pulpal diagnosis

Question 1

describe an abscess

Answer 1

Swollen area of tissue containing puss
Comes to a point and bursts
Cavity collapses
Obliteration by organization and fibrosis
Scar formation
Deep seated discharge puss along a sinus tract lined by granulation tissue which leaves an abnormal passage.

Question 2

describe dentine sensitivity

Answer 2

Pain with thermal, chemical, tactile or osmotic stimuli
Associated with exposed dentine
Exaggerate response of normal pulpo dentinal complex
Severe and sharp but does not linger on removal of stimuli
Specific factor i.e caries might have symptoms similar to reversible pulpitis

Question 3

describe reversible pulpitis

Answer 3

Pain occurs when a stimulus is applied to tooth.

When stimulus removed pain ceases in 1-2s

Question 4

what are the symptoms of reversible pulpitis

Answer 4

Pain short/sharp, not continuous – no longer than 5-10s
Stimuli- thermal,sweet
No radiographic changes other than caries

Question 5

what causes reversible pulpitis?

Answer 5

Caries into dentine, fractures,thermal, restorations.

Question 6

how would you treat reversible pulpitis?

Answer 6

Conservative pulp therapy and removal of cause
Review after 3 months
Symptom free, no sign of disease
Respond normally to sensibility test.

Question 7

what are the symptoms of irreversible pulpitis?

Answer 7

Spontaneous pain
Exaggerated response to temperature
Lingers after stimuli removed
Sensibility responsive

Question 8

what makes irreversible pulpitis difficult to diagnose?

Answer 8

Can confuse maxillary and mandibular
Tooth not tender to pressure/percussion until periapical tissues involved.
No periapical changes radiographically.

Question 9

symptoms of advanced symptomatic irreversible pulpitis

Answer 9

Excruciating pain 
Momentarily relieved by cold
Pulp allodynia 
Painful response to normally innocuous stimuli 
Hyperalgesia 
Tooth often tender to percussion 
Violent reaction to heat.

Question 10

how would you treat advanced symptomatic irreversible pulpitis?

Answer 10

RCT if restorable

Extraction

Question 11

describe odontopaste

Answer 11

antibiotic- clindamycin hydrochloride
anti-inflammatory- triamcinolone (corticosteroid)
relives pain until definitive treatment done.

Question 12

explain pulp canal calcification

Answer 12

occurs in response to trauma and irritants
painless unless necrosis with bacterial infection
causes eventual obliteration of pulp space
RCT not necessary unless clinical signs of necrosis.

Question 13

explain pulp stones

Answer 13

Discrete calcifications within the pulp of the tooth may be attached to dentine or free within pulp.
Aetiology: unknown
Significance: unknown

Question 14

explain internal resorption

Answer 14

Inflammatory, occurs at any point in pulp chamber
Activation of dentinoclasts within inflamed pulp tissue in contact with necrotic, infected coronal pulp tissue.
Asymptomatic, pulp will become necrotic
CBCT-show perforation
Tx: RCT/extraction

Question 15

explain pulp necrosis

Answer 15

Breakdown of pulpal tissue allowing bacteria to colonise the root canal system.
Pulp encased in rigid walls – no collateral circulation
Venules and lymphatics collapse under increased tissue pressure.
Irreversible pulpitis leads to liquefaction necrosis
Traumatic injury causes ischemic necrosis due to distribution of blood supply.
Symptoms:
Asymptomatic unless inflammation has progressed to periapical tissue.
No response to sensibility test.
Tx: RCT/extraction.