Pulp assessment and status PART 1 Flashcards
List 6 things that affect the response of the pulp to pathology
- Nature of the irritant
- Duration and severity of irritant
- Host defences
- Apical blood flow
- Pre-existing state of the pulp
- Anatomy of the pulp chamber
Define acute Acute pulpitis
- Blood vessels become dilated and congested
- This is quickly followed by oedema and the infiltration of neutrophils
- Local tissue necrosis may result
- This may lead to more extensive necrosis of a portion of, or the entire pulp
Define chronic pulpitis
- May follow the acute stage
- Involves the accumulation of chronic inflammatory cells and the formation of granulation tissue
- Pulp polyp may form: granulation tissue develops in response to the consistent, low grade irritation
State what reversible pulpitis is and the management
- Reversible pulpitis:
• Provoked pain (by thermal, chemical or mechanical irritants). Pain disappears upon removal of stimulus
• Short, sharp bouts of pain
• The fluid movement within dentinal tubules stimulates the odontoblasts and associated fast-conducting A fibres in the pulp which produce sharp, quickly reversible dental pain
Management and treatment:
• Relieved with analgesia via cold, sweet, minimal with heat
• May be suitable for a pulpotomy procedure
State what irreversible pulpitis is in terms of its signs and symptoms
- Irreversible pulpitis
• Un-stimulated, intermittent or spontaneous pain
• Can be sharp or dull throbbing pain
• Stimulated by heat particularly or cold
• Not always relieved with analgesia
• Prolonged pain even after the thermal stimulus has been removed
• Sleep disruption / nocturnal pain-
• May be minimal change in the radiographic appearance of the peri-radicular bone
• When symptomatic irreversible pulpitis remains untreated, the pulp will eventually become necrotic
NOT SUITABLE for pulpotomy
Describe the characteristics of alveolar abscesses, and recognise it is as a consequence to acute pulpitis and acute worsening of chronic pulpitis
- Acute periapical abscesses cause severe pain due to the build up of pus and oedema acting on the nerve endings in the PDL
- The tooth is extruded and mobile- If it starts off as an acute pulpitis
- NO radiographic evidence of this process if it starts of acute pulpitis. If it forms from a chronic condition, a radiolucency will be evident.
- Widening of the PDL space is an early radiographic sign of periapical / interradicular inflammation
State the locations of alveolar abscesses and cellulitis
- Alveolar abscess: If the pus remains localised underneath the periosteum:–It may cause a swelling ( alveolar abscess or larger intra-oral swelling)
- Cellulitis: Infection spreads along fascia to cause cellulitis
State the 3 instances in which radiographic evidence of pulp diseases are seen
- Chronic abscesses
- Granulomas
- Cysts
State the 8 radiographic changes of pulpal infection
- Reparative dentine and tubular sclerosis
- Condensing osteitis
- Pulp stones
- Pulp obliteration
- Interradicular radiolucency/ widened PDL space
- Periapical granuloma
- Cysts
- External and internal
- inflammatory resorption
Explain the radiographic sign of reparative dentine and tubular sclerosis
- Reparative dentine: More irregular and contains fewer dentinal tubules than primary dentine
- Tubular sclerosis: Obliteration of the tubules and its replacement with calcified material
- Tubular sclerosis/reparative dentine make the dentine less permeable, decreasing sensitivity and slowing caries progress
Explain the radiographic sign of condensing osteitis
- Low grade pulpitis may cause bone proliferation
- Condensing osteitis is seen as a radiopaque lesion associated with the root apices
- Reactive bony sclerosis to pulpal inflammation
Explain the radiographic sign of pulp stones
• Calcified bodies with an organic matrix in the coronal pulp
Explain the radiographic sign of pulp obliteration
- May follow traumatic injury to the apical blood vessels which is not significant enough to cause pulp necrosis
- Large quantities of irregular dentine form in the pulp chamber and root canals causes pulp obliteration
Explain the radiographic sign of periodical granuloma
- Occurs due to long standing inflammation in the bone surrounding the apex of a non-vital tooth
- Consists of granulation tissue and fibrous (scar) tissue replacing bone
- Process is self - limiting, but it does not heal (regenerate bone) independently
- A clearly demarcated periapical radiolucency exists
- Requires referral to the dentist
Explain the radiographic sign of cysts
- May arise from epithelial residues (cell rests of Malassez) in the periodontal ligament as a consequence of inflammation, following the death of the dental pulp
- Requires referral to dentist
