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BDS 2: Preparing for Patients > L16 Management of Dental Pulp Exposure > Flashcards

L16 Management of Dental Pulp Exposure Flashcards

1
Q

How is dental pulp exposure defined?

A

A breach in the integrity of the root chamber or root canal.

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2
Q

How does pulp exposure affect odontoblasts?

A

Causes irreversible damage to affected odontoblasts, and the death of the primary odontoblasts in that region.

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3
Q

What is the difference between class I and II pulp exposure?

A

Class I: trauma or iatrogenic cause

Class II: caries

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4
Q

How can pulp exposure be prevented?

A
  • Gum shields for high risk sports
  • MID principles of carious tissue removal
  • Preserve residual dentine of axial wall
  • Be aware of pulp morphology, shape and size from radiographs
  • Keep stained dentine on the cavity floor, it is okay to have an uneven floor
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5
Q

What is the ESE?

A

European society for endodontology.

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6
Q

How does the ESE define a deep carious lesion?

A

Caries reaching the inner quarter of dentine but with a zone of hard/firm dentine between caries and pulp which can be seen radiographically.
There is a risk of pulp exposure during operative treatment.

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7
Q

How does the ESE define an extremely deep carious lesion?

A

Caries penetrating the entire thickness of dentine, radiographically detectable.
Pulp exposure is unavoidable.

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8
Q

Compare the symptoms of reversible vs irreversible pulpitis.

A

Reversible: symptomless, or brief mild pain

Irreversible: prolonged, radiating and spontaneous pain, sleep disturbance

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9
Q

How should you proceed if you identify deep caries radiographically or clinically but the patient has no pain.

A

Carry out sensibility testing.

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10
Q

What are the 2 treatment options for extremely deep caries?

A
  1. Vital pulp therapy (endo course)

2. Selective carious tissue removal or stepwise removal to soft dentine on axial wall

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11
Q

How should you manage pulp exposure with iatrogenic causes?

A
  • Don’t panic
  • Ensure cavity is isolated and moisture free
  • Dry cavity with cotton wool, do not use 3-in-1
  • Pulp cap
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12
Q

What factors influence treatment choice after pulp exposure?

A
  • Size of exposure
  • Caries present? Caries free?
  • Symptomatic or asymptomatic
  • Stage of root development (age, closed or open apices)

Better prognosis for small, caries-free exposure of asymptomatic tooth with open root apices.

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13
Q

Describe how a pulp cap is carried out for a class I exposure.

A
  • Preserve aseptic working field
  • Arrest bleeding with cotton pledget moistened with 2% buffered sodium hypochlorite
  • Apply biomaterial (hydraulic calcium silicate) directly onto exposed pulp (Biodentine or MTA) before placing a permanent restoration
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14
Q

Which therapeutic agents are used to pulp cap for class I exposures?

A
  • If tooth is asymptomatic/has symptoms of reversible pulpitis: hydraulic calcium silicate cement, or Dycal (cheap)
  • If tooth has symptoms of irreversible pulptitis: Ledermix/Odontopaste, only if unable to extract pulp at that same appointment
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15
Q

Describe the use of biodentine as a pulp cap material.

A
  • Tricalcium sislicate cement
  • Bioactive and biocompatible
  • Acts as its own temporary dressing
  • Does not require prep (etching or bonding)
  • Soluble, low wear resistance (not to be used permanently)
  • Long setting time (12-20 minutes)
  • Removed after 3 months, small layer kepy over axial wall and composite placed
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16
Q

Describe the use of MTA as a pulp cap material.

A
  • Mineral trioxide aggregate cement
  • Strongly alkaline
  • Antimicrobial actions
  • Promotes tertiary dentine formation
  • Extremely poor handling properties (gritty and slow setting time)
17
Q

Describe the use of Dycal as a pulp cap material.

A
  • Not used in UDH, used in some practices because it’s cheaper
  • Strongly alkaline
  • Bacteriostatic
  • Induces mineralisation (bioactive)
  • Radiopaque
  • Poor compressive strength
  • Soluble in water, acid and saliva, isolation important
18
Q

Describe the use of Ledermix or Odontopaste as a pulp cap material.

A
  • Used for symptomatic teeth
  • Suppresses the inflammatory response of the pulp
  • Reduces pain
  • Used for teeth set to recieve endo treatment or extraction
19
Q

Describe how you would restore a tooth after a class I exposure.

A
  • Mineralised bridge will have formed over the pulp
  • This bridge has non-mineralised defects making it vulnerable to bacterial invasion
  • Marginal seal extremely important
20
Q

How long after treating a class I exposure should you perform a sensibility test?

A

Review after one week to carry out sensibility test, check pulp vitality.

BDS 2: Preparing for Patients (6 decks)

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