Pulpal Diseases and Diagnosis Flashcards
The pulp contains
nerves
blood vessels
connective tissue
What limits the available room for expansion and restricts the pulp’s ability to tolerate edema
Dentin
The pulp lacks _______, which severely limits its ability to cope
with bacteria, necrotic tissue, and inflammation.
collateral circulation
hard tissue-secreting cells
odontoblasts
what is formed to protected the pulp from injury?
odontoblasts and mesenchymal cells that differentiate into osteoblasts
The sensibility of the dental pulp is controlled by what nerve fibers?
A-delta
C
What type of nerve fibers are A-delta and C
afferent
A-delta fibers
are larger myelinated nerves that enter the root canal and divide into
smaller branches, coursing coronally through the pulp
How is pain perceived by a-delta fibers
immediately as quick, sharp, momentary pain, which dissipates quickly
what cell layer and tissue is intimately associated with the a-delta fibers?
odontoblastic cell layer and dentin
aka the pulpodentinal complex
what is it called when the response is exaggerated and disproportionate to
the challenging stimulus
hyperalgesia
C fibers
small, unmylenated nerves that course centrally in the pulp stroma
C fiber pain surfaces with
tissue injury and is mediated by inflammatory mediators,
vascular changes in blood volume and blood flow and increases in tissue pressure
When C fiber pain dominates, it signifies what
irreversible local tissue damage
How can you classify pupal diseases
normal pulp
reversible pulpitis
Symptomatic irreversible pulpits
Asymptomatic Irreversible Pulpitis
Pulp Necrosis
Previously treated
In RP, thermal stimuli (usually cold) cause a
quick, sharp, hypersensitive response that
subsides as soon as the stimulus is removed
What may cause reversible pulpits
Any irritant that can affect the pulp
In RP, if the irritant is removed, what happens to the pulp?
return to a normal healthy state
In RP, if the irritant remains, what happens to the pulp?
the symptoms may lead to irreversible pulpitis
How to distinguish between symptomatic irreversible and reversible pulpitis
- Reversible pulpits causes a momentary painful response to thermal change that
subsides as soon as the stimulus. symptomatic irreversible pulpits causes a painful response to thermal change that
lingers after the stimulus is removed - Reversible pulpits does not involve a complaint of spontaneous
What is the crossover from RP to IP
penetration of bacteria
What is symptomatic irreversible pulpitis
the pulp has been damaged beyond repair, and even with removal
of the irritant, it will not heal
what is the end result of irreversible pulpitis?
necrosis
what are characteristics of SIP
spontaneous, unprovoked, intermittent or continuous pain
postural change, such as lying down or
bending over, induces pain
what tool of vitality is of little value in the diagnosis of SIP
electrical pulp test
are there clinical syptoms of AIP
There are no clinical symptoms, but inflammation produced by caries, caries
excavation or trauma occurs
what leads to pulp necrosis
Untreated irreversible pulpits
Traumatic injury
Any event that causes long-term interruption of the blood supply to the pulp
what can pulp necrosis be further classified as
partial or total
what is partial necrosis
Partial necrosis may manifest with some of the symptoms associated with irreversible pulpits.
For example, a tooth with two canals could have and inflamed pulp in one canal and necrotic
pulp in the other.
what is total necrosis
asymptomatic before it affects the PDL, and there is no response to thermal
or electrical pulp tests
what leads to thickening of the PDL and manifests as tenderness to percussion and chewing
Protein breakdown products and bacteria and their toxins eventually spread beyond the apical foramen
Previously Treated Pulp means?
Clinical diagnostic category indicating that the tooth has been endodonticaly
treated and the canals are obdurated with various filling materials other than
intracanal medicaments. i.e. CaOH