissue pressure, pressure acts directly on sensory nerve receptors

Question 10

T or F: Restorative Procedures are common cause of injury

Answer 10

True - among various forms of dental treatment, restorative procedures are the most common cause of pulpal injury

Question 11

Sources of leaky bacteria

Answer 11

ingrowth from surface, bacteria in smear layer, bacteria in deep dentin

Question 12

Cavity Prep Depth

Answer 12

diameter and density of dentinal tubules inc in direct proportion to the depth of cavity prep
*deeper dentin = more concentration of dentinal tubules
need 2 mm of dentin thickness

Question 13

Heat prevention

Answer 13

high-speed w/ efficient water coolant
light pressure
intermittent cutting

Question 14

Dentin desiccation due to heating

Answer 14

Outward movement of dentinal fluid, can displace odontoblasts, prolonged air drying should be avoided

Question 15

Hydraulic Forces

Answer 15

impressions or cementation can produce outward mvmt of dentinal fluid

Question 16

Factors affecting microleakage

Answer 16

Marginal adaptation of material, shrinkage, contraction gaps, elastic deformation of tooth structure