Pulpal response to irritants

Question 1

What do the consequences of pulpal inflammation depend on?

Answer 1

if the effects are transitory or lasting

if the pulp can completely recover form the irritation

patients age

Question 2

What happens to the size of the pulp with age?

Answer 2

smaller, less vascularised, not as high innervated

due to secondary dentine formation, reduce the size and volume of the pulp

Question 3

How does an older pulp respond to infection?

Answer 3

not as well, it is smaller

less likley to reverse inflammatory response

Question 4

What are signs of reversible pulpitis?

Answer 4

acute toothache and pains with momentary cold

Question 5

What should you examine when checking a tooth?

Answer 5

if the tooth is tender to percussion

if there is tenderness in the buccal sulcus

if it is mobile

if there are signs of infection

• associated with a necrotic pulp, hard to decipher levels of inflammation.

Question 6

What are the 3 ways the pulp will protect itself against caries?

Answer 6

1. a decrease in dentine permeability
2. tertiary dentine formation
3. inflammatory and immune reactions

Question 7

How does the pulp decrease the permeability of dentine?

Answer 7

the pulp upregulates this secretion of intratubular dentine and direct deposition of mineral crystals into narrowed tubule lumens

this is called dentinal sclerosis and decrease dentine permeability

Question 8

How is tertiary dentine formation initiated?

Answer 8

In early carious lesions, acidic by-products degrade dentine matrix, liberating bioactive molecules

diffuse across the dentine and signal tertiary dentine = dentinogenesis

Question 9

What type of dentine is stimulated in a mild stimuli?

Answer 9

reactionary dentine

Question 10

What type of dentine is produced in with a stronger stimuli?

Answer 10

reparative dentine

caused by odontoblast death and new progenitor cells are needed

tubular structure is irregular and permeable

Question 11

What is ore impermeable, reactionary or reparative dentine?

Answer 11

reactionary, more regular tubule formation

Question 12

What first detects the caries?

Answer 12

odontoblasts

Question 13

What immune cells are released in response to carious lesion?

Answer 13

proinflammatory cytokines
chemokines
antimicrobial peptides

Question 14

where do immune cells gather?

Answer 14

pulp

Question 15

What do the afferent nerve endings beside the odontoblasts release?

Answer 15

proinflammatory neuropeptides

Question 16

What happens as the caries progress towards the pulp?

Answer 16

the pulps immune response increases its intensity

the density of chronic infiltrate increases

accompanied by angiogenesis and capillary sprouting

Question 17

What are the immune cells associated with a more severe immune response?

Answer 17

increase in pulpal lymphocytes, plasma cells, neutrophils, macrophages

Question 18

What can form when there is chronic inflammation in or near the pulp?

Answer 18

focal micro-abscesses can begin to form

Question 19

What cells aggregate beside the odontoblastic processes in severe inflammatory response?

Answer 19

dendritic cells, leading to a focal concentration of antibodies beneath the advancing lesion

Question 20

What happens to the pulp with the increase in inflammatory cells?

Answer 20

increase in pulpal tissue pressure and increases the outward dentinal fluid flow due to positive pulpal pressure

Question 21

What occurs when the caries get extremely close to the pulp?

Answer 21

there is an acute exacerbation of the existing chronic inflammation

involving an influx of neutrophils

Question 22

What can focal micro-abscesses cause?

Answer 22

pulpal necrosis

Question 23

When can the dentinal tubules be exposed?

Answer 23

developmental defects

disease processes

periodontal/surgical procedures

Question 24

Do the pulp and dentinal tubules communicate directly with one another?

Answer 24

yes

Question 25

If a tooth is chipped and the dentinal tubules are exposed, are the pulpal inflammatory changes transient of permanent?

Answer 25

transient

as long as the pulpal vascular supply remains intact and bacterial invasion prevented

aim to treat quickly and appropriately.

aim to seal the dentine asap

Question 26

What are factors which can influence the pulps response when placing a restoration?

Answer 26

LA
cavity depth or remaining dentine thickness (RDT)
contamination of the cavity with microbes
heat generated
desiccation/dehydration
materials used

Question 27

Does a deep preparation, have more r less effect on pulp reaction?

Answer 27

increasing severe pulpal reaction

likelihood of the pulp becoming irreversibly inflamed much greater

Question 28

What is RDT?

Answer 28

REMAINING DENTINE THICKNESS

Question 29

What is a good and bad barrier for RDT?

Answer 29

Over 2mm is good

under 2mm is bad - compromise recovery of pulp

Question 30

What happens to the permeability of the RDT over time?

Answer 30

decreases

Question 31

Why does the permeability of the RDT decrease over time?

Answer 31

most likely due to reactionary dentine and dentinal tubule necrosis

Question 32

What type of preparation leaves the pulp less protected from preparation trauma?

Answer 32

a deep cavities with small RDTs

Question 33

What is used to minimise contamination?

Answer 33

rubber dam to prevent salivary contamination

Question 34

What is microleakage?

Answer 34

leakage of ions, fluids, bacteria and bacteria by-products through the tooth-restoration interface

it occurs when there is poor seal between the tooth preparation and the restorative material

Question 35

What can microleakage lead to?

Answer 35

secondary caries
pulpal inflammation.. potentially necrosis
partial or total loss of the restoration itself

Question 36

What is said to be the greatest threat to the vitality of the pulp in restorations?

Answer 36

microleakage

Question 37

What dental material has good insulation?

Answer 37

dentine - but can damage the pulp

Question 38

What temperature can cause irreversible pulp inflammation?

Answer 38

rise of 10 d.c

Question 39

What can a rise of 20 dc pulp temperature cause?

Answer 39

pulp abscess formation

Question 40

When will a rise in pulpal temperature occur?

Answer 40

cavity preparation

crown prep

light curing

finishing/polishing a restoration

polishing teeth

curing of resins

Question 41

What are the effects of heat generation in the pulp?

Answer 41

loss of odontoblasts or their aspiration into the dentinal tubules and subsequent pulpal inflammation

Question 42

Why should you not over dry dentin?

Answer 42

results in outward fluid flow

can result in aspiration of odontoblast cell bodies into tubules
- causing pulpal inflammation

some tubules are not repopulated and become dead tracts