principles of treatment and diseases of the vital pulp

Question 1

endodontology

Answer 1

• therapeutic procedure

Question 2

vitality vs sensibility

Answer 2

• vitality (blood supply)

- sensibility (innervation

Question 3

why is pulp vitality important

Answer 3

1) to keep the tooth i.e. avoid extraction
2) to avoid root canal treatment
3) preserve the structural integrity of the tooth
4) maintain proprioception of the pulp
5) minimise operative treatment

Question 4

consequences of loss of pulp vitality

Answer 4

1) Consequences to individual
- inflammation and infection of the pulp, and the local and systemic consequences of this
- includes pain, in different grades and unpredictable nature
2) consequences to the tooth
Necrotic pulp
- loss of proprioception
- breakdown of pulp into dentine: discolouration (dark tooth)
- need to RCT or XLA

Question 5

why avoid extraction

Answer 5

1) loss of tooth
2) functional and aesthetic problems
3) avoid compromising other teeth
4) avoid other treatment modalities with increased morbidity and unpredictable outcomes

Question 6

why avoid RCT

Answer 6

1) To avoid irreversible and catastrophic structural degradation
2) to maintain proprioception
3) to avoid periapical and peri radicular infection – with local and systemic complications

Question 7

reduction in fracture strength is due to

Answer 7

• loss of structural integrity
• tubular sclerosis, secondary and reparative dentine
• reduction in the amount of mature collagen in the dentine matrix
• eugenol increases dentine microhardness makes dentine more brittle (and the irrigation used to clean out the bacteria)
• not due to a decrease in moisture content

Question 8

effects of operative damage

Answer 8

overheating
inappropriate cavity preparation 
overcasting due to caries removal
mismatch of material properties
inappropriate use of materials

Question 9

sequel of untreated pulpal inflammation

Answer 9

1) Pulpitis – symptomatic or asymptomatic
2) pulp necrosis
3) root canal infection, leading to periapical inflammatory lesion (periapical periodontitis)

Question 10

types of management of caries

Answer 10

radical
- total and uncompromising removal of caries and if pulpal exposure occurs then it is managed biologically
conservative
- biological caires exaction to remove infected dentine but retaining affected dentine so avoiding pulpal exposure
- this improved chances of avoiding rCT

Question 11

vital pulp treatments lists

Answer 11

1) Partial caries removal
2) indirect pulp capping
3) direct pulp capping
4) partial pulpotomy
5) coronal pulpotomy
6) pulpectomy and RCT

Question 12

indirect pulp capping

Answer 12

no exposure of pulp

caries affected dentine is retained in close proximity

Question 13

direct pulp capping

Answer 13

• managing the exposed surface of the pulp using a suitable material to try and stimulate dentine bridge formation to close over the exposure so repairing the breach

Question 14

partial pulpotomy

Answer 14

removal of inflamed coronal portion of the pulp tissue

Question 15

coronal pulpotomy

Answer 15

removal of all coronal pulp

Question 16

pulp capping

Answer 16

results in formation of permeable tertiary dentine