Pulpal Diagnosis Flashcards
What are the 4 possible pulpal diagnosis?
- Reversible Pulpitis
- Irreversible Pulpitis
- Periapical Periodontitis
- Dental Absces
What is inflammation and what can be a describing word for it?
A response of living tissue to injury.
Described by the suffix ‘-itis’ (inflammation of… )
What is Acute Inflammation?
Initial tissue reaction to a wide range of injurious agents:
- Physical
- Chemical
- Microbiological
- Immunological
Lasts for hours / few days.
Predominant cell : ➢ Neutrophil
What are the 5 cardinal signs of inflammation?
- Redness
- Heat
- Pain
- Swelling
- Loss of function
What is Chronic Inflammation?
Duration is longer lasting - days, weeks months or years. Predominant cells:
- lymphocytes
- plasma cells
- macrophages
What is the function of What Acute Inflammatory Response?
A defence mechanism
- provides an exudate which brings proteins, fluids and cells to an area of damage
- destroys and/or eliminates the injurious agent
- breaks down the damaged tissue and removes the debris.
What are the 4 possible outcomes (sequelae) of acute inflammation?
Possible outcomes:
- Resolution
- Suppuration
- Organisation
- Chronic inflammation.
What is suppuration?
Formation of pus.
Causative agent must be fairly persistent and is virtually always infective pyogenic bacteria Staph Aureus, Strep pyogenes, Neisseria, coliform organisms.
What is an abscess?
- A localised collection of pus (suppurative inflammation)
- Can appear in an acute or chronic infection
- Is associated with tissue destruction and swelling
How does a Abscess disappear?
- Points
- Bursts
- Abscess cavity collapses
- Obliterated by ‘organisation’ and fibrosis
- Scar formation
- Deep seated abscesses sometimes discharge their pus along a sinus tract, lined by granulation tissue (a fibrous connective tissue found in healing wounds) which leaves an abnormal passage – a sinus tract.
What is Organisation?
This is the replacement of tissue by granulation tissue.
- Large amounts of fibrin are formed.
- Can become necrotic.
- Exudate / debris cannot be removed or discharged
How does Chronic Inflammation occur?
- If the agent causing acute inflammation is not removed it may progress onto chronic stages
- Chronic inflammation is *Characterised by continuing inflammation at the same time as attempts at healing*
- Attempts at reconstruction of damaged tissue happen simultaneously with inflammation
- Balance of destruction and healing/repair.
What is the clinical effects and sequelae of chronic Inflammation?
Mostly related to the healing and repair process.
Following tissue damage or loss from any cause there may be a number of different sequelae:
- Resolution
- Regeneration
- Repair
What is the normal pulp?
- Symptom free
- Normally responds to sensibility testing
- Mild response that subsides immediately when stimulus is removed
- Histologically - no inflammatory change
What dentine sensitivity?
Pain occurs with thermal, chemical, tactile or osmotic stimuli and is associated with exposed dentine
An exaggerated response of normal pulpo-dentinal complex
Severe and sharp but does not linger on removal of stimulus
When there is a specific factor (caries, fractures, recent restorations etc.) the symptoms may be identical however the diagnosis is REVERSIBLE PULPITIS
What is reversible pulpitis?
Symptoms:
- Pain short and sharp, not spontaneous
- Stimuli – thermal, sweet – short, sharp pain
- Lasts no longer than 5-10secs
- No radiographic changes, other than caries
Causes:
- Caries into dentine, fractures, restorative procedures, trauma