OB- Care of the Pulp

Question 1

What is the pulp?

Answer 1

The tissue that lies in the middle of the tooth.

Question 2

What is characteristic of the pulp with age?

Answer 2

The pulp gets narrower with age as secondary dentine is laid down.

Question 3

What can damage the pulp during a restoration?

Answer 3

The heat from high speed handpeice (we use water to cool this down)

Using the 3in1 to wash and dry leaves dehyrated dentine as the natural fluid is washed away.

Drilling cuts away the odontoblast processes.

The restoration material which is toxic.

Question 4

What is the rdt?

Answer 4

The remaining dentine thickness is the distance between the pulp and the cavity.

The greater the RDT the less likely you are to damage the pulp.

Question 5

Why does caries spread quicker in dentine closer to the pulp?

Answer 5

As the tubules in dentine become deeper they become wider. This makes them more permeable so bacteria can move in and out.

Question 6

Discuss the Short sharp pain felt in the pulp

Answer 6

Short sharp pain is caused by stimulated alpha fibres. These are myelinated.

We can test this using the electric pulp test.

Question 7

discuss the dull aching pain felt in the pulp

Answer 7

A dull aching pain is caused by C fibre stimulation. (aChing for C fibres) These are non-myelinated fibres.

This stimulation results in an increased pulpal blood flow and increased pressure in the pulp. The pain is due to the inability of the pulp to expand.

Question 8

How do we classifiy the pulpal diagnosis

Answer 8

By:

What is going on periapically

What is going on within the pulp.

Question 9

What are the 5 classifications for the pulpal diagnosis?

Answer 9

1. Healthy
2. Reversible pulpitis
3. Irreversible pulpitis
4. Necrotic Pulp.
5. Previously treated.

Question 10

Compare reversible to irreversible pulpitis

Answer 10

Reversible pulpitis describes tissue that is still vital, it is just inflamed.

There is no change in pulp blood fow.

Clinical- pain is in response to cold and lasts a long time

If you treat the cause (such as caries the pulp should settle down)

Irreversible pulpitis describes a tooth in the process of dying off.

There is change in the pulp blood flow.

Clinical- Pain is spontaneous & responds to heat. It keeps the patient up at night.

Treatment would be a root canal or tooth extraction.

Question 11

What are the classifications for periapical diagnosis?

Answer 11

1. Normal
2. symptomatic Periodontitis
3. Asymptomatic Periodontitis
4. Acute periapical abcess
5. Chronic periapical abcess
6. Condensing osteitis

Question 12

What is shown by this image?

Answer 12

Symptomatic or Asymptomatic periodontitis where there is inflamation of the apical periodontium (Dark shaddow at the bottom of the tooth.

The pressure build up (from inflamation) causes pain.

Question 13

What is this?

Answer 13

An acute apical abcess

Question 14

Compare acute and chronic apical abcesses

Answer 14

Acute apical abscesses cause lots of inflammation and a pressure build up.

You drain the abscess to treat it & remove the infected pulp.

Chronic apical abcesses are not painful as the infection drains out on its own.

Question 15

What is shown in this image?

Answer 15

This is a bony reaction to inflamation (note the white on the xray)

known as condensing osteitis.

Question 16

What can we tell from this clinical presentation?

Answer 16

A yellow tooth means that dentinal tubules have been obliterated. This allows light to pass through (causing the yellow colour)

Question 17

What can we tell from this clinical presentation?

Answer 17

There are blood products in the dentinal tissue such as the pulp.

Question 18

What can we tell from this clinical presentation?

Answer 18

This tells resorption has occured.

Question 19

what is a sensibility test?

Answer 19

These are used to determine the nerve response of teeth (Decide if they are vital or non vital)

Question 20

Give some examples of sensibility tests:

Answer 20

• Electric pulp tester- this stimulates the alpha and delta fibres & asks the patient if they can feel tingling from the current.
• Thermal tests- these cause the movement of hydrodynamic forces. If the patient does not feel the heat/cold then the tooth is non vital.
• Isolation- tooth is isolated with a rubber dam and sprayed with cool water.
• Test drilling- stick a handpeice in without LA to see if they can feel it

Question 21

What clinical factors can influence the pulp?

Answer 21

Carious pulp exposure- So we prevent flakes of caries getting into the pulp by removing caries from the wall before the floor.

Age of the teeth- In older teeth the pulp shrinks. The RDT is greater but there is a reduced pulp regeneration pottential. Younger patients pulp will recover better.

Previous periodontal disease causes the pulp to prematurely age in order to recover.

Previous pulpal insult- Getting close to the pulp causes teritary dentine to be produced and the pulp to shrink back. (Premature aging)

Question 22

What is a cavity sealer?

Answer 22

They protect the pulp from bacteria and the toxic effects of restorative materials. You cover the whole pulpal dentine.

Question 23

What are cavity base liners?

Answer 23

These provide thermal protection from the effects of the restorative material

e.g. Resin modified glass Ionomer.

Question 24

What is stepwise excavation?

Answer 24

This can be used if you are at risk of pulp exposure for deep caries.

You leave some of the caries in so that tertiary dentine is produced.

This increases the RDT meaning you can drill out the rest of the caries at a later date.

Question 25

When do we use Resin modified glass ionomer in clinic?

Answer 25

This is used as a indirect pulp cap (also known as a lining).

It is used when the RDT between the cavity and the pulp is small. We place it on the deepest parts of the cavity where there is likely to be poor dentine.

Question 26

When do we use Calcium hydroxide in clinic?

Answer 26

This is used as a lining when the pulp is exposed (direct pulp cap) as it promotes dentine bridge formation.

Question 27

How do we know if a patient has irreversible pulpitis?

Answer 27

The pulp continues to bleed.

(in this case we don’t use the calcium hydroxide)