ICP L10: Pulpal pathology

Question 1

How is a pulpal diagnosis achieved

Answer 1

By taking into account the following factors

1. Patients description of subjective symptoms
2. Pulp sensibility testing (cold test, electric pulp test)
3. Radiographic examination

Question 2

What factors of caries treatment could affect the pulp healing response

Answer 2

• drill speed
• use of coolant
• operator pressure
• extent of cavity preparation
• unnecessary iatrogenic removal of dentine
• extensive and prolonged use of etchants

Question 3

Outline the two biological events occurring in pulpal repair

Answer 3

1. Progenitor cell recruitment = reparative dentinogenesis

2. Odontoblast-like cell deifferentiation and stimulation of dentine matrix secretion = reparative dentinogenesis

Question 4

What are the issues with indirect pulp capping

Answer 4

• don’t know how rapid the carious process has been
• don’t know how much tertiary dentine has formed
• don’t know when to stop excavating

Question 5

What are the issues with direct pulp capping

Answer 5

• blood supply to pulp is cruicial
• pulp tissue becomes more fibrous with age and the volume reduces as a result of secondary dentine formation and reactionary dentine over the years

Question 6

What is used for pulp capping and why is one of these better

Answer 6

1. Calcium hydroxide
   - potassium leakage
   - poor seal
2. Mineral trioxide aggregate
   - fine hydrophilic particles
   - mixed with sterile water
   - biocompatible with pulp
   - good seal
   - predictable dentine bridge formation