Pulp assessment and status PART 2 Flashcards
Describe what normal pulp status looks like
- Teeth with a normal pulp do not exhibit any spontaneous symptom
- The pulp will respond to pulp tests and the symptoms produced from such tests are mild and do not cause any distress. The result is a transient sensation that disappears in seconds
State the 7 oral clinical signs of pulp pathology
- Loss of marginal ridge
- Fracture of occlusal triangular ridges
- Extended caries undermining cusp
- Gross breakdown
- Tooth mobility
- Tender to percussion (TTP) • Inflammation, swelling and fistula
State the 2 extra oral tissue signs of pulp pathology
- Lymphadenopathy
* Facial cellulitis
State 3 ways you can assess the PDL and its supporting structures
- Palpate the buccal / lingual vestibule area
- Palpate lymph nodes
- Tap tooth with end of instrument gently (avoid if tooth hurts)
State the three types of pulp sensibility tests, and explain why it is not sensible to use on primary teeth
- Electric current tests
- Cold tests
- Vitality tests
- Children will not have achieved the cognitive development necessary to respond reliably to a potentially painful stimulus.
What are the 6 things you would look out for during the radiographic exam that would guide your treatment options?
• Extent of caries, deep restorations, previous pulp treatment- The amount of reactionary dentine
• The size of the pulp chamber
• Position and proximity of pulp horns
• Physiology and pathologic root resorption
• Furcal or periapical pathology involvement
Presence and position of the permanent successor
List the 7 goals of pulp therapy
- Tooth restored and retained until normal exfoliation
- Arch length and vertical dimension maintained
- Clinically asymptomatic
- Histologically free of inflammation
- Radiographically free of pathology
- Systemically – no adverse effects
- Materials and techniques non-threatening to subjacent permanent teeth
List the 5 treatment options available for primary teeth, and state when they are used
- Indirect Pulp Cap: (generally contra-indicated for primary teeth. It is only used in exceptional circumstances where patient compliance is considered).
- Direct Pulp Cap: (generally contra-indicated for primary teeth. Only used when there is insufficient time and pulpal exposure was not anticipated. MUST be followed by pulpotomy next visit)
- Pulpotomy: Indication is reversible pulpitis. It is a vital pulp therapy for primary teeth
- Pulpectomy: Used for irreversible pulpitis where alveolar bone is free from destruction. Has a failure rate mainly due to morphological irregularities
- Extraction: Odontogenic infections, necrosis, irreversible pulpitis. As well as teeth with hopeless prognosis such as badly broken teeth and those with internal/ external inflammatory resorption.
Explain why direct pulp capping has a poor prognosis
- High failure rate due to undifferentiated mesenchymal cells which may become odontoclasts, leading to internal resorption
- Pulpal inflammation usually persists and results in total pulp necrosis and abscess formation or internal root resorption
- An enforced extraction is a common eventuality
- Common sequela is abscess formation
- Pulpotomy offers much higher success rate
Describe the consequences of early loss of deciduous teeth
- Mesial drift and space loss
- Midline shift
- Delayed eruption
- Alteration of sequence
- Lack of guidance for permanent teeth
State the things you should consider when deciding between restoring and extracting
- Length of time to exfoliation (don’t restore close to exfoliation–if less than 2/3 of root left)
- Development of successor or distal tooth
- The occlusion
List 4 contraindications for pulp therapy
- Pulp therapy relies on the adaptive healing response after treatment, so patients with a significant compromised immune system are considered poor candidates for endodontic therapy
- Congenital heart defects which may require antibiotic prophylaxis
- Immunosuppressed patients and those with poor healing potentials
- Patients who are severely immunosuppressed, such as oncology patients, extraction will be indicated
List and describe the indications for pulp therapy
- Bleeding Disorders and Coagulopathies: Patient with a bleeding diathesis (eg haemophilia) may use home based factor replacement. The decision to extract or retain a pulpal involved tooth should be made in consultation with patient’s haematologist and supervising dentist
- Hypodontia: In case of congenital absence of teeth, the decision to extract or retain individual teeth will be influenced by the overall orthodontic strategy. In some cases, it may require extraction to facilitate space closure; in other cases, timing of extraction can be critical, necessitating pulp treatment or may be necessary to maintain a primary tooth without a successor. Orthodontic evaluation should be considered prior to completion of treatment planning.
