managing deep carious lesions

Question 1

What is the aim of preserving the pulp?

Answer 1

Preserving pulp vitality.

Question 2

What is deep caries?

Answer 2

Reaches the inner 1/3 of dentine but with a some of hard or firm dentine between the caries and the pulp.

Question 3

What is extremely deep caries?

Answer 3

Caries penetrating the entire thickness of dentine.

Question 4

Pulpal response is usually associated with caries into dentine. Is this always the case?

Answer 4

No. Caries in enamel can also prompt a pulpal response.

Question 5

What techniques does sensibility testing encompass to reach a diagnosis?

Answer 5

TTP
Pressure
Mobility
Sinus
EPT
Cold Test

Question 6

Principles of sensibility testing:

Answer 6

Suspect teeth should be tested with a control.
Cold tests are first line.
Be wary of false negative in older patients, heavily restored teeth and teeth that have experienced trauma.

Question 7

Selective caries removal in 1 stage:

Answer 7

soft dentine can be removedwith hand instruments
firm dentine resists hand instruments
hard dentine resists probe penetration and scratching

Question 8

Symptoms of Reversible Pulpitis

Answer 8

pain or discomfort initiated by cold or sweet stimuli resolving shortly after removal

Question 9

Response for irreversible pulpitis.

Answer 9

More intense pain that is spontaneous or radiating, longer lasting and lingers after stimulus removal.

Question 10

Definition of indirect pulp capping:

Answer 10

Application of a material directly onto a thin layer of dentine close to the pulp with the aim of producing a positive biological response so the pulp can protect itself.

Question 11

Definition of a direct pulp cap:

Answer 11

Application of a material directly onto the pulp with the aim of producing a positive biological response so the pulp can protect itself.

Question 12

What is a partial pulpotomy?

Answer 12

Removal of a small portion of tissue followed by the application of a material directly onto the pulp with the aim of producing a positive biological response so the pup can protect itself.

Question 13

What is a full pulpotomy?

Answer 13

Complete removal of the coronal pulp to the root canal orification level followed by the application of a material directly onto the remaining pulp with the aim of producing a positive biological response so it can protect itself.

Question 14

Stages or an INDIRECT pulp cap:

Answer 14

1. Tooth isolated with complete cavity prep.
2. Disinfect with cotton pellets soaked in sodium hypochlorite (0.5-5%) for 30 seconds to a minute.
3. Dry and cover the cavity with a CSC (biodentine or setting calcium hydroxide if an appropriate CSC isn’t available).
   - If calcium hydroxide is used, it should be sealed with GIC or RMGIC before being definitively restored and kept under review.

Question 15

Why is calcium hydroxide not really the material of choice for an indirect pulp cap?

Answer 15

Calcium hydroxide cracks and isn’t very reliable.

Question 16

How is a DIRECT pulp cap carried out?

Answer 16

1. Isolate tooth and soak using cotton pellets.
2. If not controlled within 5 mins, a partial pulpotomy is indicated (NOT WITHIN SCOPE OF THERAPIST).
3. Exposed pulp should be covered with a CSC/calcium hydroxide.
4. Definitively restore and keep tooth under review.
5. Explain to pt that further treatment could be indicated if tooth becomes symptomatic.