Intro to Operative Part 2

Question 1

Dentinal tubules are filled with
odontoblastic processes and
wrapped in afferent nerves and
dentinal fluid .

•(most accepted theory of pain
transmission).

Answer 1

Hydrodynamic theory of pain

transmission

Question 2

When enamel or cementum is
removed during cavity
preparation, the external seal of dentin is lost, which allows small fluid movements in the tubules. This movement causes distortions in the afferent nerve endings,
hence, pain.

Answer 2

Hydrodynamic theory of pain

transmission

Question 3

T/F: DENTIN MUST BE TREATED WITH GREAT CARE

DURING RESTORATIVE PROCEDURES

Answer 3

True

Question 4

T/F: Dentin should not be dehydrated by air blasts, as this

could cause aspiration of odontoblasts into tubules.

Answer 4

True

Question 5

1.
Caries is extensive enough that pulpal complications are likely
to occur soon.
2.
It is desirable to quickly eliminate large carious lesions that are
a source for caries infection in the patient’s mouth.
3.
Time does not permit definitive restoration of one or many
large lesions.
4.
The prognosis for the pulp is questionable, and definitive
restoration should be deferred until the pulp’s condition can be
better assessed.

Answer 5

Caries control restorations are performed, as part of a larger caries control plan, when one or more of these conditions exist:

Question 6

Used when a deep carious lesion occurs and
there is no clinical or radiographic evidence of
irreversible pulp damage

Answer 6

The Indirect Pulp Cap

Question 7

Remember, caries is usually

deeper than it appears to be on X ray.

Answer 7

true

Question 8

•
Remove all caries, both affected and infected dentin,
from all areas except the deepest, close to the pulp.
•
Leave the last little bit of infected dentin, cover it with
calcium hydroxide (
Dycal or Life), and glass ionomer
Vitrabond ).
•
Place a temporary restoration, such as IRM or Ketac Silver.
It is OK to leave some undermined enamel
temporarily to
help hold in the temporary restoration.

Answer 8

The Two Appointment Approach:

Question 9

WHat is the most common approach to the indirect pulp cap?

Answer 9

Single appointment

Question 10

•
Used when a small pulpal
exposure occurs during cavity
preparation.

Answer 10

Direct pulp cap

Question 11

It is most successful when the
exposure is mechanical rather than
carious,

Answer 11

Direct pulp cap

Question 12

T/F: •
There is a very real chance that the pulp cap will not work. Confirm vitality
some months later with a radiograph and some form of pulp testing (electric
pulp test, cold test).

Answer 12

True

Question 13

t/f: Pulp caps are more effective on young patients with large pulp chambers
and open root canals that provide better circulation to the area where we
are trying to induce dentin bridge formation.

Answer 13

True

Question 14

Direct pulp caps work better at the tips of pulp horns than they do on an
exposure on the side of a pulp chamber (as from a class V

Answer 14

true

Question 15

T/F:If the tooth will require a crown to adequately restore it, DO NOT RELY ON
A DIRECT PULP CAP . Do endodontics before crowning teeth that have had
direct exposures, and, if necessary, a form of endodontic post reinforcement
before crowning.

Answer 15

true

Question 16

t/f: ALL Restorations must
adequately seal the cavity to
avoid microleakage bacterial
penetration, and of course
recurrent decay.

Answer 16

True

Question 17

35% phosphoric acid pH=0

Answer 17

Acid conditioners

Question 18

––(HEMA) pH=2.5 do not remove smear layer. These
“self etch” primers do not treat the dentin with 35% phosphoric
acid before bonding. They have a weaker bond, but have other
advantanges

Answer 18

Acidic primers

Question 19

a_______ primer or wetting agent is applied to wet the

dentin and prepare for easier penetration of the

Answer 19

hydrophilic

Question 20

________resin bonding agent that can adapt to the moist
dentin and co polymerize with the composite resin
restoration.

Answer 20

hydropobic

Question 21

Most of the bond strength develops from resin penetrating
and adapting to the demineralized_____ dentin and
exposed collagen fibers. The resultant resin interdiffusion
zone is often termed the____ layer

Answer 21

intertubular

hybrid

Question 22

more tubules, larger diameter of tubules, reduced amount of intertubular dentin in deep areas

Answer 22

deep Denting

Question 23

A twinge of pain may be due to sugar, cold, or acid
from caries first contacting dentin. Pain lasting a few
seconds may be due to the irritant continuously
present or applied repeatedly.

Answer 23

Reversible Pulpitis

Question 24

As long as an irritant, such as touching an ice stick to
the tooth causes pain that lingers no more than 10 to
15 seconds after removal, it’s called _____ ______
and can be treated with a restoration.

Answer 24

reversible pulpitis

Question 25

When pain is either spontaneous , or if elicited by an irritant lingers more than 15 seconds infection of the pulp often has occurred and resolution by operative dentistry treatment is usually not possible; root canal therapy is advised for this condition termed______ pulpitis

Answer 25

irreversible

Question 26

When this irreversible pulpitis is untreated, ______ _______ follows, typified by spontaneous, continuous, throbbing pain or pain elicited by heat that can be relieved by cold , and then, later, with no response to any stimulus . As inflammation and infection move beyond the root apex, the tooth may become sensitive to percussion • R oot canal therapy is needed. •

Answer 26

pulpal necrosis

Question 27

Usually manifests as cold sensitivity, and sometimes spontaneous pain, in the maxillary posterior teeth. Often hard to isolate to a single tooth.

Answer 27

Maxillary Sinusitis

Question 28

Usually manifests as cold sensitivity, or a sudden usually unreproducible pain when chewing. An instrument called a Tooth Sleuth can often elicit the pain when placed between the teeth in the central groove areas or at the tips of individual cusps. Cracks can sometimes progress into the pulp chamber and cause pulp necrosis, or cusps may eventually fracture off. Cracks can sometimes be seen externally with a fiber optic light, or it may be necessary to remove restorations to see them. These teeth require crowning.

Answer 28

Cracked Tooth

Question 29

Usually manifests as cold sensitivity, or pain in chewing. Slight tooth movements when the teeth are clenched and then moved from side to side may be seen, but not always. This is called fremitis . Pain can often be relieved by occlusal adjustments. .

Answer 29

Occlusal trauma

Question 30

``` Is slightly softer than dentin and consists of about 45% to 50% inorganic material by weight. Covers the apical root. • It is permeable to a variety of materials. • Light yellow and slightly lighter in color than dentin, it has the highest fluoride content of all the mineralized tissue. ```

Answer 30

cementum

Question 31

T/F: Improper contacts can result in food impaction, producing periodontal disease, carious lesions, and possible movement of the teeth.

Answer 31

true

Question 32

``` Proximal contacts are slightly______ to the center of the proximal surface faciolingually . ```

Answer 32

facial

Question 33

T/F: It is extremely important to not destroy attached keratinized tissue in the restorative process. This must be preserved.

Answer 33

True